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Effects of
care farms
Scientic research on the benets
of care farms for clients
EFFECTS OF CARE FARMS - Scientic research on the benets of care farms for clients
TABLE OF CONTENTS
Introduction: Does care farming help? 4
1. Care farming 6
1.1 A short history on the emergence of the care farming sector 7
1.2 Developments in healthcare and welfare sector 12
1.3 Connecting care provision on farms with trends in health and social care 13
2. Effects of care on farms for specic client groups 16
2.1 Children and young people 16
2.2 People suffering from psychological ill health and those suffering from
drug or alcohol addiction 24
2.3 Older people with dementia 34
2.4 People with learning difculties 38
3. Qualities of care farms 40
3.1 Specic qualities of care farms 40
3.2 Care farmer – client relationship 42
3.3 The farm as a social community 42
3.4 Useful daily occupation and work 43
3.5 Green natural surroundings 44
4. Conclusion 50
2 3
4 5
Recent study results
But what exactly are the effects of working or liv-
ing on a care farm? Can we prove the inuence
on health and quality of life of people that stay on
a farm? The scientic research on the effects of
care farms is still at a relatively early stage par-
ticularly when compared to research conducted
on interventions like cognitive behavioural ther-
apy. However, the rst insights into the effects of
green care are emerging.
This report gives an overview of the recent
scientic research on the effects of care farm-
ing. Some of the studies presented are more
general, others look at the effects on specic cli-
ent groups such as older people with dementia,
young people with behavioural problems or peo-
ple with a history of drug addiction.
It is important to have more evidence of the ef-
fects of care faming. Firstly, to prove that health
care budgets are spent in a proper way. Sec-
ondly, to give clients more insight into the pos-
sibilities of having care or work on a farm. Lastly
with the results of the research, the care farming
sector can develop and professionalise.
This report was originally written for a Dutch
audience. Because of questions and interest
from other countries, it has been translated into
English. Therefore, this report will often refer to
the care farming sector and the context in the
Netherlands.
Does care farming help?
During their stay on a care farm, older people
with dementia have a better nutritional status
and take more uids. Also, young people with
difculties show less behavioural problems
after their stay on a farm. In some way, we are
not surprised that living and working on a farm
where there is fresh air, physical work and per-
sonal attention benets people. We can say
that care and agriculture did not meet each
other by coincidence. Centuries ago, this was
already the case. If we look at the European
context, we see that the number of so called
‘care farms’ are growing rapidly. For example,
in the Netherlands, we see that the number of
care farms now exceeds 1,000, and that the
number of clients working or living on those
farms is around 15,000. The development in
the Netherlands is connected to other develop-
ments in the health and welfare sector, like a
more active role in the daily life for people with
disabilities - creating a living and working situ-
ation which empowers people and gives them
the ability to participate in society.
Alongside the development of care farms in
Europe, we see a broader evolution of activi-
ties that have a link with green care. And fur-
thermore, a development of concepts and
activities related to multifunctional agriculture
- such as urban agriculture. Multifunctionality
and civic engagement have given greater vis-
ibility to farming and have created opportuni-
ties for enhanced rural-urban interaction.
6 7
1.1 A short history on the
emergence of the care farming
sector
Utilizing nature or agriculture in caring for peo-
ple is historical. We know that in the Middle Ages
prisons, hospitals and monasteries often had dif-
ferent areas which we would now classify as a
‘therapeutic outside spaces’.
One of the oldest and most famous care farming
programmes was founded around 1350 in Gheel,
Flanders (Roosen, 2007). In a rural environment,
care was offered to people who needed it. They
worked alongside families from the village as part
of a daily routine and structure, in which agrar-
ian activities were paramount. The programme
in Gheel is one of the rst examples of what we
would now call a therapeutic living and working
community. To this day people with (learning) dis-
abilities can seek refuge there.
In the previous century during the forties, more
and more therapeutic living and working com-
munities were founded, where nature was con-
sidered an important element in the therapy. In
Ireland and the UK especially, these therapeutic
communities caught on quickly through the inu-
ence of the Camphill movement1
1 Camphill is an heilpedagogical movement that
was founded in 1939 and has an anthroposophical basis.
The Camphill communities offer mentally as well as physi-
cally challenged people the opportunity to live and work to-
gether with care providers and their families.
‘A care farm has a natural emphasis
on empowerment, participating in
society and support of informal net-
works of participants.’
We see that the number of care farms in Europe
is growing. As previously mentioned, the num-
ber of care farms in the Netherlands has grown
to over 1,000. Also, in other European countries
such as Norway, Italy, Belgium and the UK, we
see a growth in the number of care farms.
‘The’ care farm does not exist. Most care farms
come into being when an agrarian enterprise de-
velops itself into a care farm. There are also care
farms that start as a gardening project within a care
institution. In the Netherlands, we see a number
of care farms have grown into fully-edged, certi-
ed health care institutions. The number of partici-
pants that take advantage of care on a farm dif-
fers. On some farms two participants will work with
the farmer two days a week, on other care farms
forty participants will nd a suitable day-activity.
Care for different client groups
Care farms direct their services towards many dif-
ferent client groups from the health-care and wel-
fare sector, such as people with learning difcul-
ties, people with psychological problems or older
people. In addition some care farms will take in
people with addiction problems who, after nish-
ing their ‘detox’ in a clinic, go working on a farm.
Participants come to the farm for day-activity, a
sheltered work project, therapy or a place to live.
The people who participate, often have diverse
reasons why, temporarily, they cannot participate
in the regular workforce; or why they require res-
pite care. An example of respite care provision
are farms that give care to disabled children at
the weekends. This gives the parents the oppor-
tunity to pay more attention to their other children
or to do something else. The stay and work on
the farm often has as a goal to repair participants’
self-sufciency and to help them realize a dream
of participating in society or the normal workforce.
Care farms differ from one another not only in the
client group they provide care for, but also in their
staff. Depending on the client group, the number
of participants and the type of care farm, the guid-
ance is in the hands of the farmer, the farmer’s
wife, hired agriculture or care professionals, care
professionals who come along from the care-
institution or volunteers. Many participants who
come to a farm use their personal health budget
to reimburse the care provided (see textbox).
1. Care farming
Care farms are enterprises where farming and health-
care are being combined. These farms open their gates
for people that need the care of a sheltered workplace in
a natural environment.
The Dutch ‘general law on exceptional medical expenses’ (AWBZ)
provides general insurance covering the Dutch population against
special health care needs. Care is either provided ‘in kind’ through
certied health care institutions or can be hired by clients through
a personal budget. A signicant amount of care farms in The Neth-
erlands is nanced by clients’ personal budgets. Others receive
nancing through the health care institution where the client lives.
A few farms themselves are registered as a certied health care
institution. Recent changes in the AWBZ have resulted in care
farms and care farm cooperatives (jointly) applying for an AWBZ
certicate to provide care ‘in kind’. Another and increasingly im-
portant nancer of care farms - also formally responsible for pro-
viding care services to the client groups concerned - is the local
municipality.
8
Literature
Ketelaars, D., E. Baars & H. Kroon ( 2001)
Werkend herstellen: een onderzoek naar
therapeutische (leef)werkgemeenschappen
voor mensen met psychiatrische problematiek
Dronten: Stichting Omslag en Trimbos-instituut.
Roest, A.E., (2009) Kijk op multifunctionele land-
bouw, omzet en impact: achtergronddocument.
Den Haag: LEI Wageningen UR.
Roosens, E. & L. van de Walle (2007) Geel re-
visited. After centuries of mental rehabilitation.
Antwerpen-Apeldoorn: Garant.
Sempik, J., R. Hine & D. Wilcox (eds.) (2010)
Green Care: A Conceptual Framework, report of
working group on the Health Benets of Green
Care, COST Action 866, Green Care in Agricul-
ture. Loughborough: Centre for Child and Family
Research, Loughborough University.
Ulrich, R. (1984) View through a window may inu-
ence recovery from surgery. Science, 224: 420-1.
In the UK during the fties and sixties, many hor-
ticultural projects were also founded aimed at
people with disabilities. In these projects, men-
tors and therapists offer gardening as a specic
day activity.
The Netherlands also saw the foundation of
therapeutic communities where people with per-
sonality disorders received shelter and support.
These communities often started out as a small-
scale project with clear ideals and were. They
were usually founded in protest at the giant care
institutions (Ketelaars, 2001).
In the fties and sixties, attitudes changed rega-
dering patients in care facilities such as psychiat-
ric hospitals working in the management of gar-
dens and farms. It was considered unreasonable
to let them take part in these activities without
being paid and as a result many projects disap-
peared.
Recent developments
In recent years, interest in the relationship be-
tween nature, green environments and health
has grown once more. According to some, this
is partly to be credited to research done by the
American researcher Robert Ulrich who discov-
ered that patients recovering from an operation in
a hospital with a view onto nature would recover
more quickly when compared to patients whose
view was limited to a stone wall (Ulrich, 1984).
The amount of farmers’ businesses that combine
agriculture with care in the Netherlands has in-
creased dramatically in the last decade. The es-
timated turnover of the sector lay at almost 50
million euro in 2008 (Roest et al., 2009).
Due to the strong growth in the sector, a need
arose for it to professionalise itself.
As such, care farms have united in regional co-
operative relationships. Some of these different
regional unions have their own AWBZ-certicate.
In 2009, some care farming cooperatives found-
ed the Federation of Dutch Care Farmers. This
federation represents the interests of the care
farmers and took over the products and services
formerly provided by the National Support-centre
for Agriculture & Care that was founded in 1999
and received funding from both the ministries of
Agriculture and of Healthcare.
The care sector is connected to the Federation
of Dutch Care Farmers by way of the Council
of Advice. In this council, healthcare insurance
companies, client and consumer organisations
and the ministry of Healthcare are represented.
A lot of attention has also come for ensuring the
quality of the care services that the farms offer.
In 2000, a quality system was put in place by the
then Support-centre, that then was tightened on
multiple occasions. In the last revision that took
place in the beginning of 2011, a lot of empha-
sis was put on the opinions of the client and on
the question as to what extent the care farm ts
into his or her needs. How satised they are with
their daycare or work, own roles and tasks on the
farm? In order to measure the customer satisfac-
tion structurally and to use the information for im-
proving the quality of care, there is also a quality
handbook and a customer satisfaction system
initiated for care farms which are connected to
the Federation.
In addition, there is also independent research in
progress investigating the phenomenon of care
farms and into the experiences of the care that
they offer to different client groups. The follow-
ing chapters give an idea of the results of these
studies.
