Toward a proposal for a national strategy for access to outdoor stays in residential care facilities for older adults in Sweden

Background: Research consistently demonstrates that access to nature plays a significant role in supporting health and wellbeing, particularly among older adults and individuals experiencing illness. Research reviews show that treatment interventions in outdoor environments have positive effects on older adults' health, quality of life, and physical capacity, that socialization and cognitive ability are promoted, and that stress and depression can be reduced. Despite this knowledge, there is currently no national strategy for access to outdoor environments and outdoor stays at residential care facilities for older adults in Sweden. Purpose: The purpose of this paper is to propose a national strategy, along with ideas for implementation, developed through a collaborative workshop process. Methods: The study comprised three collaborative digital workshops, i.e., participants worked with the researchers leading the process. The participants were purposefully sampled and included researchers and representatives from relevant authorities and organizations, as well as stakeholders, practitioners, and key players in residential care facilities for older adults. Five researchers oversaw the iterative process, which lasted for one and a half years. Workshop 1 established a shared foundation and generated initial inputs, which informed the development of a draft proposal. This draft was refined through feedback and discussions in Workshop 2 and further elaborated in Workshop 3 with a focus on implementation strategies. Thus, the research team synthesized the outcomes from all workshops through an iterative process, resulting in the final version of the national strategy proposal. Results: The results present visions and proposals structured around four policy areas: 1. Outdoor stays; 2. Outdoor care and rehabilitation; 3. The outdoor environment; 4. Knowledge transfer. The results contain detailed descriptions for each of the policy areas, as well as proposals for how to realize the policy areas in a Swedish context. Discussion: We do not know of any country that has developed a similar national strategy, and therefore, in the final part of this paper, we discuss the generalizability of the strategy, as well as how it relates to person-centered care.