A new type of dementia care that is offered on a farm setting, green care farms (GCFs), is emerging from the Netherlands (1). GCFs programs are an empowerment-oriented, strengths-based, community-based service that aims to improve the quality of life of people with dementia (PWD) (2). Previous research on residents living on GCFs reported that, compared to usual care, quality of life (QOL) was higher, especially in the areas of positive effect, social relationships, and having something to do (3); furthermore, caregivers working in GCFs were more positive about the physical environment, activities, and person-centered care (4).
Identifying the most beneficial activities for PWD has been a priority in dementia research, especially given the challenge of aging societies, whereby people worldwide are generally living longer, thus increasing the incidence of dementia. According to Harmer (5), PWD, staff, and carers have different views about what makes activities meaningful; staff and family caregivers consider activities that maintain physical well-being meaningful, whereas PWD find meaning in activities that address their psychological and social needs. According to De Bruins (6), farm activities fit within normal daily life and are considerably different from traditional nursing home activities, which often have an institutional character (e.g., memory training and bingo). In addition, according to Moyle (7), the factors associated with a positive QOL were relationships with family members and other people, the need for control over their lives, and, more importantly, the need to contribute to their communities. According to a qualitative analysis of in-depth interviews with PWD, a key factor in preserving personal dignity is engagement in meaningful activities within the safe and secure environment of the patient’s home (8).
To enable PWD in Japan to perform meaningful activities, we developed the only vernacular GCFs in Japan, which is called rice farming care (RFC) (9–12). This project began in 2016 and was made available to PWD who visit the day-care center located in the psychiatric hospital, as well as to PWD living in the nearby group home. Historically, people living in psychiatric hospitals and their related institutions are sometimes secluded from their fellow patients, families, friends, and visitors (13). However, since the launch of this project, we have observed that various people, i.e., family members, volunteers, researchers, and city officers, more frequently visit the hospital and that patient–patient, staff-staff, and patient-staff communication has improved. Thus, while the RFC might have an inclusive effect for otherwise excluded people, the mechanism underlying this effect has not yet been explored. As described elsewhere (10), rice farming has special cultural importance in Japan. For example, rice wine is offered to deities during Japanese rituals; rice plays a crucial role in communal activities, in that to eat rice from the same pan represents strong friendship within a person’s social group; the “land of abundant rice” is often used as a poetic name of ancient Japan; and finally, the emperor himself plants and harvests rice (14). Rice farming might therefore be a meaningful activity for PWD who can no longer participate in society as before.
The aim of this study was to 1) implement GCFs which use rice farming in Japan, which is common in East Asian environments; 2) explore the positive experiences of PWD who completed the RFC program (qualitative measures); and 3) compare the effect of RFC with that of usual care for well-being and cognitive ability (quantitative measures).