9
10
such as cultivating vegetables in a garden. Working in the garden is then a means
for people to develop a work routine.
Participants can also interact with animals. There is a distinction made by the creators
of this model between, on the one hand, having the animal as a means for therapeutic
purposes, such as in equine therapy. We are then discussing animal-assisted therapy.
If on the other hand the aim is to bring a client of a care institution into contact with ani-
mals, we are then discussing animal-assisted intervention. An example of this is the
‘pets corner’ in some nursing homes where the elderly can care for or pamper pets.
The gure clearly shows whether an activity makes a contribution to health improve-
ment (health promotion), treatment (therapy) or work rehabilitation. On care farms
there are activities present where participants can be both passively and actively
involved with nature. These activities can offer a contribution to health promotion,
therapy or work rehabilitation of the participants and therefore contribute to their
general quality of life.
Literature
Haubenhofer, D.K., M. Elings, J. Hassink and R. Hine (2009) The development of
green care in Western European countries. Explore 2010; 6: 106-111.
Green care: cure, care and health promotion in a
natural environment
Offering care on farms is one of the forms of green care. Green care is the umbrella
term for activities that relate to health promotion or care interventions in a natural
environment. It can be about providing care on a farm for people suffering from
addiction, but it can also include wilderness therapy for young people or facilitated
walks for people suffering with depression. We use this term here because research
has been done into multiple forms of green care activities. The mechanisms behind
these different activities, that are responsible for their effects, often overlap. That
makes those studies of interest for the care farming sector. The results of some of
these studies have been included in this report for that reason.
The gure below shows how care farming sits alongside other green care activities.
It shows that care farming not only offers care or day activity, but also is represented
as an intervention that can contribute to health promotion, therapy and (work)reha-
bilitation.
In this gure, the researchers clearly show which green care activities there are.
Firstly, they make a distinction in activities where participants are present in nature
but do not make very active use of natural elements (experiencing natural environ-
ment). One example is a group of ofce workers who during their lunch break go for
a walk in the park. By walking in the park, people recover from their work stresses
but they do not have direct interaction with nature. The opposite is true for some
activities where there is interaction with nature (interacting with natural elements),
Figure 1: Overview of ‘green care’ activities and the relationship
with nature (Haubenhofer et al., 2010)
11
12 13
In the late nineties, this concept was intro-
duced into the Netherlands (Boevink e.a., 2006;
Deegan, 2001). Interest in the approach in-
creased greatly over the years. This was caused,
in part, by the activities of the team Herstel-Em-
powerment-Ervaringsdeskundigheid (Recovery-
Empowerment-Experience), the HEE-team. The
HEE-team’s goal was supporting people with
serious and enduring mental health problems
to get themselves out of a position that they ex-
perienced as inferior. They learned to speak up
for themselves as equals with respect to their
aid workers. The HEE-team stimulated further
thought inside the mental health sector about re-
covery oriented care. This form of care focuses
on:
• The life story and the experience of the client
alongside their medical history
• Strengthening the control and freedom of
choice of the clients (empowerment)
• Developing, formalizing and implementing
the client’s own effort and experience
• Involving clients in their own care
Boevink (2005) argues that for the recovery of
clients, it is important that care workers get to
know them in their normal lives. Care workers
must not cling to a treatment relationship but pur-
sue a relationship that is aimed at co-operation
and equality. Clients report that they nd it im-
portant that care workers are not prejudiced and
listen to them, accept them and are an involved
interlocutor. Within the recovery- and empower-
ment- approach, a number of principles are used
to strengthen the client’s own strength, principles
such as focusing on integration into society and
involvement of that society, to help them use
their own power and make their own choices.
Also, the recognition that recovery is possible is
paramount, just like the recognition of the value
of support from the environment and informal
networks and the emphasis on the relationship
between client and mentor.
1.3 Connecting care provision
on farms with trends in
health and social care
A care farm offers recipients of care a facility
where they can experience essential elements
from the previously discussed streams and de-
velopments (Hassink, e.a., 2011). Emphasis is
laid in a very natural way on empowerment of
the participants, on integration into society and
support of informal social networks. The starting
point on a care farm is the participation in nor-
mal work (Hassink, 2009). Participants receive a
workplace outside of the regular care system. It
is an environment that they experience as less
stigmatising. Also, the emphasis is on the pos-
sibilities instead of on the limitations of the par-
ticipant. The focus on the individual and being a
part of the lives of the farmer, his family and a
broader community, leads to empowerment and
to socially embedded care.
Hassink and others (2011) indicate that in the
long-term care the emphasis will be on putting
the needs of the client as paramount. Care will
increasingly have to be connected to the percep-
tion of the care recipient. The care offered on
farms is often small-scale. This makes it easily
possible to observe the individual needs of a par-
ticipant. In the tasks that are offered to partici-
pants, it is the participant’s individual possibilities
which are the highest priority.
1.2 Developments in health-
care and welfare sector
The services that care farms offer are consistent
with different current developments and changes
in the care and welfare sector in the Netherlands.
They can be separated into two main trends: the
stimulation of care recipients to participate in so-
ciety; and the stimulation of their ability to stand
up for themselves i.e. empowerment.
Stimulating participation in society
Socialization of care
Socialization means that people are stimulated
and enabled to participate in society (De Wilde,
2002). The idea to have people with a demand
for care remain independent and live among
other citizens and have their care and guidance
offered nearby, originated in the 1980s. The ex-
tramuralisation also came into vogue at that time
(i.e. a shift from care provided in institutions to
care provided at home). The development to so-
cialize care takes this a step further. It refers to
a conscious effort from clients, their friends and
family, professionals and the society as a whole,
to make space for the people who previously
stood outside society (Kal, 2001).
Socialization has special relevance towards peo-
ple with a mental, physical or psychological disabil-
ity. The starting point for care is to look at people’s
possibilities instead of their limitations. People are
addressed as to where their talents lie, what they
can do and where they have room for growth. Ad-
ditionally, disabilities are approached differently
because often, people can also learn from their
limitations. Increasingly, people that experience(d)
having a disability are being utilized. Making use
of their own personal expertise has become an
important point for many patients, clients and peo-
ple with a disability (Van Haaster e.a., 2010).
Community care
Community care has as a goal that people with a
disability can lead a life that is as normal as pos-
sible. They do not only receive support from care
providers and care facilities, but also from other
parties within society (Bouduin, 2002). The prin-
ciple of community care is care in the commu-
nity and care by the community (Kwekkeboom,
2010).
Rehabilitation approach
Rehabilitation is about improving the functioning
of the client in different areas of life. That can be
achieved by making clients more skillful and ad-
justing their environment in a way that they are
functional with their own ability (Van Weeghel,
1995). Rehabilitation is a movement that aims
to create possibilities for chronic psychiatric pa-
tients. The goal is to allow the patient to become
a full citizen.
Different rehabilitation approaches exist but they
each emphasize that the client plays an impor-
tant role in his or her rehabilitation and that a long
term approach is essential. In the last few years
an idea has taken hold that rehabilitation pro-
grammes should primarily be aimed at strength-
ening the natural tendency of clients to grow. The
approach is then not so much teaching skills or
making the environment suitable, as supporting
and stimulating the recovery process of the cli-
ents themselves (Boevink, 2006). The focus of
rehabilitation, aside from areas of life residency
and social contact, is mainly on work and useful
daily activity from the view that working can have
health-giving properties (Van Weeghel, 1995).
Empowerment and self-reliance
Recovery approach
Clients all have their own experiences. These
need to direct the actions and interventions of
care workers. This is the starting point for the re-
covery approach. This approach was introduced
and developed by clients and consumer organi-
sations in America (Chamberlin, 1997). Clients
indicate that hope, empowerment and the de-
ployment and use of their own experiences are
key terms for their recovery and through recovery
self-reliance.
14
Literature
Bennett, D. (2003) Rehabilitatie is mensenwerk.
De ontwikkeling van een visie. In: Rehabilitatie,
een orientatie en een beschrijving van drie bena-
deringswijzen. M. Nuy (ed.), SWP, pp 11-16.
Boevink, W. (2005) Over leven na psychiatrie. In:
Individuele rehabilitatie, behandeling en herstel
van mensen met psychiatrische problemen. J.
Droës (Ed.) Amsterdam: SWP.
Boevink, W. A. Plooy & S. van Rooijen (2006)
Herstel, empowerment en ervaringsdeskundig-
heid van mensen met psychische aandoeningen.
Amsterdam: SWP.
Bouduin, D. A. McCulloch & A. Liégeois (2002)
Good care in the community: ethical aspects
of deinstitutionalisation in mental health care.
Utrecht: Trimbos-instituut.
Chamberlin, J. (1997) A working denition of em-
powerment. Psychiatric Rehabilitation Journal 20
(4): 43-46.
Deegan, P.E. (2001) Recovery as a self-directed
process of healing and transformation. In C.
Brown (Ed.) Recovery and wellness: Models of
hope and empowerment for people with mental
illness, Haworth Press: New York, p. 5–21.
Haaster, H. van, D. Hidajattoellah, J. Knooren &
J.P. Wilken (2009) Kaderdocument Ervarings-
deskundigheid. Utrecht: Hogeschool Utrecht,
Kenniscentrum Sociale Innovatie.
Hassink, J. (2009) Zorgboerderijen dragen bij
aan empowerment en eigen kracht van deelne-
mers. Wageningen: Plant Research Internatio-
nal.
Hassink, J., A. van Dijk & D. Klein Bramel (2011)
Waarden van Landbouw en Zorg. Wageningen:
Plant Research International.
Kal, D. (2001) Kwartiermaken. Werken aan ruim-
te voor mensen met een psychiatrische achter-
grond. Amsterdam: Uitgeverij Boom
Kendall, K.S. & M.B. Kenkel (1989) Social ex-
change in the natural helping interaction. Journal
of rural community psychology. 10: 25-45.
Weeghel, J. van (2005) Herstelwerkzaamheden.
Arbeidsrehabilitatie van psychiatrische patiën-
ten. Utrecht: SWP.
Wilde, G. de (2002) Erbij horen. Advies Task-
force Vermaatschappelijking Geestelijke Ge-
zondheidszorg. Utrecht: Trimbos-instituut.
15
16 17
Youth experience that on the
farm they are an employee in-
stead of a client. They learn
which competences they have
and how to you those compe-
tences in the future.
It helps young people to get a handle on their
lives again in a safe environment.
There is also much less aggression on a farm
than inside a school or a facility. There, young
people may be in contact with other troubled
individuals, which increases the likelihood of
conicts.
