Why is it that residential health care facilities are often perceived as sterile, stagnant institutions consisting of little more than long, tile hallways and a bingo room? Visions of wheelchairs lining a concrete slab in front of an austere medical building come to mind, with nary a thought given to landscape design, save for a weekly grass cutting. Sadly, such necessary facilities are often avoided, left only for the forgotten and those who can no longer fend for themselves.

Landscape Architects perhaps have no greater opportunity to enhance the well-being of the general public than in the realm of health care facilities. As a source of peace, distraction or conversion, the landscape of these confining environments directly impacts the lives of their residents by providing a changing element of nature to experience and encounter. As our population ages, such facilities must gain acceptance and respect-- for they indeed may serve as a necessity for many of us in the future.

An ongoing project by New Berlin-based Plant Associates Inc., a landscape architectural design/build firm headed by Karol M. Kulas, ASLA, and Gregory D. Long, ASLA, The Sunrise Care Center in Milwaukee, Wisconsin is a non-profit, residential health care facility which uniquely responds to the needs of the elderly and the physically challenged, and provides special considerations for the visually impaired. This project is an important opportunity for the residential health care industry to understand the quality of landscape environment that is achievable for their residents.

Plant Associates Inc. has been involved from the early stages of the facility's design development, working with the facility administrator, Mike Kern, and the architectural team of Aldrian Guszkowski to implement a plan that provides Sunrise residents with an optimal living environment. Having also supplied landscape construction services, the firm continues an ongoing relationship with the center-- which opened for its first residents on February 15, 1994-- in order to enhance it as funds become available. An inherent concern for the accessibility and participation of the visually impaired in this landscape serves as a unique example of the possibilities that are attainable for residents with varying degrees of mobility.

Security, dignity and a sense of independence are all integral parts of a successful landscape development that encourages residents to feel satisfied, proud, and "at home" in their surroundings. By envisioning themselves as living in the facility, Kulas and Long took special care to accommodate the needs of future Sunrise residents, and so created a comfortable, residential atmosphere for the complex.

This project focuses on a series of outdoor spaces that enables resident interaction, outdoor recreation (including barbecues and group activities), and conversation with visitors. An entrance walk provides provides residents with access to and mobility around the garden, while the main patio area constitutes a showcase of details that enhance the outdoor experience of the visually impaired. In conjunction with a "Way Finding" art program on the interior of the building, visual cues and navigational guides integrated into the landscape design-- the placement of plant materials, a circulation path through the patio, and the outdoor furniture arrangement-- aid residents with direction and circulation. Spatial organization grants residents outdoor independence within easy view of the nurses' stations for safety and security.

The entrance garden allows residents to meet visitors and guests "at the front door" of the facility for an increased sense of independence. An entry walk greets visitors with a vibrant array of colors. Multi-stem Serviceberries (Amelanchier canadensis) bloom both delicate white flowers in spring and strong, golden-orange colored interest in autumn. These plantings create a smaller, private space for individual family conferences just down the path from the main entrance of the facility.

Surrounded by sweeping lawns, the main patio was designed to allow the greatest diversity of people to move unguided and unhindered throughout the exterior space. Interspersed throughout trees, shrubs, flowering annuals and perennials are seating areas that allow for close contact with plant materials and resident interaction with views of the entire patio. Composed of an eight-foot grid of brushed concrete, the checkerboard-patterned patio integrates with a gently meandering, exposed aggregate pathway to enable easy circulation and add colorful contrast visible from the rooms above. A brushed finish not only reduces the glare off the patio, but also provides less slick of a surface for an unsteady foot; the surface of the path also serves as an important textural distinction from path to patio, easily noticed by the visually impaired who tend to slightly shuffle their feet when walking. The two different surfaces deliberately sound and feel different-- which allows for easier navigation when using a cane-- in order to create an unintimidating social space that encourages Sunrise resident interaction in the outdoor garden environment.

Another significant feature-- a Stone Wall block retaining wall system at the rear of the building along a service drive-- holds the grade along the wall of the building while creating a raised planter visible from the second floor therapy room. This wall complements the color and material of the building, and in fact saved the client the higher costs of a previously proposed poured concrete wall-- a key factor when working with a non-profit institution. This solution proposed by the Landscape Architects transformed a grading problem into an asset for the facility that enhances the experience of residents and visitors alike.

As the design had to work within the context of a residential area, the parking areas were carefully hidden from both the street and adjoining properties by a plant and fence combination to meet parking lot zoning ordinances. A short fence beyond the patio garden serves to prevent curious neighborhood children from being caught underfoot while doubling as a subtle guide for residents with Alzheimer's disease. And the primarily residential location of the facility does offer the advantage of less noise than a busy commercial area. While the luxuries of a larger site near a hospital complex are sometimes more convenient for health care facilities, a residential neighborhood adds dignity and a stronger sense of being at home for residents.

Plant Associates Inc.'s position as a design/build firm has allowed the Landscape Architects to remain in contact with Sunrise administration and residents on a regular basis. It is this relationship that has proved so rewarding for Karol Kulas, who deems it "most humbling to work with people who may not have all that you have. To be able to do something for someone that is so appreciated... this is the 'blood and guts' of Landscape Architecture." Thoughtful use of design techniques and materials has created a distinct solution that is friendly to residents and their visitors by providing convenient access for various levels of mobility. As a vital link in today's health care industry, residential health care facilities should be regarded as exactly that: residences. It is only by delegating such care in design that success is achievable-- through contribution to the health, safety and well-being of residents in health care facilities.

