Patient/Caregiver Home Program Instructions (Horticultural Therapy)

Patient/Caregiver Information

Patient Name: [Patient name]

Date of Birth: [Date of birth]

Date Provided: [Date provided]

Clinician: [Clinician name, credentials]

Clinic Contact: [Clinic phone number]

These instructions are for: [Caregiver name] assisting [Patient name] (Include only if caregiver is the primary recipient of instructions.)

What We're Practicing at Home

[One to two sentences explaining the purpose of this home program and how it connects to patient's meaningful goals] (Use plain language and active voice. Lead with what the patient will gain, not the diagnosis.)

• [Goal 1 in plain language]
• [Goal 2 in plain language] (Include only if established)
• [Goal 3 in plain language] (Include only if established)

We will set clear goals together at your next visit. (Include only if goals are not yet defined.)

Safety Information

Medical precautions:

• [Confirmed precaution in simple Do/Don't language] (Include only precautions explicitly confirmed and relevant to gardening tasks.)

[No specific therapy-related restrictions were identified today. / If you are not sure whether an activity is safe for you, pause and call our clinic.] (Choose whichever applies. Omit if complete precautions listed above.)

Stop and rest if you notice:

• Dizziness
• Chest pain
• Unusual shortness of breath
• New or worsening swelling
• New numbness or weakness
• Increased pain

Call 911 if:

• Chest pain that does not go away
• Severe shortness of breath
• Signs of stroke (face droop, arm weakness, speech trouble)
• Any other emergency symptoms

Call our clinic same day if:

• New or increasing swelling
• Wound changes or drainage
• Fever
• Symptom flares that don't improve with rest

Garden safety reminders: (Include only items that apply. Omit outdoor items if program is indoor/tabletop only.)

• Wear gloves and cover any cuts
• Wash hands after soil contact
• Use the right tool for the task
• Work in shade or use sun protection for outdoor tasks
• Wear stable footwear and keep pathways clear
• Sit for tasks if balance is limited
• Avoid pesticides and fertilizers unless specifically approved

Do NOT do right now

• [Specific prohibited action] (Include this section only if explicit contraindications exist. Otherwise omit entirely.)

Your Home Program

Schedule: [Number] days per week | [Number] minutes per session | Rest breaks: [Guidance]

[Time-of-day recommendation if relevant] (Include only if timing affects patient success.)

What you'll need:

• [Supply or tool with low-cost alternative if applicable]
• [Adaptive equipment if prescribed: built-up handles, lightweight watering can, raised container, kneeling pad]

(If home setup is unknown, offer options rather than fixed placements.)

[Activity 1 name]

Why this helps: [One sentence linking to patient's goal]

1. [Step with posture and hand-use cues as needed]
2. [Step]
3. [Step]

How much: [Reps, time, or sets with rest guidance]

Stop if: [Activity-specific warning signs]

Caregiver assistance: [Level of help and safe assist cues] (Include only if assistance is needed.)

• Make it easier: [Simplification option] (Include only if graded progression is intended.)
• Make it harder: [Progression option] (Include only if graded progression is intended.)

[Activity 2 name]

Why this helps: [One sentence linking to patient's goal]

1. [Step]
2. [Step]

How much: [Reps, time, or sets with rest guidance]

Stop if: [Activity-specific warning signs]

Caregiver assistance: [Level of help and safe assist cues] (Include only if assistance is needed.)

• Make it easier: [Simplification option] (Include only if graded progression is intended.)
• Make it harder: [Progression option] (Include only if graded progression is intended.)

(Add or remove activities as needed to match the plan.)

Pacing tips

• Rest before you are exhausted
• Break tasks into smaller parts
• Spread heavier tasks across the week
• Keep supplies within easy reach
• If symptoms flare, shorten time or take more breaks

(Include this section when fatigue, pain, or endurance are relevant concerns.)

Tracking & Next Steps

Use this log to track your practice. Bring it to your next visit.

Date	Activity	Minutes	How it felt (easy/medium/hard or 0–10)	Notes

Next appointment: [Date/time / To be scheduled]

What we'll review: [Planned progression or adjustments]

We reviewed these instructions together today. You were able to explain the activities and when to stop. (Include only if teach-back was performed.)