Continuity in the treatment
The farmer or the farmer’s partner is always
present. When a young person arrives from
school, they can share their story about the day.
In regular facilities, young people have to deal
with frequent changes in the support staff. Staff
members have their own norms and values, as
well as their own methods and ideas. This can
be difcult for young people who are looking for
clarity and stability.
Qualities of care farms for young
people with behavioural problems
In co-operation with Wageningen UR, the Plat-
form Jeugdzorgboerderijen (Platform Youth
Care Farms) (2010), has researched which
qualities of care farms offer support to young
people with behavioural problems. These young
people are often stuck in the home situation (ar-
guments and aggression, runaway behaviour),
school or work (they avoid going to school or
work) or have the wrong friends and no positive
way to use their leisure time (drugs, criminality).
Clarity and safety
The daily routine on the farm and the quietness
of a rural environment, provide structure, clarity
and safety to young people. These are required
for their positive development. On a farm, struc-
ture is naturally in place, whereas in a different
(care) environment, structure must be created.
Care farms can provide services for diverse groups of
care recipients: people with learning difculties, people
with psychological problems, older people with dementia,
young people with behavioural problems and others. Each
group requires a different sort of care, set of activities and
guidance.
2. Effects of care on farms for
specic client groups
Over the last few years, various studies have
been implemented on the effects of working and
living on a care farm on different client groups.
2.1 Children and young people
Increasingly vulnerable young people nd help
and shelter on care farms. These ‘youth care
farms’ offer care to children and young people
between the ages of 2 to 18 years old. Some
have special programmes in after school hours
or weekends for young children with ADHD or
with an autistic disorder. Other farms function
as a crisis shelter for young people that need to
be placed outside of the home environment for
a certain period of time. Around this last client
group, recent research has been done to map
the effects and specic qualities of care farms.
18 19
Effect study on individual combined
study-work programmes on farms
for troubled young people between
the ages of 16 and 20
Together with different organisations for youth
care, Jan Hassink of Plant Research International
(Wageningen UR) together with Praktikon (Rad-
boud University) have researched the effects and
benets of care farms for troubled young people.
One of the studies was performed by Topaze, a
youth care provider in Schijndel, the Netherlands.
Topaze offers young people individual work-and-
stay programmes on a farm. These focus on
learning through experience. On a yearly basis,
around 25 young people are placed on 25 farms.
In the last ve years, roughly 100 young people
have nished a work-and-stay programme on a
farm. When they start, almost all of them have
poor contact with their parents; often they have
no daytime activity in the form of school or work
and no useful leisure activity. They show behav-
ioural problems, use drugs and have contact with
the police. Their self-condence is marginal.
The young people participating in the programme
live in a residential unit on the farm, which is to
be maintained by themselves, and they help with
farm work. The young person eats a cooked
meal with the farm family and lives on his or her
own for the rest of the time. The programme
takes one year, half of which is spent on the farm
and the other half is spent in a post-support pro-
gramme, during which the young people in most
cases lives at home. Both the young people and
their parents receive distance support.
Of the more than 100 young people who were
signed up for the programme in 2009, 69% com-
pleted it as planned, 19% stopped prematurely
and 13% decided ultimately not to start it. The
young people who completed the programme
were mainly boys (89%) and of Dutch nationality
(90%).
The study investigated whether participating
young people themselves saw improvements in
the characteristic aspects of ‘learning through
experience’: their daily functioning, self-appreci-
ation and self-determination, the self-perceived
behavioural problems, how they handle prob-
lems, stressful events and intense thoughts or
feelings. The care workers from Topaze reported
how the young people scored on contact with
their own families, participation in school or work,
their residence, contact with the police, debts,
use of leisure time, alcohol and drug use, wellbe-
ing, behavioural problems and self-worth.
The questionnaires were completed at the begin-
ning and end of the farm programme, and at the
end of the follow up programme. Control group
data was used as a reference.
Results
> Reduction in behavioural problems
From the questionnaires that the young people
themselves completed, it is evident that the farm
programme has a positive effect on their behav-
ioural problems and self respect (table 1). These
positive effects remain visible a year after nish-
ing the farm programme. The effects on dealing
with problems (coping behaviour) are minor.
Table 1. Changes after experiential learning on the
youth care farm (percentage of young people with
those problems)
----------------------------------------------------
1 Internalising behaviour is behaviour focusing in-
ward, expressing itself as anxiety, depression, withdrawal
and physical manifestations.
2 Externalising behaviour is outward focused be-
haviour, such as aggression, rebellion, insubordination and
rage.
Role model
The farmer can set an example for young people
who are having trouble with their identity. In gen-
eral, the farmer is proud of his business and what
he has achieved. The farm life is his or her iden-
tity. This shows on the farmer. The farmer is a
professional from whom young people can learn.
Experience tells us that Moroccan youth that nd
a place to work on the farm, acknowledge the
farmer’s authority more easily than they would
with a youth care workers (Hassink, e.a., 2011).
The farm family members can also serve as role
models. Youth care workers mention the impor-
tance of this family for the young person (Plat-
form Jeugdzorgboerderijen, 2010). The young
people themselves have indicated that they ap-
preciate the contact with the farm family.
Involvement and responsibility
On the farm, the young person works together
with the farmer. He or she is also part of the life
of the farm family. This creates an atmosphere of
equality. Through this co-operation and in some
cases co-habitation too, the farmer and the young
person are able to build a personal relationship.
Youth care farmers indicate that they nd it nor-
mal to talk about their own lives and experience
while working. In facilities, warnings are given
about this: a relationship that is too personal is
not professional and can lead to disappointment.
Farmers indicate that they have the freedom to
conduct matters in their own way, and therefore
some of them dare to take more risks. They can
explore the limits of the young people, which can
stimulate their sense of responsibility.
From earlier research in youth care, it is evident
that the attention of care workers - listening, be-
ing taken seriously, open and honest treatment,
trust and doing normal things together - are very
important to them (Meerdink, 1999).
Emphasis on what young people can do
The farmer usually doesn’t focus on the problem
the young person has, but looks mostly at what
he or she can contribute. This creates positive
attention. Young people themselves feel like they
are given the role of an employee on the farm,
rather than that of a client. They can discover
their qualities and utilise them.
Learning in real life
On a farm, no articial situations have to be
created for the young people in order to learn
something. Youth care workers point out that a
farm is part of real life. Disaffected young people
who are alienated from society, can experience
involvement again on the farm. Going ‘back to
basics’ is a good alternative to alienation. The
farm is also an environment full of life processes
(births and deaths of animals, the cycle of the
seasons, nurturing plants and animals) that can
give young people insight into their own lives.
Afliation to interests
Young people who drop out of school, often nd
the lessons at school too abstract. Attending ani-
mals and plants on the farm is very practical: it is
clear why it needs to be done and animals react
immediately. This stimulates a sense of respon-
sibility.
Young people often need an environment that is
‘unnished’, where they can ll in the blanks for
themselves. The farm offers this environment,
which allows them also to use their own creativ-
ity. Boys nd it especially fun to ‘tinker with things’
or doing other artisan work. On the farm it often
goes without saying there is space for this kind
of activities.
Outside of their own environment
An advantage of staying on a farm is that it is of-
ten literally and guratively far removed from the
environment where the young people are from
and where they got into trouble. Therefore, they
are less tempted to ‘take the wrong turn again’.
Aspect Start Finish
Internalisation132 8
Externalisation245 15
Self respect 21 4
20 2. Effecten van zorg op boerderijen voor specieke doelgroepen
Both the young people who follow an individual
work-and-stay programme and those who receive
temporary shelter on the farm, show a reduction
in behavioural problems. The programme also
leads to an improvement in the young people’s
contact with their own family, their self-esteem
and their wellbeing. In many situations, school
performance improves or the young person is
more likely to re-engage in school or work. For
the older participants we see a strong decrease
in substance abuse.
Employees from Topaze indicate that the farm
programme causes marked improvements in
contact with the family, school absence or work,
police contact, use of drugs, use of leisure time,
wellbeing, behavioural problems and self-con-
dence (table 2). After the follow up programme,
these improvements normalise somewhat, but
the percentage of young people who use drugs,
come in contact with the police or experience be-
havioural problems, is signicantly lower than at
the start of the programme (table 2).
Table 2. Changes per performance-indicator (% )
> Less aggression and conicts
Young people report that on the farm they experi-
ence less stimulation and less aggression com-
pared to a traditional (care) facility or at school.
Also, there are fewer conicts. In regular facili-
ties, they mostly have contact with other young
people who also have difculties, so the chances
of conicts arising are greater.
> Respite care and prevention
Due to the accessible shelter provided by the
farm, the need for more intensive care at a lat-
er stage can be prevented. With juveniles that
receive day- weekend- or guest shelter, there
is also mention of powerful unburdening of the
home situation (Platform Youth Care Farms,
2010).
Literature
Platform Jeugdzorgboerderijen (2010) De
jeugdzorgboerderij. Een wenkend perspectief.
Wageningen: Wageningen UR
Hassink, J., R. de Meyer, P. van der Sman & J.
Veerman (2011) Effectiviteit van ervarend leren
op de boerderij. Tijdschrift voor de Orthopedoga-
giek 50 (2):51-63.
Hassink, J. (2009) Zorgboerderijen dragen bij
aan empowerment en eigen kracht van deelne-
mers. Wageningen: Plant Research Internatio-
nal.
Meerdink, J. (1999) Weet u wat een hulpverlener
moet doen? Kinderen en jongeren over de kwa-
liteit van uitvoerend medewerkers in de (semi-)
residentiële hulpverlening. Utrecht: SWP.
21
Performance-Indicator Start Fin-
ish
Follow up
programme
% % %
Good contact with father 12 58 73
Good contact with mother 33 83 81
Daytime activity 14 88 87
Good use of leisure time 5 51 58
Wellbeing 16 80 81
Self-condence 9 83 81
No police contact 22 95 81
No drugs 12 80 50
No behavioural problems 3 50 46
22 23
Nature and children with ADHD
An American study by Nancy Wells (Cornell University, 2000) has explored the relationship
between nature and the prevention of ADHD in children. Children from 7 to 12 years old that
moved to a greener environment as part of a programme, appeared to display fewer ADHD-
symptoms after the relocation. In a different study, researchers performed an experiment with
children diagnosed with AD(H)D in the same age group. They went for accompanied walks of
twenty minutes in three different environments: a natural environment (city park) and two urban
environments (inner-city and residential area). After each walk, an attention test was conducted.