Sidebar: A Sensational Plant Palette

Recently completed, the garden area at the edge of the patio is a thoughtfully crafted arrangement of color and texture. When viewed from above, the patio invites residents down to interact with the plants and each other. The garden provides more than a visual experience of color, as it comes alive to set a seasonal scene for activities, gatherings, and conversation. The tall, erect form of Karl Foerster Feather Reed Grass (Calamagros acutiflora 'Karl Foerster') creates a focal point that sways in the breeze, while the white flowers of Professor van der Wielen Astilbe (Astilbe thungergii 'Prof. van der Wielen') contrast against the evergreen mass of the Hetz Midget Arborvitae (Thuja occidentalis 'Hetz Midget'). Dried seedpods of Purple Coneflower (Echinacea purpurea) and swaying grass stems create a unique winter character when arching above a blanket of freshly fallen snow. Dormant plant materials remain throughout the Wisconsin winter, creating new and varied forms to be enjoyed throughout the season. Greenspire linden trees (Tilia cordata 'Greenspire') lend a striking reddish brown bark during winter months.

In addition to creating a visual feast of color, the landscape appeals to the other senses as well. A variety of textures and forms are within reach, allowing residents to encounter the plant materials and feel their differences. Bee Balm (Menarda), a native prairie plant, provides bright red flowers during the summer, sharing a minty fragrance with those nearby. Japanese tree lilacs (Syringa reticulata) just beyond the fence offer striking colorful flowers in late June. The fragrances of a flowering perennial, the feel of the summer sun, and the sound of breezes through the tree branches all take on a deeper significance for residents who otherwise cannot experience the visual elements in a garden setting. The simplest stimulation of the senses can trigger a memory or thought, reminding residents of previous experiences and familiar places.

Slide Cutlines:

1. The site plan for the Sunrise Care Center includes a front entrance garden and courtyard, parking lot screening, a significant retaining wall, main patio and adjacent garden. Although there are varied aspects of the site, each section considers the residents of this specialized residential health care facility.

2, 24. This early photo of the patio before the recent addition of the adjacent garden and fence illustrates the essence of the Sunrise Care Center philosophy: to provide individual residential health care within an environment that blends with its surroundings.

3, 22. Brightly colored annuals greet visitors at the main entrance to the complex.

4. Multi-stemmed service berries provide year-round interest with masses of white flowers in the spring and golden-orange hues in the autumn along the building entrance from the parking lot. Perennials and annuals complete the plant palette.

5, 23. The entry courtyard between two wings of the building craved a sense of life. Before the plantings were established, a cold, concrete corridor welcomed residents.

6. The planting scheme softens the harshness of the concrete block structure while creating a separate space beyond the primary building entrance. The interior courtyard serves as a private gathering area for family members.

7. The entry walk is frequently used as an area for residents to greet visitors at the "front door" of the facility. The courtyard area feels secluded and separate from the parking lot and main entrance, giving residents and families a sense of privacy.

8. The design had to adhere to strict screening ordinances imposed by the city of Milwaukee for construction in a residential neighborhood. This combination of plants and fencing allows for an attractive composition that screens the parking lot when viewed from on and off site.

9. The plantings along the north side of the parking lot not only buffer the area from the residences, but also greet visitors with an array of blooms throughout the summer. These screening elements help the facility to blend with the neighborhood and provide a residential-like atmosphere for the residents.

10. The northeast end of the building presented a severe change in grade along the service drive.

11. The block retaining wall not only saved the client the high costs of a proposed poured concrete wall, but also complements the architecture in color and texture. The retaining wall was structurally engineered with a Miragrid system to hold the soil along the drive.

12. The retaining wall continues west along the north side of the building, creating a raised planter for residents in the therapy rooms to look out upon.

13. The patio, as viewed from the street, resembles a typical residential yard. The fence serves as a subtle guide for patients suffering from Alzheimer's disease, while providing a backdrop for the new perennial garden.

14. The entire patio is easily viewed from resident windows on the second floor. A proposed future addition to the project would include a garden along the exterior of the fence which to tie in with existing plantings already visible from the street.

15. This view depicts the patio and new garden from above. The moveable furniture allows for varied uses and group activities.

16. A showcase of plants along the edge of the patio appeal to all of the senses. From swaying grasses to fragrant perennials, the textures, scents and colors entice residents to experience their distinct offerings.

17. Fixed seating blends well with moveable tables and chairs to facilitate those residents in wheelchairs and provide room for all.

18. The patio is often used for organized group activities, including this recent Barber Shop quartet entertainment session. Resident participation in such events is usually over ninety percent.

19. The most significant feature of the patio is the exposed aggregate path winding through the brushed concrete grid. The different textures are easily distinguished by the visually impaired who use a cane to navigate the loop through the outdoor space.

20, 21, 26, 27. The Sunrise Care Center project provides the residents with an outdoor space in which to interact with each other and enjoy the outdoors. The entire site development strives to increase the experience of the residents who live there.