Best of Stand-Alone Memory Care 2015: Setting a New Standard

A 3-year-old boy came to Abe’s Garden last September, on the first night that visitors were welcomed to the new memory care building in Nashville. He clambered on the rocks and felled trees in the expansive courtyard, until he paused to say, “I love it here. Can I come back tomorrow?”

“I don’t know many communities that hear that very often,” says Kim Hawkins, principal with Hawkins Partners Inc. and the landscape architect on the project, who witnessed the moment. “That was a clue we were doing something right.”

Doing things right had been a firm guiding principle of the team behind Abe’s Garden since the very beginning. And that’s one reason why the project took nearly a full decade to go from concept to reality.

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Those years were spent poring over research about the latest theories and practices in memory care, collaborating with designers, touring existing communities, and convening leaders from medicine, senior housing, and academia to provide input.

The vision was to offer not only the highest quality of care for residents, but create a center to continually test new practices and disseminate knowledge about memory care, says Executive Director Andrew B. Sandler, Ph.D.

The very fact that Abe’s Garden has an executive director with a doctorate underscores its dual purpose, to be a first-rate senior living provider but also a research and teaching hub to help set new industry standards. Hence its full name: Abe’s Garden Alzheimer’s and Memory Care Center of Excellence.

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The community is well on its way to achieving its lofty goals, in the estimation of judges in the Senior Housing News Design Awards.

The concept

Abe’s Garden is named after Dr. Abram C. Shmerling. A prominent Nashville physician, Shmerling established one of the city’s first fully integrated medical clinics. After an 11-year battle with Alzheimer’s disease, Shmerling died in 2006 at the age of 79.

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Seeing the need for innovative, evidence-based memory care instilled a sense of mission in Shmerling’s son, Michael, a successful entrepreneur. With the help of a team that included his sister Judy, Michael led the effort to create Abe’s Garden.

The concept began to take firmer shape when Park Manor, a seven-story retirement community built in 1962, came on the market. Michael Shmerling zeroed in on this 7.4-acre property as a potential building site and formed a nonprofit corporation to purchase it and develop Abe’s Garden.

“The request for [Park Manor] bids had two criteria: mission and price,” says Zeitlin. “They sold it to Abe’s Garden. We were first in mission and third in price.”

With the location secured, the stage was set for architect Manuel Zeitlin, a distant cousin of Michael Shmerling and brother-in-law of Beth Zeitlin, who now is director of marketing and development at Abe’s Garden. The architect was not only aligned with the project as a family connection, though; his firm of Manuel Zeitlin LLC is known for out-of-the-box designs that made them a fitting choice for a project that was looking to create a new template for memory care, rather than adopting existing design principles.

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To accomplish this, the architect jumped into research. He attended conferences of the Pioneer Network, which advocates for culture change in senior care, and he connected with people such as Betsy Brawley, who has authored books such as “Design Innovations for Aging and Alzheimer’s.”

Vanderbilt University’s Center for Quality Aging was another institution involved early-on in Abe’s Garden, and it continues to play a part, collaborating on areas such as resident assessment, staff training, and quality monitoring and improvement.

“I read every piece of literature I could get my hands on,” Zeitlin says of the conceptualizing phase. “What came out of it was that most of what’s out there about design was anecdotal.”

This influenced the emerging designs for the building, which would be constructed beside the existing Park Manor tower. Abe’s Garden would include three different “households” that would offer distinct, controlled environments that over time could generate data on a whole array of design elements.

“We can gather data on different lighting, for example,” Zeitlin says. “[We can evaluate] how it affects the amount of food residents eat, their amount of sleep.”

The approach to lighting design is representative of the comprehensive push for innovation that the development team undertook. Mike Shmerling sponsored a dinner in Washington, D.C., to bring the Abe’s Garden team together with about a dozen leading lighting researchers, Zeitlin says. Ultimately, Rensselaer Polytechnic Institute took on Abe’s Garden as a lighting design project.

Rensselaer’s Mariana Figueiro, Ph.D., developed the 24-hour lighting scheme for the community, based on the existing lighting research for people with Alzheimer’s. Her scheme is meant to reduce glare and shadows, help regulate circadian rhythms, and reduce falls.

“It was one of those things that took us a lot longer than someone saying we need seven lights here, four here, this is what’s cost effective, order the package,” Beth Zeitlin says.

Despite the importance of research, the idea of course was not to create a sterile, lab-like setting for residents. The designers were at pains to create a residential feel, and the architecture and design were tied closely to programmatic innovations. For instance, the households were themed: “Connection to Nature,” “Arts & Lifelong Learning,” and “Music & Movement.” Each includes features to support related programming—such as a working greenhouse in the nature-oriented household.

“It’s a trend that has been in Europe for some time, and now it’s being translated to facilities in the U.S.,” says Jeff Anderzhon, FAIA, senior planner/design architect for Eppstein Uhen Architects and a judge on the 2015 SHN Design Awards panel. “I think that’s great because it involves the residents in social interaction because they have a common base.”

Before construction got underway, the concept underwent another round of significant revisions based on a meeting—called a charrette—with a cross-disciplinary group of experts, including gerontology researchers, aging care design authorities, a senior care operator, and others.