The results showed that the children could remember more numbers after walking through the
park than after the walk through the inner-city or residential area (Faber, Taylor & Kuo, 2008). It
must be said that all of the above mentioned studies have methodological shortcomings, there-
fore, the correlation between nature and AD(H)D should be treated with a degree of caution.
The research study ‘Nature as a therapy for ADHD’ (Van den Berg, 2011) also concludes that
for children with AD(H)D, a natural environment is especially good for performing ‘difcult’ cog-
nitive tasks that call on their ability to oversee and plan their work. A green environment is not
the ultimate remedy, but can have a positive effect on certain aspects of their behaviour and
wellbeing.
Literature
Faber Taylor, A. & F. E. Kuo (2009) Children with attention decits concentrate better after walk
in the park. Journal of Attention Disorders, Mar 2009; vol.12: pp. 402-409.
Van den Berg, A. & E. de Hek (2009) Groene kansen voor de jeugd. Stand van zaken onder-
zoek jeugd, natuur, gezondheid. Wageningen: Alterra.
Wells, N.M. (2000) At home with nature. Effects of ‘green-ness’ on children’s cognitive function-
ing. Environment and Behaviour, 32: 775-795.
24 2. Effecten van zorg op boerderijen voor specieke doelgroepen
Participants indicate that it is pleasant to be part
of a community: the farm family, the care workers
and their colleagues on the farm. They practice
developing social contacts. Additionally, on the
farm they not only come in contact with people
who share the same fate, but also with very dif-
ferent people that attend or visit the farm.
Small-scale
Addiction care workers report that, in their ex-
perience, participants tend to show off in larger
groups. This behaviour often leads to aggression
or use of inappropriate language. On care farms,
the groups are often small, which leads to such
behaviour being less common. Care workers
also report that the jobs on the farm foster a ‘we’-
feeling, the feeling of accomplishing something
together.
Attitude of the farmer and care workers
The appreciation that the farmer and care work-
ers give to participants causes them to feel wel-
come and increases their self-condence. This
appreciation is intensied by the farmer opening
his enterprise to them. They are welcome and
accepted just as they are. This acceptation by
‘normal’ people is valued greatly by the partici-
pants.
Effect study on participants from
psychiatric and addiction care work-
ing on care farms
In an effect study of people with a background
of psychiatric and/or addiction care working on
care farms, Marjolein Elings (2011) followed par-
ticipants on care farms as well as other day care
and work projects for this client group. The hy-
pothesis of this researcher was that social func-
tioning, the quality of life and the nutrition pattern
of participants on care farms would improve and
increase in comparison to participants of other
work projects.
In a quasi-experimental research study, she fol-
lowed participants of both groups throughout one
year. They lled out a questionnaire at the start of
their engagement on a care farm or work project
hang around on the street. On the street or at
home the temptation to think about drugs or al-
cohol is too great. Additionally, participants with
psychiatric problems state that the work distracts
them from their symptoms. While working, they
are less likely to think about their problems.
Having work offers participants in addiction care
the possibility to leave their old world behind. It is
often difcult for them to abandon their old group
of friends. They can avoid them now in the eve-
nings by saying that they have work early next
morning and therefore do not have time. Having
work thus functions as an important safety pre-
caution.
The tasks on a farm are often varied; this allows
participants to try a range of activities. It helps
them to reect on what interests and qualities
they have.
Structure and routine
The majority of the participants in the study have
spent a long time at home, in a clinic or facility,
doing very little. For them, it is pleasant to be
working again and to have daily goals. Working
on the farm allows participants to rebuild a rou-
tine. The care workers see the determination and
the motivation of participants increase. Partici-
pants also live up to their agreements which lead
them to doing more work. Animal care especially,
stimulates their sense of responsibility.
Different environment
The farm offers participants a different environ-
ment to the one they are used to. Many of them
come from the city. They report that in the city,
they are surrounded by stimuli. On the farm,
there is peace and space. Participants experi-
ence, for example, the seasons much more than
in the city. They are able to relax and nd the
space to think about themselves.
Social community
For both the people in psychiatric as well as ad-
diction care, the farm is a safe environment to
practice. It represents a transition between their
illness or addiction and the step towards regular
or voluntary work or towards society in general.
2.2 People suffering from
psychological ill health
and those suffering from
drug and alcohol addiction
People with psychological or addiction problems
attend care farms for different reasons. In many
cases, they work on a care farm to have a useful
occupation and by doing so add structure and rou-
tine to their week. Often, this daytime activity has
as an underlying goal, such as resocialisation, re-
habilitation or recovery. Some participants in this
client group work on the farm as part of a labour
integration programme whereby the ultimate goal
is nding (regular) work.
In this representation of research results regarding
care on farms, people from psychiatric and addic-
tion care are treated as one group. Research into
the effects of care farms so far has mainly treated
participants as a single group, without making any
further distinction. Research shows that around
70% of the participants from the addiction care
also have signs of psychological problems, i.e. a
double diagnosis.
Qualities of care farms for people in
psychiatric and addiction care
Plant Research International (Wageningen UR)
in collaboration with the Trimbos Institute has
studied which qualities on the care farm are im-
portant for people with psychological or addiction
problems (2011). Wageningen UR conducted a
comparable study jointly with the Louis Bolk Insti-
tute. In both studies, the researchers asked par-
ticipants in focus groups or in-depth interviews
which elements and qualities of the farm were
important for their recovery process. The follow-
ing qualities of care farms for this client group
emerged:
Useful work and distraction
Working on the farm helps participants with an
addiction problem to overcome their addiction by
allowing them to focus their thoughts on other
things. They have a goal during the time they are
on the farm and do not have to sit at home or
25
26 27
> Being restful
Participants report that the care farm helps them
in settling down. Care farms provide a safe en-
vironment with sufcient space. Physical work
in the open air makes participants tired; they
go home satised and therefore sleep better.
> Increased self-esteem and self-respect
Self-esteem and self-respect of the participants
increases by working on a farm. Appreciation
and acceptance of the care farmer and care
providers as well as achieving positive results
through work, also contribute to this. The feeling
of being meaningfully engaged and seeing the
positive results of their labour gives participants
a feeling of self-respect. They have a goal to
achieve. The fact that outsiders such as fam-
ily and friends look at them differently is also a
contributing factor.
> Demonstrating more social behaviour
Care providers see changes in the behaviour of
participants. Addiction care providers are familiar
with the participants from consumption rooms4 or
social lodgings. They observe that participants
become more social on the farm and show more
solidarity. Participants encourage each other to
come to the farm. This is a big difference from
their egocentric attitude in consumption rooms
and social lodgings. Participants use a different
language and talk about different topics on the
farm. They take more account of each other and
are better mannered.
> Increase of perseverance, engagement and
responsibility
Perseverance increases as participants work
longer on the farm. They learn to wake up on
time, to keep their agreements and to build up
a positive work experience. By undertaking spe-
cic tasks, they develop their sense of responsi-
bility. Tending the animals and plants leads to an
increase in engagement.
Conclusion
This research shows that participants from the
client group of people with drug problems and
people with psychiatric backgrounds feel more
able-bodied and useful when they work together
on a care farm. It is the combination of various
factors that sets the care farm apart from other
work or day care projects. Care farms are for
many participants a pleasant and safe haven
between their sickness and/or addiction and so-
ciety in general and regular or voluntary work in
particular.
whilst the guidance scored 7.9. The results of 45
participants who worked longer than a year on
the farm show increased levels of satisfaction.
They give work on the farm a score of 8.2 and
guidance a score of 8.3.
The quantitative data from this study show that
there is neither signicant improvement nor sig-
nicant deterioration of the quality of life, social
and psychological functioning and nutrition pat-
terns of participants on care farms. This could be
due to the drop out of participants from the study,
which made the number of respondents too small
to show signicant results.
Qualitative results
It is striking that the interviews with around 50
participants, care farmers and care providers,
very clearly show the benecial inuence of care
farms. The following effects of working on a care
farm were noted:
> Improved condition
Participants feel tter, build up muscular power
and regain their energy. By not using substanc-
es, people with an addiction problem allowed
their body to recover.
> Increased appetite
Working on a care farm leads to a better appetite.
This is important for participants under addic-
tion care as they have neglected themselves for
longer or shorter periods of time. The care farm
provides a clear structure of coffee, lunch and
tea breaks. Thus, participants build up a normal
eating regime again. This is further enhanced
by participants cooking together on some care
farms. Working in the open air also works up an
appetite.
> Get more things done
Participants have to get used to the work rhythm
on a farm, but afterwards, the care providers no-
tice that participants become more productive.
They learn to get on with working on their own,
making choices and dividing their energy better so
that they manage to keep working the whole day.
(baseline). A second measurement was done af-
ter half a year and a third one after a year.
The complete questionnaire was composed of
different, commonly-used, standardised ques-
tionnaires in the care sector. It measured the
quality of life and the psychological and social
functioning of participants. The research also
included questions on social-demographic fea-
tures, medicines, use of care and resources.
Alongside these quantitative methods, focus
group discussions and in-depth interviews were
carried out.
A total of 149 participants completed the base-
line questionnaire, 113 of whom worked on a
care farm and 35 from other work projects. The
second questionnaire, after half a year, was com-
pleted by 67 participants; 53 participants of care
farms and 14 from other work projects. The last
questionnaire, after a year, was completed by 28
participants, with the majority of 21 participants
from care farms and the remaining 7 from other
work projects.
Quantitative results
> Quality of life
At the start of working on a care farm or work
project, the scores of participants of both groups
on the quality of life and social and psychologi-
cal functioning were roughly the same. During
the year that they were followed, neither the care
farm participants nor the participants of other
work projects showed any signicant progress or
regress in the different domains. No differences
were found between the two groups. However,
participants used addictive substances less fre-
quently during the whole year and had less con-
tact with caregivers or care facilities.
> Satisfaction
The satisfaction of participants on care farms
was measured by translating the GGZ (Men-
tal Health Care) thermometer for participants of
care farms (Van Erp, 2004). The results show
that participants who have worked for one year
on the farm are very satised with the guidance
received. The work got an average score of 7.8
----------------------------------------------------
4 Location where drugs can be used, i.e. to prevent
drug related litter in public spaces.
28 2. Effecten van zorg op boerderijen voor specieke doelgroepen
Literature
M. Elings, D. Haubenhofer, J. Hassink, P. Riet-
berg & H. Michon (2011) Effecten van zorgboer-
derijen en andere dagbestedingsprojecten voor
mensen met een psychiatrische of verslavings-
zorgachtergrond. Wageningen: Plant Research
International en Trimbos-instituut.
