During our time working with the sisters on the horticulture project, the nursing home garden was a key feature that brought joy to the environment. In conversations with some of the sisters, we were occasionally invited into their rooms, where they shared their experiences and perspectives with us. We observed that most rooms contained a large window offering a view of the garden from various angles. The sisters frequently mentioned this view in conversation, particularly when discussing their daily lives or what brought them joy at this stage of life. A meaningful connection to nature and active engagement in nurturing it may not only improve mood symptoms in the geriatric population but also aid in depression management. Studies in positive environmental psychology have demonstrated that a sense of connection to nature has a positive overall effect on the human psyche. Our longitudinal observations supported this, as the garden was consistently described as one of the facility's most cherished features.

The horticulture project also facilitated a connection to the broader community. In addition to medical students, undergraduate students from Saint Joseph's University regularly visited to engage with the sisters and assist with garden-related activities, such as creating pressed-flower cards. Residents expressed enthusiasm for these crafts and valued the intergenerational interaction, suggesting that communal engagement, combined with environmental connection, supported their overall psychological well-being.

Many sisters reported significant lifetime losses, including loss of mobility, the death of peers, and grief related to the COVID-19 pandemic. Despite these challenges, they expressed hope for the future and a continued sense of purpose. They attributed this resilience to their faith and gratitude for their living situation and caregivers. According to the National Alliance on Mental Illness (NAMI), faith provides community, structure, connectedness, and coping mechanisms, all of which aid in depression prevention and recovery. Most of the sisters we interviewed showed signs of mild cognitive impairment to dementia, and one would assume they would experience loneliness and isolation. According to the National Institute on Aging, depression is common among individuals with dementia and is often an early warning sign of dementia in elderly adults. Yet, the sisters all seemed to deny experiencing depression or depressive episodes strongly and attribute their positive outlook on life to their faith. The nursing home staff supports the sisters in their continued practice of being in community by facilitating structured religious gatherings.

Along with the structured and respected Mass schedules, many of the sisters shared that most of their days each month were filled with activities or events. Each month, the sisters were given a calendar full of daily activities. Additionally, we couldn't help but notice that no matter the morning we visited the nursing home, the sisters were participating in the same structured morning routine. Research from the Center for Brain Mind Medicine at Harvard University indicates that routine provides stability and reassurance for individuals with dementia. Staff operated with high efficiency, gently redirecting residents to scheduled activities, including Mass, and our interview schedule was designed to minimize disruption. This intentional adherence to structure likely enhances residents' positive experiences and overall quality of life.

Over the past year, it was a pleasure speaking with the sisters and working with the undergraduate students. We saw the potential benefits of integrating horticulture therapy, spiritual community, and predictable routines in nursing home settings. We hope that more nursing homes follow their lead and implement these programs and structures to improve the mental health outcomes and quality of life for geriatric populations living in nursing home communities.