One of the changes to come out of that meeting related to a central component of the design, which was that the three households would be arranged around a central courtyard that would provide a rich outdoor experience for residents—the garden in Abe’s Garden. Originally, the concept was that people would come into the building from a main entrance and then move through the interior to each of the different households, taking the courtyard out of play unless people decided to step outside.

At the charrette, environmental psychologist/gerontologist Lorraine G. Hiatt, Ph.D., questioned this aspect of the design, according to Manuel Zeitlin.

“Her point was, when you go to visit someone … you walk through their front door,” Zeitlin says. “So, let’s have everyone walk through the courtyard and enter the households through a front door. Well, what about when it’s raining or snowing? What do you do when you visit friends? You wear a coat or umbrella. We’re not trying to insulate or overprotect. We’re trying to allow residents to experience and enjoy each moment as much as possible.”

The construction

Part of the long gestation period for Abe’s Garden was due to the intense research that informed the design, but construction also depended on identifying the right contractors—and raising the $14.4 million needed for the project, which included renovations to the existing Park Manor building.

The fundraising campaign began in earnest in 2008, just before the bottom fell out of the economy. For about two years, most of the local Nashville foundations paused all their capital funding, Beth Zeitlin says.

At the same time that the capital raising campaign was working in this difficult environment, there was a switch in the main contractor for the project. Originally, a local contractor had been secured; while there were no significant issues with this contractor, the architecture firm had a relationship with multinational construction company Skanska.

Skanska embraced the Abe’s Garden mission and, more than the original contractor, was able to contribute the kind of innovative construction solutions needed to realize the ambitious goals of the project—for example, taking the time to find the right roof shingling to create the desired residential feel on a commercial property at the needed price point.

Price was crucial not only in terms of meeting the project’s budget, but because the Abe’s Garden team was committed to creating a building that would be replicable. They wanted Abe’s Garden to be a community that other organizations could reasonably copy in their own markets.

Originally, the project was intended to be done in two phases, but Skanska also determined that doing all the work at once would save $1 million in construction costs.

“We knew the longer we waited, the more construction costs would increase and that we would deepen our debt,” Zeitlin says.

So, even without all the needed capital in hand, ground was broken. Ultimately, the capital campaign raised about $11 million, and the rest of the costs have been financed through tax-exempt bond financing through Suntrust Bank.

The completion

The Abe’s Garden grand opening occurred in September 2015, after a year-and-a-half of construction. On day one, there was a waiting list for all 42 spots.

The completed building is noteworthy not only for its evidence-based design but for moving away from a traditional look and feel, with crown moulding and columns, to incorporate a more modern and eclectic aesthetic. It echoes some of the 1960s design features of the existing Park Manor building, such as an orange-shaded brick, and a striking interior design by Perkins Eastman.

“I really liked the contemporary approach to it, they weren’t trying to mimic the past in any way,” says John Cronin, AIA, principal with AG Architecture and a judge in the Senior Housing News Design Awards. “You can do it contemporary and still do a cozy environment, with different places to sit and gather in groups, but not make it institutional in any way. The right furniture and color combinations are important, because [memory care residents] can get agitated and so there are nice soothing colors and lighting transitions, flooring transitions, moving from space to space, there’s a nice flow to everything.”

Some memory care buildings do try to replicate a certain past time period, Manuel Zeitlin notes. Abe’s Garden does not, to keep the building relevant as new generations of residents enter and also because there already are mixed generations living there.

The oldest resident turned 105 in January, and the community has welcomed early-onset residents in their 50s, Executive Director Andrew Sandler says.

“The campus is so large and expansive, with so much room for activities, opportunities for gardening and walking dogs,” he says. “Physically healthy people really thrive. It’s a great campus for younger people that develop Alzheimer’s.”

As for the design feature that is his favorite, Sandler speaks highly of the dining room and kitchen layout. In each household, they are close to the resident rooms, allowing people to ambulate to meals and enjoy the smells of cooking food.

Hawkins singles out the Nature Discovery area of boulders and felled trees in the courtyard and the overall connection of the indoor and outdoor spaces. Practically every room has a window, maximizing the natural light, and the programmatic nature of the design carries through to the outdoors, where activities include gardening and cooking out on grills.

“The access to the courtyard was superior, it was superb,” Anderzohn affirms. “They paid attention to detail there.”

Abe’s Garden appears to have succeeded in its goal to be a model for future memory care communities, he adds.

The project is one that he wants to keep tabs on, Cronin says, noting that his own personal experience with an aunt convinced him that gold-standard memory care—in which the physical environment supports therapeutic approaches—can have positive cognitive effects.

While the building may be complete, the project of Abe’s Garden is really just getting underway, Sandler says. No design features already have been flagged for changes, he says, but he and his team embrace a mindset of continuous improvement.

“Many do things they way they’ve always done it,” he says. “For us, it’s always been about a process that is evaluative. See what’s working, what’s not, and change in response.”

Written by Tim Mullaney
Photo credit: Nick McGinn, McGinn Photography

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