E. Baars, M. Elings & J. Hassink (2008) De Hoge
Born verbindt: kwaliteiten en effecten van zorg-
boerderij De Hoge Born. Wageningen: Plant Re-
search International en Louis Bolk instituut.
Ketelaars, D. E. Baars & H. Kroon (2001) Wer-
kend Herstellen: Een onderzoek naar thera-
peutische (leef)werkgemeenschappen voor
mensen met psychiatrische problematiek.
Utrecht: Trimbos-instituut en Louis-Bolk Instituut.
Erp, van N. (2004) Instrument voor tevreden-
heidsonderzoek onder deelnemers op zorgboer-
derij. Utrecht: Trimbos instituut.
29
2. Effecten van zorg op boerderijen voor specieke doelgroepen
Respite care: home care and prevention
Caring for a relative or close friend with a serious psychological disorder is often a
heavy burden for the care giver and for his or her environment. A study of the Dutch
Expertcenter on Informal care (Expertisecentrum Mantelzorg) reveals that many
people with psychological disorders show changes in personality, are easily irritated
and lack insight into their illness. Many care givers, therefore, need respite care, but
a large number of respite care facilities are not suited for this specic client group of
mental health clients. The study indicates that care farms are an exception. The care
farm is a small-scale, accessible facility that offers appropriate day occupation for
many mental health clients. Thus, the care farm can offer an important contribution
to respite of care givers.
Literature
M. Vermaas (2009) Respijt voor de mantelzorger-kansen voor zorgboeren. Utrecht:
Expertisecentrum Mantelzorg
M. Vermaas (2009) Werken bij de zorgboer-een adempauze voor de mantelzorger
(folder). Utrecht: Expertisecentrum Mantelzorg
Use of physical activities for mental health
In his book ‘Pillen, praten en bewegen’ (Pills, talking and exercising), Jaap van der
Stel (2005) writes about the origins of the lack of exercise in many people’s current
lifestyle. He describes what the consequences are for physical and mental health.
He demonstrates that more exercise increases the physical condition of clients with
psychiatric problems and that exercise leads to a reduction in psychological symp-
toms.
Physical activities, if applied correctly, he argues, provide benets that people can
also enjoy. Care in the form of medicines and ‘talking’, do not bring a similar sort of
enjoyment and pleasure. The positive feelings that belong to exercising are often
also the driving forces that motivate people to keep putting in the effort.
Literature
Van der Stel, J. (2005) Pillen, praten en bewegen: Nut van fysieke activiteiten voor
geestelijke gezondheid. Amsterdam: Uitgeverij SWP.
3130
33
2. Effecten van zorg op boerderijen voor specieke doelgroepen
A literature review of the effectiveness of animal-assisted interventions with a
broader client group shows that interventions with animals are effective for different
groups. The effects found were improved quality of life, decreased stress, improved
performance at school and intellectual skills, improved verbal and social skills and
social interaction (Mansfeld, 2002; Janssen & Bakker, 2007).
A study by Enders-Slengers (2000) highlights the effects of domesticated animals
such as dogs and cats on the client group of older people. One of the conclusions is
that human-animal relationships can full certain social needs where emotional and
care aspects are primary. The study also shows that pets can, to some extent, have
a protective effect in stressful circumstances.
Literature
B. Berget (2008) Animal assisted therapy: effects on persons with psychiatric disor-
ders working with farm animals. Ass: University of Life Sciences of Ass, Noorwegen.
Enders-Slengers, J.M.P. (2000) Een leven lang goed gezelschap. Empirisch onder-
zoek naar de betekenis van gezelschapsdieren voor de kwaliteit van leven van
ouderen (proefschrift). Utrecht: Universiteit van Utrecht, Faculteit Sociale Weten-
schappen.
Janssen, M. & F. Bakker (2007) De therapeutische werking van huisdieren bij psy-
chiatrische problemen: een literatuurstudie. Amsterdam: AdSearch.
Mansfeld, K. (2002) Metaanalyse zur Tiergestützten Therapie. Eine Literaturüber-
sicht unter der besonderen Berücksichtigung potentieller Wirkfaktoren sowie der
therapeutischen Indikation. Wenen: Universität Wien.
Effect study on farm animals in the treatment of
people with psychiatric problems
The Norwegian researcher Bente Berget undertook a study in 2008 into the ef-
fects of farm animals in the treatment of people with psychiatric problems. The most
important diagnoses of the people were schizophrenia, affective disorder5, anxiety
disorder and personality disorder. During a period of 12 weeks, they visited a farm
twice a week to spend 3 hours working with cows. This was in addition to their
‘standard’ treatment. The study measured change – it did a pre-measurement, a
measurement at the end of 12 weeks and a nal measurement 6 months later.
The clients lled out a questionnaire which included aspects of anxiety, depression,
coping mechanisms (tackling stressful circumstances), self-efcacy and quality of
life. Alongside the questionnaire, video clips were made of contacts between the
clients and the animals.
Results
The study revealed that the quantity of work undertaken and the quality of the work
increased during the project. No signicant decreases in anxiety or depression were
found. Also, in terms of self-efcacy, coping mechanisms and quality of life, no statis-
tically signicant differences were seen between the treatment and control groups.
The group of clients with affective disorder did indicate a positive change in terms
of self-efcacy and quality of life. They scored higher than the control group. This
group of clients appeared to benet the most from contact with animals.
32
----------------------------------------------------
5 Disorders where the (long-term) emotional status of an individual becomes either more
prominent or is underplayed. This can make people either very sombre (depressive) or very happy
(manic).
34 35
Varied activities
Care farms offer older people a more varied
daily programme. This programme is tailored
to suit the normal, familiar rhythm of the life of
older people. The activities on offer can be un-
dertaken individually or in groups, whilst many
activities in regular day care facilities are mostly
undertaken on a group basis. Older people on
care farms are also more often outside in the
open air.
More social contacts
Many older patients with dementia leave the
house less frequently and thereby lose their so-
cial contacts. They can make new contacts on
the farm. Older people nd it easier to develop a
trusting relationship with the farm owners while
care providers in regular day care facilities tend
to change frequently. On some farms, older peo-
ple come in contact with people from the village.
The farmer (or his wife), for example, takes them
along when he or she goes out to do the grocery
shopping.
Physical condition
Activities on care farms such as feeding the ani-
mals and raking leaves generally requires more
physical effort than the activities in a regular day
care facility. Such activities are also available
more regularly and include watching, feeding ani-
mals, gardening, walking and helping to prepare
the meals. Older people on care farms feel stimu-
lated to stay active and do things together, which
helps them to maintain their physical condition.
In his book ‘Young in spirit’, Jan Auke Walburg
(2010) mentions that different studies point to the
fact that physical exercise decreases the risk of
dementia.
Cognitive functioning, emotional well-be-
ing, behavioural problems
De Bruin notes in her research that the cognitive
functioning, emotional well-being and behaviour-
al problems by group of older people, both on the
care farm and in regular day care, did not display
any improvement after one year. Neither were
any differences found in these domains among
the two groups.
Conclusion
Care farms provide for older patients with de-
mentia a more varied programme than regular
day care. The stay on the farm stimulates their
intake of food and water. No signicant differenc-
es were noted in other domains of the research
among patients on care farms and in regular day
care. This could be due to the limited number of
respondents. In addition, there are differences in
the prole of those attending care farms (often
married and relatively younger men) and those
who go to regular day care (often widowed wom-
en).
Literature
Bruin, S., de (2009) Sowing in the autumn sea-
son. Exploring benets of green care farms for
dementia patients. Wageningen: Wageningen
Universiteit.
Driest, P., A. Jans, A. Roest & K. Oltmer (2010)
Thuis op de zorgboerderij. Handreiking klein-
schalig wonen voor ouderen met dementie. Ben-
nekom: Taskforce Multifunctionele Landbouw.
Hassink, J., M. Elings, R. Ferwerda & J. Rom-
mers (2007) Meerwaarde Landbouw en Zorg.
Wageningen: Plant Research International.
Walburg, J.A. (2010) Jong van geest. Optimis-
tisch ouder worden is geen kunst. Amsterdam:
Nieuw Amsterdam Uitgevers.
2.3 Older people with dementia
An increasing number of older people with de-
mentia can make use of care farms at many lo-
cations in the Netherlands. There are about 150
such care farms in total. Most of these care farms
provide day occupation for this client group. A
number of the farms also provide intensive forms
of support such as supervised living. A charac-
teristic of care services for older people on these
farms is its small scale. They mostly cater for 6 to
10 participants.
Qualities of care farms for older peo-
ple with dementia
The offer of care on farms expands the number
of options for older people as to where to receive
care. This increases the freedom of choice for
the older people and their care givers. Daily care
on a farm seems to appeal to a different group,
mainly men, than regular day care.
Small scale
A study conducted by the Trimbos Institute and
EMGO Institute (VU medical centre) (2007) re-
veals that small-scale care has a positive effect
on older people with dementia. This client group
needs a trusted and recognisable living environ-
ment with a homely atmosphere. A care farm of-
fers such an environment. The small scale of the
care provision does however sometimes make it
more difcult to attract expert staff.
Normal life
Older people experience staying on a farm as a
‘normal’ life. They are involved in daily activities
that they were used to doing at home, such as
light cleaning tasks and cooking together. There
is less space for these normal aspects in a regu-
lar care facility. There food, for example, is ca-
tered by a central kitchen.
Sometimes, older people have a stigma attached
to receiving care. A care farm can be an option for
those older people who are wary of regular day
care, to be involved in a day activity programme.
Effects of care farms on older peo-
ple with dementia
Two studies have looked specically at the ef-
fects of staying on a care farm on those with
dementia. Simone de Bruin (Wageningen
University, 2009) compared the development
of 30 older people on care farms with 23 older
people in regular day care. De Bruin followed
the participants at the start of their engage-
ment with the farm or regular care facility,
and followed up after six months and a year
later. The participants went to a farm 2 to 3
days a week on average and spent 6 hours
a day there. Those in the comparison group
spent the same time in a regular care facility.
Hassink e.a. (Plant Research International,
2007) described in their study the value of
care farms for different client groups, includ-
ing older people with dementia.
These studies provide the following picture
of the effects of care provided on care farms,
in terms of the health and well-being of older
people with dementia.
