Safe Access to Outdoor Space in Dementia Care: Gardens, Thresholds and Wandering Without Locking Doors
Outdoor space can be one of the most effective non-clinical interventions in dementia care. Fresh air, daylight, movement and meaningful activity support sleep, appetite, mood and reduced agitation. But outdoor access also introduces risks: falls, absconding, weather exposure and safeguarding vulnerabilities. High-performing services design thresholds and outdoor routes to support freedom safely, without defaulting to locked doors. This sits within environment, design and dementia-friendly settings and should reflect dementia service models that prioritise prevention, independence and least restrictive practice.
Why outdoor access is a quality issue, not a “nice-to-have”
In operational terms, outdoor access affects day-to-day stability. People who can move, regulate and engage are less likely to escalate, refuse care or require constant redirection. However, many services restrict outdoor access because the environment is not designed for safe use or because supervision expectations are unclear.
The goal is not “zero risk”. The goal is defensible, proportionate risk management with clear evidence of positive risk-taking, safeguards and review mechanisms.
Designing safe thresholds: where incidents often start
“Thresholds” (doors, steps, surfaces, changes in light, mats, and handles) are common points of confusion and falls. Dementia can reduce depth perception and the ability to judge transitions. Strong practice includes:
- Level access where possible, with non-slip surfaces and clear edging
- Consistent lighting and reduced glare between indoor and outdoor areas
- Simple, visible door furniture and intuitive exit cues
- Clear visual contrast between walkway and planting areas
Where full level access is not possible, services should show how risk is mitigated through adaptations and staff support, not blanket restriction.
Operational example 1: reducing falls at the patio doorway
Context: A service recorded repeated low-level falls near the main patio door, often mid-morning when residents moved outside.
Support approach: Environmental review found a dark indoor area leading to bright sunlight outdoors, plus a raised door threshold and a patterned mat that looked like a step.
Day-to-day delivery detail: The provider replaced the mat, improved transitional lighting, added a contrasting edge strip and adjusted the door threshold where feasible. Staff supported “guided first step” at peak times and updated mobility risk assessments to include threshold-specific risk.
How effectiveness is evidenced: Falls mapping showed a reduction in incidents at that location. The provider recorded the change in the maintenance log, falls governance minutes and the quarterly quality report shared with commissioners.
Creating “safe wandering” loops outdoors
People may walk because they are bored, anxious, in pain, seeking the toilet, or trying to “go home”. Outdoors, unmanaged wandering can become unsafe if routes lead to hazards or exits. Many services reduce risk by locking doors, but this can increase distress and can become restrictive practice unless justified and regularly reviewed.
Designing safe outdoor loops is often the least restrictive option. This includes continuous paths, clear wayfinding cues, seating points, shaded areas and visual anchors that reduce anxiety.
Operational example 2: supporting purposeful walking without absconding risk
Context: A resident repeatedly attempted to leave the building, becoming distressed when redirected. Staff were considering locking internal doors and increasing observation.
Support approach: The service analysed the pattern and found the resident walked after phone calls with family and during late afternoons.
Day-to-day delivery detail: The provider created a secure outdoor walking loop with clear boundaries, a consistent route and “destination points” (bench by flowers, bird feeder, small shed area for familiar tasks). Staff introduced a routine: “walk-and-talk” after calls, and a late afternoon outdoor period before dinner to reduce agitation.
How effectiveness is evidenced: Incident logs showed reduced attempts to exit the setting. The restrictive practice register recorded that environmental access reduced the perceived need for door locking, with monthly review documented.
Outdoor space as meaningful activity, not just access
Outdoor access works best when linked to purpose: gardening, sweeping, watering, bird feeding, walking groups, or quiet sitting with sensory items. These activities reduce distress when they match the person’s history and preferences.
Services should avoid “token gardens” that are inaccessible, poorly maintained or only used during planned activities. If the space exists, it should be operationally usable every day.
Operational example 3: managing weather, hydration and dignity outdoors
Context: A service noticed that during warmer months, residents spent more time outside but some returned dehydrated or sunburnt. Staff became risk-averse and restricted access.
Support approach: The provider treated this as a systems issue: outdoor access was valuable but required safeguards.
Day-to-day delivery detail: The service introduced shaded seating, accessible water points, sun hats available at exits and a simple “outdoor check” routine: hydration prompt, sunscreen support where appropriate, and planned re-check times. Care plans included personal preferences and consent for support. Staff rotas incorporated outdoor presence during peak times without turning it into constant surveillance.
How effectiveness is evidenced: The provider recorded reductions in heat-related incidents and increased outdoor engagement. Evidence was triangulated through care notes, incident reporting and family feedback.
Commissioner expectation: balanced risk enablement and placement stability
Commissioner expectation: Commissioners expect providers to evidence that outdoor access is managed safely and supports outcomes—reduced distress, improved sleep, reduced incidents and stable placements. They also expect clear escalation pathways when risk changes (e.g., increased falls risk, heightened absconding risk, safeguarding concerns).
Regulator / inspector expectation: least restrictive practice and safe systems
Regulator / inspector expectation (CQC): Inspectors expect providers to avoid blanket restrictions, demonstrate positive risk-taking and show that environmental decisions are reviewed and governed. If doors are locked or access is limited, the provider should evidence why, how this is the least restrictive option, and how it is reviewed with the person and (where appropriate) family/advocates.
Governance and assurance: making outdoor access defensible
Strong governance typically includes:
- Outdoor risk assessments integrated into individual care plans (not generic)
- Environmental checks (path condition, lighting, seating, hazards) logged and actioned
- Incident review looks for environmental learning (not just “staff to monitor”)
- Restrictive practice register documents alternatives and review outcomes
- Seasonal planning (heat, ice, storms) linked to contingency arrangements
When outdoor access is designed, delivered and reviewed well, it becomes a practical demonstration of person-centred care, human rights and safe, effective risk management—exactly the kind of evidence commissioners and inspectors look for.