Local nonprofit senior living community Abe’s Garden announced a $20 million campaign to expand and enhance its memory care facilities and services, and to establish a replicable model. “Abe’s Garden has become a solution to families’ challenges for nine years. In fact, it’s become a household name,” says Risa Klein Herzog, director of donor relations at Abe’s Garden. “It’s an option for people who want to live independently, who want assisted living, and people who may need our memory support services.” She says the memory support, which is the newest addition, is the “jewel in the crown.”
Abe’s Garden was created when Mike and Lisa Shmerling purchased the former independent living residence, Park Manor in 2008. “They added services and then added assisted living while they toured the country, found best practices in memory support, and then built out the new part,” says Herzog. The plan will include adding approximately 50 percent more memory support residences which will increase capacity from the current 42 to 62. Herzog adds this will alleviate a waiting list of about 50 people a month.
A top priority for the next phase includes creating a model for memory care that can be replicated. The Shmerlings are partnering with Vanderbilt University’s division of geriatrics through the Abe Shmerling endowed chair. Herzog says it was important to the Shmerlings to be partnered with a facility that is serious about geriatric brain health.
Mike Shmerling explains that the journey to Abe’s Garden began when his father, Abe, was diagnosed with Alzheimer’s disease just six months after retiring from his medical practice. His sister, Judy, eventually moved her family back to Nashville to help with their father’s care, and suggested they find a facility that was better able to care for his needs. After visiting several local places, and trying a day program, the family was frustrated. “The issue was always the same,” says Shmerling, “It was absolute, chronic boredom. It was early stages, and he just couldn’t stand it. We’d take him out to do things and when we’d take him back, he’d almost cry. I felt helpless for one of the first times in my life.”
After consulting with friends and family in the medical field to learn where the best facility in the country was, Shmerling decided to build it. “Alzheimer’s is the sixth leading cause of death in America. One hundred percent fatal, no prevention, treatment, or cure,” he says. He consulted with specialists like Dr. Harry Johns, at the time the president of the American Alzheimer’s Association. “I asked him, ‘What is the model, the center of excellence for Alzheimer’s,’ and he couldn’t tell me. The more I looked, the more I realized that’s what we need.”
Shmerling found what he calls a “thought leader” in Dr. Sandra Simmons, professor of geriatrics at Vanderbilt. Simmons led Shmerling to visit facilities all over the world over a six-year period. The result was the purchase of the towers on Woodmont Boulevard, which they immediately turned into a nonprofit organization.
Simmons had begun her career focusing on nursing homes and long-term care quality. “Over two-thirds of long stay nursing home population has some form of cognitive impairment. It’s not always Alzheimer’s disease, but certainly dementia is prevalent in that setting,” she says.
By the time Shmerling connected with Simmons, she was conducting several clinical intervention trials to improve nutritional care quality in nursing homes. She says ensuring people with memory care issues receive proper nutrition is key to their long-term health. In addition, she was involved in studying staffing needs. “In all of our projects to improve quality of care in nursing homes, inevitably any intervention that proved efficacious required more staff time and resources than what nursing homes typically have,” she says.
And finally, Simmons says providing a staff member who can help prioritize, standardize, and routinize care is another factor in developing best practices. “No place is perfect and you’re constantly hiring and training new people. And the residents themselves, as they move along their trajectory of dementia their care needs change and you have to constantly make adjustments.”
When it comes to creating a replicable model, Simmons says it is possible to translate what Abe’s Garden is doing in other dementia care within assisted living. “The reality is that over 95% of dementia care withing assisted living facilities is private pay.” She says this is true of most chain facilities. “Families are paying a premium for their relative to live in those places.”
Simmons says the bigger challenge is in community nursing homes. “That’s where there is a bigger gap. But I’ve done many quality improvement projects in partnership and in nursing homes. The primary difference there is they can’t do everything Abe’s Garden is doing simultaneously. But most facilities have capacity to take a small piece of that.” For example, they can focus on supplement and between meal snack delivery to help bolster caloric intake. She says it is also important to help people continue to engage in activities they enjoy and to encourage freedom of movement. “Allowing people to continue to live and having the respect for the individual person and their preferences and being willing to make adaptations.”
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Education and training of staff is another key to ensuring quality of care. “Providing a positive work environment engenders longevity amongst their team.” She says staff turnover is a big problem, along with unrealistic ratios that create burnout. “All the different strategies that Abe’s Garden uses to try to foster a strong team and well-being really does make a big difference. The longer you can keep a core team of people in place, the more successful you are.” She says creating a sense of community and interconnectedness between residents and staff is also a key element of success.
The sense of community at Abe’s Garden is felt throughout the various programs. Sherry Stein has lived in the independent living program for four years after moving from her home in Tampa, Florida. “I was at a particularly low period in my life. My husband had just died, and my adult children decided I needed to be closer to one of them,” she says, “So we sat down at a family meeting and that’s how I came to Nashville.”
Stein made the move during the Covid19 pandemic, which proved challenging. “I came here, and I didn’t know anyone. Once things like the dining room opened up, it’s just a very nice place to be,” she says, “I had the security of not being alone, but I have the independence of doing what I want to do.” She calls Abe’s Garden “magical” and says it is due to the caring atmosphere. “I think the people who are at the level to make decisions that affect the whole community care about what these decisions are.”
Ryan Moses’ late father, Bob Moses, lived in the memory care section of Abe’s Garden. Ryan Moses says his father initially was in the day program at Abe’s Garden prior to needing around the clock care. “I think Abe’s Garden is second to none in terms of dignity for the individual and who they are, and then dignity for the families who are going through that.” He attributes this to the staff and the nonprofit model. “It’s a different way of approaching it. And because Abe’s does such a good job of retention of staff, and then the teaching and coaching of staff members, they have people who are really trained for this and who care.”
Moses also is impressed with the work being done to build models and metrics for other facilities. “That’s another place where I think Abe’s is going above and beyond. Not only how do we do this for ourselves, how do we create a repeatable process that we can create operating procedures around and holistic models that we can then push out all over the world.”
Ground has been broken on the expansion, with $16.4 million already committed. Shmerling says the project should be ready in 16 months. It is the next step in a 20-year history that was inspired by his dad. “The helplessness of not being able to find something for my dad created this. And since then, I’m shocked about this, this place has a lot of recognitions. Including the International Alzheimer’s Report, which is 54 countries who share best practices.”
Shmerling says 35% of residents are not from Davidson County. “We’re not about mass care. If Abe’s Garden could handle 100% of just the people diagnosed with Alzheimer’s in Nashville, we’d need 330 beds. Our mission is to demonstrate as a center of excellence best practices and disseminate those broadly and free to anybody who wants to see them.”