Nutrition
An important issue of attention in dealing with
older people with dementia is the quantity
of food and drink that they consume. Many
older patients with dementia run the risk of
being underfed and experiencing undesirable
weight loss. The research of De Bruin reveals
that older dementia patients who participate
in day care on a care farm have a higher in-
take of energy (1.2Mj per day higher), carbo-
hydrates (39 g more per day) and uid (441
g more per day) than their peers in regular
day care. Their stay on a farm ensures a sig-
nicantly better nutritional status. The Dutch
prevalence measurement of care problems in
2005 shows that 1 in 4 hospital patients, 1 in
5 clients in homecare and 1 in 6 patients in
nursing- and residential care centres, are in a
poor nutritional state. Day care on a care farm
can have a signicant impact on prevention
of dehydration, undesirable weight loss and
underfeeding.
36 37
The residents give a positive yet nuanced view of things. It appears that the resi-
dents of small-scale homes need less help for their daily activities than residents
of regular nursing homes. They are also more socially engaged than residents of
regular nursing homes. Furthermore, residents of small-scale housing enjoy their
surroundings more and often have something to do. No differences were found in
the areas of behaviour problems and the use of psychoactive drugs.
Care givers of residents in small-scale housing indicate that they are more satised
with certain aspects of care, such as personal attention for both the resident as well
as the care giver.
Care providers are extremely positive about small-scale housing. The features of
working in small-scale housing appear to be favourable: there is more autonomy,
less work requirements and more social support of colleagues.
Literature
Boekhorst, te S. (2007) Kleinschalig wonen voor ouderen met dementie: een kwali-
teitsverbetering? Tijdschrift Kwaliteit in Beeld: 8-10.
Small scale living for older patients with dementia
The Trimbos Institute together with the EMGO Institute of the VU medical centre
did a study on the effects of small-scale living for older people with dementia. The
number of small-scale residential care facilities for older people has increased in the
last couple of years. This is because of the growing awareness that traditional nurs-
ing homes do not satisfy the wishes or needs of people with dementia. Homeliness,
familiarity and recognisability are often lacking in nursing homes because they nd
their origin in hospitals with large wards and long corridors.
19 small-scale residential care facilities took part in the research, with 7 traditional
nursing homes forming the comparison group. 160 residents and their care givers
were interviewed before intake as well as 6 months later, regarding the functioning
and quality of life (resident), and health, the load of caring and satisfaction about the
care given (care giver). In addition, 380 care givers were asked about the degree of
autonomy, work requirements, social support of colleagues and mangers.
38
lenging and pleasant. Completion of the task
gives them self condence.
Care workers with knowledge of agriculture
Care farmers and care providers state that knowl-
edge of agriculture is essential to provide appro-
priate guidance to people. This ensures that they
can offer work to clients that t their capacities.
Having knowledge and experience in agriculture
is also a condition for being exible in unexpect-
ed circumstances.
Literature
M. Elings (2004) Boer, zorg dat je boer blijft!
Een onderzoek naar de specieke waarden van
een bedrijfsmatige zorgboerderij. Wageningen:
Wetenschapswinkel Wageningen UR..
2.4 People with learning
difculties
From time immemorial, people with a learning dif-
culty have worked on farms. Villagers who were
not able to get regular employment were often
welcome on farms. Even now, the largest group
of people who make use of care farms are people
with learning difculties. It is striking though that
the effects of care on this particular group have
been studied the least. It is perhaps due to the
difculties of such research, for example, a lack
of appropriate questionnaires that can be lled
out by people with learning difculties.
Additionally, the changes expected from the care
that is offered to this client group may be less
easily measured than with other client groups.
For many participants with learning difculties,
guidance towards regular work is too ambitious,
for example.
Qualities of care farms for people
with learning difculties
Marjolein Elings (Wageningen UR, 2004) studied
the specic value of a professional care farm for
people with learning difculties. She visited six
care farms and interviewed participants, care
farmers and the project care providers. The client
group were very satised with the daily occupa-
tion on the farm. Elings identied 5 qualities that
are important to make care a positive experience
for this group.
The farmer as a role model
The presence of a ‘real farmer’ was of great im-
portance to the participants. The farmer functions
as a role model for them. He is the boss on the
farm and has knowledge and skills about what
needs to be done. In unexpected situations, reg-
ularly occurring on the farm, he is able to react
and adapt in a creative manner. The farmer is by
nature an entrepreneur. This entrepreneurship
goes hand in hand with providing care, where of-
ten improvisation is required. An example of this
is a care farmer who developed a system through
which participants can independently feed the
pigs.
Meaningful work
Working on a care farm which is involved in agri-
cultural production, provides added value to par-
ticipants. This is particularly true for those with
a high level. Doing necessary and useful work
gives them appreciation and satisfaction. For
some participants, working on a care farm is a
good step towards nding employment in a regu-
lar agricultural enterprise.
Small scale
The care provided on most care farms is small
scale. Clients experience a lot of attention given
to them personally, as well as close attention
while they are working.
Social network
Participants come in contact with different peo-
ple on a care farm. This expands their social
network. The contact with the farmer’s family is
of utmost importance.
Many tasks on the care farm are carried out by
participants jointly. This helps to bring about a
feeling of solidarity between the participants,
care farmer and the care workers. Participants
nd it a stimulating experience ‘to complete the
task together’. Additionally, in working together,
they learn from each other.
Many people with learning difculties live and
work in the same place, for example, in a care
institution. During working hours on the care
farm, participants are in a different setting; in
their case living and working are separated. In
this way, they come into contact with other peo-
ple and for a while are away from their care fa-
cility and housemates.
Clients are addressed on the basis of pos-
sibilities
During their work on the care farm, participants
are considered on the basis of what they can do,
not on what they can’t do due to their disability.
Some types of work bring about a certain work
pressure. Participants experience this as chal-
39
40 41
These qualities provide an informal context, simi-
lar to that of normal life. Earlier studies show that
these specic qualities could be important in the
recovery process of participants.
Literature
Hassink, J. M. Elings, R. Ferwerda & J. Rom-
mers (2007) Meerwaarde Landbouw en Zorg.
Wageningen: Plant Research International.
Hassink, J., A. van Dijk & D. Klein Bramel (2011)
Waarden van Landbouw en Zorg. Wageningen:
Plant Research International.
Clients and care providers
experience the care farm as an
unique facility because it com-
bines the personal engagement
of the farmer, a safe social com-
munity, the useful and diverse
activities and a green environ-
ment.
3.1 Specic qualities of care
farms
Interviews with clients, care providers and care
farmers (Hassink, 2007) show clearly that they
experience the care farm as a unique facility be-
cause it combines the following qualities:
• Personal engagement of the care farmer
• A safe social community
• Range of useful and diverse activities
• A green environment
Care farms have characteristic features or qualities that -
as described in chapter 2 - have a strong inuence on the
health and well-being of their participants. In this chapter,
we take an in-depth look at four of the most noteworthy of
these qualities.
3. Qualities of care farms
Figure 2: Qualities of care farms (Hassink, 2010)
Informal
non-care context
Attitude and
engagement of farmer
and care providers
Social
community
Useful and diverse
activities
Green
environment
42 43
The ‘social exchange theory’ (Vaux, 1998) pro-
poses that social relationships are important be-
cause of their reciprocity. People complement
each other and are a valuable resource for one
another.
Additionally, developmental psychology places
importance on safe and stable bonding relation-
ships. Weiss (1973) suggests six fundamental
interpersonal requirements that, to a certain ex-
tent, are fullled within relationships:
• attachment
• social integration
• reassurance of worth
• reliable alliance
• guidance (advice, information and
protection)
• opportunity to be nurtured
According to Weiss, inability to meet these re-
quirements can lead to psychological difculties.
Research reveals that safety and positive rela-
tionships reduce stress and speed up the recov-
ery process (Caplan, 1974; Eriksen, 1994; Kulik
& Mahler, 1989; Wineeld, e.a., 1992).
Literature
Caplan, G. (1974) Support systems and commu-
nity mental health: lectures on concept develop-
ment. New York: Behavioral Publications.
Durkheim, E. (1951) Suicide: a study in sociol-
ogy. New York: The Free Press.
Eriksen, W. (1994) The role of social support in
the pathogenesis of coronary heart disease: a
literature review. Journal of Family Practice 11:
201-209.
Kendall, K.S. & M.B. Kenkel (1989) Social ex-
change in the natural helping interaction. Journal
of Rural Community Psychology, 10 (2): 25-45.
Kulik, J.A. & H.I.M. Mahler (1989) Social support
and recovery from surgery. Health Psychology 8:
221-238.
Piat, M., S. Wohl & D. DuRuisseau (2006) The
use of volunteers to promote community integra-
tion for persons with serious mental illness. Inter-
national Journal of Psychosocial Rehabilitation.
10 (2): 49-57.
Schachter, S. (1959) The psychology of af-
liation: experimental studies of the sources of
gregariousness. Stanford: Stanford University
Press.
Vaux, A. (1988) Social support: theory, research
and intervention. New York: Preager Publishers.
Walter, U.M. & C.G. Petr (2006) Lessons from
research on paraprofessionals for attendant care
in children’s mental health. Community mental
health journal. 42 (5): 459-75.
Weiss, R.S.(1973) Loneliness: The experience of
emotional and social isolation. Cambridge: MIT
Press.
Wineeld, H.R., A.H. Wineeld & M. Tiggemann
(1992) Social support and psychological well-
being in younger adults. The multi-dimensional
support scale. Journal of Personality Assess-
ment, 58(1):198-210.
3.4 Useful daily occupation
and work
On care farms, participants work together on day-
to-day activities, each according to his or her own
capacities. Having a useful day occupation or
work has a positive inuence on the physical as
well as psychological well-being of people (Bar-
tley, 1994; Cable, e.a., 2008). In their studies,
Van Weeghel (1995) and Boardman (2003) men-
tion that work gives people a structure, an iden-
tity and an opportunity to develop themselves. It
broadens their horizons, provides social contacts
and gives them the feeling of belonging. Work is
forcing people to be active, offering them the op-
portunity to become physically tired. In general
this leads to better physical health.
Bohart, A.C.(2000) The client is the most impor-
tant common factor: Clients´self-healing capaci-
ties and psychotherapy. Journal of Psychothera-
py Integration 10: 127-149.
Ketelaars, D., E. Baars & H. Kroon ( 2001)
Werkend herstellen: een onderzoek naar thera-
peutische (leef)werkgemeenschappen voor
mensen met psychiatrische problematiek Dront-
en: Stichting Omslag en Trimbos-instituut.
Lambert,M.J.(1992) Implications of outcome re-
search for psychotherapy integration. In: J.C.
