Abe’s Garden in Nashville is rare in the world of memory care communities, not only because it’s the result of an unusual public-private partnership, but because its building permits aging in place—not the locked-down, limited environment many people with dementia experience. The project itself was a massive collaboration that included architects Perkins Eastman (Chicago) and Manuel Zeitlin Architects (Nashville), developer Skanska (Nashville), landscape architect Hawkins Partners (Nashville), and more, all supported by guidance and expertise from researchers at the Vanderbilt Center for Quality Aging (VCQA).

The 36,000-square-foot community formally opened in Nashville in September 2015, with an adult day and evening care program for up to 15 participants and three residential households that accommodate 12, 13, and 17 adults, respectively. It includes the 7.4-acre Park Manor Senior Lifestyle Community, a senior independent and assisted living facility that Abe’s Garden purchased in 2008. And it truly is part of a whole.

The Abe’s Garden central courtyard (measuring nearly a quarter of an acre) is the core of the parallelogram-shaped complex; one of the complex’s sides is primarily dedicated to Park Manor, one is shared, and the others are Abe’s Garden. Interactions between residents are encouraged; although each community has a separate entrance, one need only walk across the courtyard to enter the other.

The result is a solution that sidesteps locked doors with limited-access, risk-managed environments traditionally used in memory care, favoring a design that stimulates and provokes the senses, and helps residents stay engaged and alert in their environment.


A new answer
The project is the brainchild of business executive Michael Shmerling, whose father, Abe, had Alzheimer’s. Frustrated by the limiting options for care, Shmerling founded Abe’s Garden as a nonprofit after his father’s death. During Abe’s final years, Shmerling dove into research mode, eventually collaborating with researchers at VCQA, who not only reviewed initial plans and weighed in on design but are now gathering data at the community to support best practices in memory care.

Next, Shmerling, who today serves as board chair for Abe’s Garden, brought to the design team a vision for a community where safety and independence would come into balance, with emphasis on promoting cognitive maintenance through sensory stimulation. And Schmerling wanted a comprehensive solution, as well, which he asked VCQA researchers to help him define.

“He said, ‘We’re going to sit down with a blank piece of paper and you tell me what this population needs, not only the people who have Alzheimer’s and other dementias, but the families, doctors, nurses, care partners, and pharmacists. Let’s look at everybody who’s going to impact this population and what would be the utopian community,” says Beth Zeitlin, director of marketing and development at Abe’s Garden.

This meant taking a few extra risks along the way. For example, Abe’s Garden features a backyard grill and doors that freely open to the outdoors. The kitchens use induction stovetops, but traditional ovens are used for daily baking in the households. “We tried to reduce risk, but we didn’t try to eliminate risk,” she says.

Because of a lack of available research on design features for memory care residents, existing evidence for assisted living communities was used in the process, as well, along with a dash of creativity. Designers selected night tables with recessed amber lighting that illuminates paths of travel without disrupting sleep in resident suites; incorporated plentiful opportunities to step or gaze outside; and offered choice and provocations in displays, such as a range of art that invites residents to explore, consider, and comment. (Think Life magazine covers, a Degas poster, and a photograph of a honky-tonk sign in Nashville.)

The result? A space that supports person-centered care and allows residents to remain independent, maximizing choice and promoting evidence-based best practices, like establishing connections to nature, music, and movement. “We embraced the idea that we might not have all the answers and the answer we have today may not be the answer that we promote for someone who’s building 24 months from now,” Zeitlin says of the design, which she hopes will continue to evolve.

In and out
Organizationally, the community’s three households are each themed: One is dedicated to the arts and lifelong learning and features a concrete-floored craft room where residents can create; the second, with a spacious greenhouse, is focused on nature; and the third is based on music and movement. Each household has a large central kitchen tailored to its design, where residents can chat, enjoy a communal dinner, or watch meal preparation taking place.

Day/evening care participants are free to interact with residents of the households, too. “A lot of memory care facilities don’t want to mix temporary with full-time residents because they say it will disturb them, but the day and evening program participants aren’t separate from the households. That makes life more interesting for residents,” Zeitlin says.

In an outdoor garden, a gurgling water feature invites residents to stick their hands in and splash. Nearby, the trunk of a tree and a boulder garden encourage visitors to experience the crackly bark or roughness of the stone. In another area, vegetable and herb plantings allow residents, family, and staff members to get their hands dirty, while a backyard grill is on hand to create aromas that tease the appetite. “The more senses we can engage, the better for maintaining cognitive function,” says Kim Hawkins, founding principal of Hawkins Partners.

The garden design also takes into account the varying mobility of residents, accommodating, for example, those in wheelchairs with garden beds they can pull up to and those using walkers with vertical wall gardens. Such invitations to engage also stave off boredom, loneliness, and depression, adds Zeitlin.

Outdoors, the project team continued to deliberately flout the extreme risk aversion other communities often practice. “There is risk here. Somebody could scrape their knee on a rock or bump into something or feel sun in their face or get wet,” says Manuel Zeitlin, the project’s lead architect. “This isn’t an environment designed to shelter people from life, but to engage them in it. That’s the difference. Alzheimer’s is a tough experience for families; it’s a death sentence. Trying to create a place where every day still has some joy in it, where people can still learn, still love—that sort of pervades the whole process.”

More to come
The colorful result is a community far different from that of many people’s imagination. Beth Zeitlin says stories of residents who had refused to leave their rooms in previous communities but who joyfully engage at Abe’s Garden are plentiful. Research to document results will focus on the effects of choice in activities of daily living.

For example, Abe’s Garden’s more person-centered approach might allow residents to wake up naturally, instead of being woken up, or caregivers might ask residents if they’d prefer to brush their teeth first or drink coffee first. One outcome being measured is how much time it takes to deliver ideal care, weighing this model against current trends to require staff to complete care objectives within a limited time to quicken the pace.

And the VCQA efforts that helped Abe’s Garden open its doors will also drive ongoing, evidence-based staff training programs and program evaluations, resulting in a collection of data that both Abe’s Garden leaders and their VCQA colleagues hope will improve memory care facilities across the U.S. “There really isn’t a lot of evidence-based design in the field of Alzheimer’s,” Beth Zeitlin says. “There’s a lot of anecdotal, experiential design out there, but one of the principal goals of Abe’s Garden is to create a research engine where we can generate and disseminate as much information as possible about design and other factors that can improve the lives of  residents, families, and care partners.” 

Robin Donovan is a freelance writer and editor. She can be reached at rkdonovan@gmail.com.