Norcross and M.R. Goldstein (eds.). Handbook
of psychotherapy integration. New York: Basic
Books.
Leyssen, M.(2009) Tijd voor de ziel. Tielt: Lannoo
uitgeverij.
Verhaege, P.( 2010) Het einde van de psycho-
therapie. Amsterdam: De Bezige Bij.
3.3 The farm as a social
community
Working on a farm ensures that participants are
part of a social community consisting of other
participants, the farmer and his / her spouse
and other care providers. The farm itself is again
part of a larger community. Social relationships
are essential for human beings. Sociologist
Durkheim (1951) argues that people receive a
certain role when they belong to a community
and maintain connections with others. This role
(or roles) denes their identity and the extent to
which they feel socially integrated. In addition to
physical protection, relationships provide emo-
tional protection (Schachter, 1959).
3.2 Care farmer – client
relationship
The relationship between the care provider and
the client is an important theme in the research
related to the treatment and care of people.
Bachelor and Horvath (1999) refer to empathy,
understanding, engagement, warmth and friend-
ship as being the most dening factors for both
successful treatment and client satisfaction. Pro-
fessor of psychotherapy Leyssen (2007) agrees
with this. According to Leyssen, sincere interest,
empathy and authenticity are of great importance
in the contact between the care provider and the
client. Research into the effectiveness of client
treatment, shows that a therapeutic relationship
and the extent to which the patient takes an ac-
tive part in the treatment, largely determines
whether treatment has a positive result (Verhae-
ghe, 2010). A review of several studies reveals
that 30% of the effect of treatment is brought
about by the relationship between the treatment
provider and the client (Ketelaars e.a., 2001; Bo-
hart, 2000; Lambart, 1992).
In addition, it appears that the relationship be-
tween the participant and the care farmer is im-
portant. In interviews, participants mention that
they, in fact, value the role of the farmer as a non-
care professional. So far, little research has been
done on the role of non-care professionals in pro-
viding guidance to clients. Research does con-
rm that people with chronic psychiatric problems
value volunteers for being good listeners, and for
being reliable, friendly, respectful and supportive.
Clients do not have preconceived negative views
about non-professionals and are, therefore, more
eager to cooperate with them. (Kendall, 1989;
Piat e.a., 2006; Walter & Petr, 2006).
Literature
Bachelor, A. & A. Horvath (1999) The therapeu-
tic relationship. In: A. Hubble, B.L. Ducan & S.D.
Miller (eds), The heart and the soul of change.
What works in therapy. American Psychological
Association, Washington.
44 45
attention span and concentration. If people have
a view of nature from their homes or if they have
plants in their ofces, it improves their cognitive
functioning (Van den Berg, 2003). Studies by
Kuo and Sullivan (2001) provide a similar picture.
They undertook research in a low-income suburb
of Chicago with identical apartment blocks. Their
study revealed that having a view with more
greenery improved the concentration of residents
which in turn led to less aggression among them.
Quicker recovery
Several researchers have studied the effects of
watching nature videos and concluded that it
leads to a lower heart rate, lower blood pressure
and less facial tension (Laumann, 2003). Hartig
(2003) studied the body responses of people
when they were walking. This study showed that
people’s bodies are restored when they walked in
an area with natural amenities; whilst when walk-
ing in an urban area, their blood pressure rose.
Healthier through exercise
Contact with nature can positively inuence the
health of people because it stimulates them to be
physically active (Dutch Health Advisory Board,
2004). Currently, there aren’t sufcient studies
that focus on the connection between the physi-
cal environment and exercise. However, there
are studies that focus on the environmental fac-
tors that stimulate exercise (Sallis, e.a., 1998).
These studies, in general, reveal that a natural
environment is more valued than an urban envi-
ronment. Thus, the Health Advisory Board states
that a natural environment is more inviting for ex-
ercise and therefore stimulates longer periods of
exercise. The research undertaken by De Vries
(2002), however, indicates that there is no hard
evidence to support this notion. .
Literature
Gezondheidsraad en Raad voor Ruimtelijke,
Milieu- en Natuuronderzoek (2004) Natuur en
gezondheid. Invloed van natuur op sociaal, psy-
chisch en lichamelijk welbevinden. Den Haag:
Gezondheidsraad en RMNO.
Hartig, T., G.W. Evans, L.D. Jamner (2003)
Tracking restoration in natural and urban eld
settings. Journal of Environmental Psychology,
23:109-123.
Hartig, T. M. Mang & G.W. Evans (1991) Restor-
ative effects of natural environment experiences.
Environment and Behaviour, 23: 3-27.
Kuo, F.E., & Sullivan, W.C. (2001) Aggression
and violence in the inner city: Impacts of environ-
ment via mental fatigue. Environment & Behav-
ior, 33(4), Special Issue on Restorative Environ-
ments, 543-571
Laumann, K., T. Garling & K.M. Stormark (2003)
Selective attention and heart rate responses to
natural and urban environments. Journal of Envi-
ronmental Psychology, 23: 125-134.
Sallis, J.F. A. Bauman & M. Pratt (1990) Determi-
nants of exercise behavior. Exercise and Sport
Sciences Reviews. 18: 307-330.
Ulrich, R.S., R.F. Simons, B.D. Losito, E. Fiorito,
M.A. Miles & M. Zelson (1991) Stress recovery
during exposure to natural and urban environ-
ments. Journal of Environmental Psychology, 11:
201-203.
De Vries, S., R.A. Verheij, P.P. Groenewegen &
P. Spreeuwenberg (2003) Natural environments,
healthy environments? An exploratory analysis
of the relationship between green space and
health. Environment and Planning, 35:1717-31.
Van den Berg, A.E., Koole, S.L. and Van der
Wulp, N.Y. (2003) Environmental preference and
restoration: (How) are they related? Journal of
Environmental Psychology 23(2) 135-146
Of course, not every work situation has such a
positive outcome. People generally judge their
work as being positive if it is useful and if it has
sufcient variation. Kielhofner (2002) notes that
people have an inbuilt desire to be usefully oc-
cupied. Useful and meaningful activities provide
structure and rhythm in life. In addition, such ac-
tivities stimulate and improve the development of
physical and social skills, giving people the feel-
ing of being competent and knowledgeable.
Christiansen et al (2005) have developed a mod-
el that shows people’s identity and sense of use-
fulness is derived from their daily activities. This
‘person-environment-occupation-performance’
(PEOP)-model comprises of four elements:
• Person: the intrinsic factors of the person
• Environment: the factors of the surroundings
• Occupation: what a person likes to do
• Performance: the manner in which a person
performs this
By building up meaningful and successful experi-
ences, one can become more self assured and
develop a feeling of independence and being
knowledgeable. These characteristics are neces-
sary to deal with other challenges (Christiansen
et al, 2005).
Literature
Bartley, M. (1994) Unemployment and ill health:
understanding the relationship. Journal of Epide-
miology and Community Health, 48: 333-337.
Boardman, J. (2003) Work, employment and
psychiatric disability. Advances in psychiatric
treatment, 9: 327-334.
Cable, N., A. Sacker & M. Bartley (2008) The
effect of employment on psychological health
in mid-adulthood: ndings from the 1970 British
Cohort Study. Journal of Epidemiology and Com-
munity Health, 62.
Christiansen, C.H., C. M. Baum & J. Bass-Hau-
gen (eds.) (2005) Occupational Therapy: Perfor-
mance, Participation and Well-being, 3rd edition.
Thorofare NJ: SLACK Incorporated.
Kielhofner, G. (2002) Model of Human Occupa-
tion. 3rd edition. Baltimore: Lippincott Williams &
Wilkins.
Weeghel, van J. (1995) Herstelwerkzaamheden.
Arbeidsrehabilitatie van psychiatrische patiënt-
en. Utrecht: SWP.
3.5 Green natural
surroundings
One of the most fundamental characteristics of
care on a farm is that people are ‘brought into
contact with nature again’. The Dutch Health
Advisory Board concluded in 2004 that people’s
contact with nature is decreasing. At the same
time, and perhaps not coincidentally, more and
more studies are pointing out that contact with
nature can lead to improved health and well-be-
ing. Here we state some of the key effects that
nature or green spaces have on people, as men-
tioned in diverse studies regarding the subject.
Below, we summarise three theories that may
explain the mechanisms causing these effects.
Results of research into nature and
human health
A better mood
Multiple studies provide strong indications that
looking at pictures of nature as well as taking
walks in nature improves people’s mood. Feel-
ings of fear and anger are reduced while posi-
tive feelings are enhanced (Hartig, 2003; Ulrich,
1991; Hartig, 1991). The restorative effects hap-
pen both in natural spaces as well as in urban
areas (such as parks and water-rich environ-
ments) and in natural forests.
Improved concentration
Studies indicate that having contact with nature
has a signicantly positive effect on people’s
46
Literature
Lewis, C.A. (1996) Green Nature, Human Na-
ture: The meaning of plants in our lives. United
States: University of Illinois
Wilson, E.O. (1984) Biophilia: The human bond
with other species. Cambridge: Harvard Univer-
sity Press.
Explanatory theories
How can the positive inuence of contact with
nature on health be explained? Researchers are
of the opinion that being in nature helps people
to recover from stress in particular (Dutch Health
Advisory Board, 2004). The most important theo-
ries on how stress is released come from the At-
tention Restoration Theory (ART) of Kaplan and
Kaplan (1989), the psycho-evolutionary model of
Ulrich (1984) and the Biophilia theory (Wilson,
1984). These theories assume an evolutionary,
innate basis for restorative effects of nature.
1. Attention restoration theory: nature re-
stores overload of the mind
According to Kaplan and Kaplan (1989) people
in nature are restored from attention exhaustion.
Attention exhaustion is caused by doing cogni-
tive tasks that require long periods of focused
attention and active suppression of irrelevant
information. Holding one’s attention focused on
something for a long period of time can lead to
overload. This reduces performance and creates
irritation.
According to Kaplan and Kaplan, contact with a
natural environment contributes in two ways to
the restoration of attention fatigue. Firstly, nature
provides an opportunity to take distance from
routine tasks and thoughts (‘being away’). Sec-
ondly, nature catches one’s attention automati-
cally without having to think about it (‘soft fas-
cination’). Therefore, being in or being actively
engaged in nature has a restorative effect on a
human being.
Literature
Kaplan, S. (1995) The restorative benets of na-
ture: towards an integrative framework. Journal
of Environmental Psychology. 15:169-182.
2. Nature brings about faster restoration
The researcher Roger Ulrich (1991) bases his
studies on a biological / evolutionary principle.
He states that human evolution took place in a
natural environment. Those who reacted posi-
tively to the natural and recovered more easily
from stress were at an advantage from an evolu-
tionary perspective. He came to this hypothesis
after his famous hospital experiment in which
patients who looked out at greenery recovered
faster than those who looked at a wall. In another
study he discovered that the heart rate of people
who watched a stressful thriller recovered faster
if they watched a nature video thereafter rather
than a video with images of trafc (Ulrich, 1983).
Literature
Ulrich, R.S., R.F. Simons, B.D. Losito, E. Fiorito,
M.A. Miles & M. Zelson (1991) Stress recovery
during exposure to natural and urban environ-
ments. Journal of Environmental Psychology, 11:
201-230.1.
Ulrich, R.S. (1983) Aesthetic and affective re-
sponse to natural environment. In: I. Altman &
J.F. Wohlwill (Eds.) Human Behavior and Envi-
ronment. New York: Plenum.
3. The Biophilia theory: the desire for na-
ture is innate
The English researcher Edward Wilson (1984)
developed the Biophilia hypothesis. This states
that people have an innate desire for nature.
They are naturally attracted to other living be-
ings. Wilson concludes from his research that
this innate attraction is dened biologically. This
originates from the evolutionary process humans
have undergone.
The researcher Charles Lewis has developed
these ideas. He suggests that humans have
grown out of an originally natural environment.
Today, people live primarily in densely populated
cities and their contact with nature has become
scarce. Lewis argues that the environment has
changed at a faster rate than the evolution of
humans. According to Lewis, the lack of contact
with nature can lead to different problems such
as obesity and behavioural disorders.
47
48
Client satisfaction system
In the spring of 2011, the Federation of Care Farmers in the Netherlands, as part
of the obligatory quality system for the sector, developed a client satisfaction sys-
tem. This system will provide new on-going data in the future about, among other
things, the satisfaction experienced by participants on care farms and about the
rate at which participants’ self-reliance grows.
Several small-scale pilot studies of this satisfaction system have been undertaken
among the client groups of older people, children/young people and people with
psychiatric complaints. These studies conrm some of the qualities of care farms,
also mentioned in other studies, such as providing people the opportunity to be
out in the open and the contact with plants and animals. The pilot studies also
show that learning new skills, doing things together, and having social contacts
are some of the important aspects that care farms offer their participants.
Literature
Hassink, J., H. van Haaster & F. Bergsma (2011) Verslag proef toetsing bij Landzi-
jde en 4 zorgboerderijen voor ouderen en jongeren in het kader van een pilot voor
ontwikkeling van vragenlijsten. IGBP, Solidair Consultancy en Wageningen UR.
Different mechanisms that play a simultaneous role
The effect that contact with nature has on people is the result of different mechanisms
that operate alongside each other. A good example is making contact with animals.
Many people nd it pleasant to pet animals, to take care of them and to be in their com-
pany. Having animals often leads to other social contacts. The tasks of caring that come
with having pets can lead to an improved self-condence for the person providing this
care. Caring for animals teaches people to care for others. It gives the person a task of
caring that places him/her in a different role: caring for another instead of being cared
for him/herself. Thus, contact with animals can, in various ways, lead to an improved
quality of life.
Literature
Janssen, M. & F. Bakker (2007) Huisdieren in de psychiatrie: een enquête onder GGZ-
instellingen. Amsterdam: AdSearch.
Greenery in the living environment and health
A study into the relationship between the quantity of greenery in the living environment
and the health of residents shows that the quantity of greenery in the living environment
has a relationship to how residents experience their health. People who live in an envi-
ronment with more greenery feel healthier (Maas, 2009). This conclusion is in line with
a study of De Vries et al (2003), indicating that people who have more green in their
living environment experience less health-related complaints and better mental health.
They note this positive effect on the population in general, and particularly among older
people, housewives and people from low socio-economic groups. The researchers sug-
gest that this comes from the fact that these groups of people spend most of their time
in their living environment. The study by Maas also shows that people with more green-
ery in their living environment feel less lonely and are less prone to feel a lack of social
support. This applies specically to those people with a low socio-economic status. An
earlier study by Vreke et al (2006) also shows a relationship between greenery in the
living environment and prevention of obesity among children.
Literature
J. Maas (2009) Vitamin G: Green environment, healthy environment. Utrecht: Nivel.
De Vries, S., J. Maas & H. Kramer (2009) Effecten van nabije natuur op gezondheid en
welzijn. Wageningen: Alterra.
Vreke, J., J.L. Donders, F. Langers, I.E. Salverda & F.R. Veeneklaas (2006) Potenties van
groen! De invloed van groen in en om de stad op overgewicht bij kinderen en op het bin-
den van huishoudens met midden- en hoge inkomens aan de stad. Wageningen: Alterra.
49
50 51
Sequel
The information in this publication invites all
those engaged in the care sector – care provid-
ers, health insurers, care referral providers, cli-
ents and researchers - to critically reect on their
own professional practice. With the results in
hand, they can look at what care on a farm can
mean in the total spectrum of care and well-be-
ing. It provides a basis for further joint research
to investigate how care farming can be improved
and where there are new chances for cross pol-
lination between farming and care.
The results help entrepreneurs in care farming to
reect on their work and continue to add value to
their services, without losing sight of the unique
aspects offered by a care farm.
Care farmers can focus on their specic qualities,
the client groups they serve and how they can
set up work and care for these client groups in an
optimal way. It may be interesting to see whether
better nutrition and uid balance of older people
on care farms can also be obtained for clients in
need of addiction care, a group that gladly come
to care farms for recovery and reintegration.
A care farm provides communi-
ty integration in a natural way,
with emphasis on participants’
own strenght, an individual
approach and a consideration
of the relationships involved.
What does living and working on a farm pro-
vide participants with, in terms of recovery and
improvement of their quality of life? In the end,
this is what matters and an independent look at
whether the approach and methods t in with the
professionalization process, is taking place in the
care farming sector.
This publication has described different scientic
qualitative and quantitative studies that discuss
the effects of the care being offered. It is not easy
to draw denitive conclusions as the studies are
still limited in size and comprise of a great diver-
sity of client groups and types of care farms.
Naturally present
The studies show signicantly positive results,
such as better nutrition and uid balance of older
people with dementia on care farms, in compari-
son to regular care facilities; or the decrease of
problematic behaviour and the increase of self
esteem among young people who follow a path
on a farm through the youth welfare institution
Topaze.
4. Conclusion
Research data collected from different client
groups give a strong indication that care farms
have specic qualities that many participants can
benet from. These include the relationship be-
tween the farmer (male or female) and the client,
being part of a social community and engaging in
useful activities in a green environment. The fact
that the farm provides an informal, non-care con-
text is also experienced very positively by most
participants. They value this way of taking part in
‘normal life’.
With these key qualities, care farms provide a
concrete approach to care giving that is current-
ly in vogue: socialisation of care (participation),
community care, and empowerment (strengthen-
ing of self reliance). A care farm provides com-
munity integration in a natural way, with empha-
sis on participants’ own strength, an individual
approach and a consideration of the relation-
ships involved.
It speaks to the imagination of many people: the farm as
a small-scale location to receive care, where participants
work in the open air with plants and animals in a natural
rhythm where they can ‘bloom’. It is also important to look
at the evidence base underpinning the effects of care on
farms and to use the information to develop further (the
quality of) the care being offered.
52 53
“My feeling of self-esteem and
self-condence has grown
enormously. Here, I have the
opportunity to bring things to a
successful end”
Participant of care farm ‘De Noorderhoeve’
Health insurers and the Ministry of Health can
assess whether forms of care farming provide
a good supplement to the approach of care in
which increasing participation in society and/or
ow from care into employment and education
is paramount. It could also be assessed whether
care offered on farms is appropriate for more cli-
ent groups.
Client groups can use the ndings to assess
whether they receive the care they are looking
for and how they can help to further develop ad-
equate forms of care that care farms offer.
Finally, the collection of effect studies in this pub-
lication exposes the gaps in knowledge, which
can be addressed through further research. A
resource of new research data will be the client
satisfaction system to be operationalised shortly
by the Federation of Care Farmers in the Nether-
lands. This system will ensure continuous meas-
urement of the satisfaction of customers regard-
ing care on individual care farms.
54 55
56
Colophon
This publication was originally published by the Taskforce Multifunctional Agriculture in co-operation
with Plant Research International, Wageningen UR, Trimbos Institute and Praktikon/Radboud University
(2011)
Author
Marjolein Elings, Plant Research International, Wageningen UR (marjolein.elings@wur.nl)
Editor
Miranda Kofjberg, Communication Consultancy, De Lynx
Lay out
Annemarie Wijmenga, Communication Consultancy, De Lynx
English translation
ETC Advisory Group
English language editing
Dorine Ruter, ETC Advisory Group, with support of Farming for Health members:
• Deirdre O Connor, School of Agriculture and Food Science, University College Dublin, Ireland
• Rachel Hine, School of Biological Sciences, University of Essex, UK
• Joe Sempik, Independent Research Consultant & Special Lecturer, University of Nottingham, UK
Photographs
Marjolein Elings: 2 (L+R), 3 (L), 9, 21, 39, 47, 51, 55
Taskforce Multifunctional Agriculture: 4/5, 30, 32, 49, 53
Inge Hondebrink: 7, 36/37, 41
Yvon Schuler/ Orgyd procesadvies: 3 (R), 11, 15, 23, 29, 33
Wageningen UR, Communication Services: 17, 54 (L+R)
Cees van Stiphout: 25, 55 (L)
Printing
Plant Research International, Wageningen UR, The Netherlands
Download
This publication can be downloaded from
• www.pri.wur.nl
• www.etc-adviesgroepnederland.org
• www.farmingforhealth.org
April 2012
Europees Landbouwfonds voor
Plattelandsontwikkeling: Europa
investeert in zijn platteland.
EFFECTS OF CARE FARMS - Scientic research on the benets of care farms for clients
Over the last years, the number of care farms has grown rapidly
in Europe and beyond. Research was implemented to study how
for example young people with behavioural problems or older
people with dementia benet from their stay on a care farm. And
what are the effects of working or living on a care farm?
Research shows that care farms give people with disabilities a
more active role in their daily live and create a living and working
situation which empowers people and gives them the ability to
participate in society. This report presents relevant facts and g-
ures on the effects and added value of care farms. The report was
originally written for a Dutch audience, but has been translated
into English to meet the growing interest in this topic worldwide.
Author:
Marjolein Elings, Plant Research International, Wageningen UR
