No Garden Variety Charette

Innovative annual meetings are helping to transform Abe’s Garden into a much-needed center of excellence for the Alzheimer’s community.

By Kevin Woo | February 4, 2013

There’s an old joke that often circulates within organizations: How do you measure success? Punchline: One meeting at a time. For Beth Zeitlin, the director of marketing and development at Abe’s Garden, an assisted-living facility in Nashville, all it took was a one-day charette to review and provide guidance on plans to expand its current campus into a larger facility.

What’s a charette, you ask? Charette is a French term describing an intense period of collaboration, planning and sharing among people with different backgrounds who are brought together in order to make big decisions to move a project forward. The term is typically used to describe projects that involve long-range community or architectural planning.

Charettes tend to be more visual than normal meetings, relying heavily on drawings, mockups, pictures and schematics. They’re also more free flowing, less agenda-driven and are designed to make big decisions. By contrast, many meetings tend to not have a specific end-goal. They are frequently driven by personalities and time. And, too often, it takes more than one for big decisions to be made.

In October, Zeitlin brought together 16 Alzheimer’s and dementia experts to participate in a one-day charette. The goal was to review and evaluate the architectural plans for the expansion of Abe’s Garden, which will transform it from a 120-bed independent and assisted-living facility to a “new” Abe’s Garden that will have 48 additional beds, dedicated to people who have been diagnosed with Alzheimer’s or some other form of dementia. When completed, the “new” Abe’s Garden will be the first assisted living facility in the U.S. dedicated to caring for Alzheimer’s and dementia patients.

In addition to the residential expansion, a 5,700-square-foot research facility will be built. The new research center will allow academics, doctors, behavioral scientists, interior designers for the elderly and gerontologists to conduct ongoing research on Alzheimer’s and dementia. The dedicated research center will also be the first of its kind in the U.S.

Michael Shmerling, the son of Abraham Shmerling for whom Abe’s Garden was named, hopes that the assisted living and academic research facilities will become a model for other such centers around the world.

“If you think of the other leading causes of death in the U.S., such as cancer, heart disease, stroke or drug addition, there are centers of excellence that are looked to as models for patient treatment and ongoing medical research,” Shmerling said. “These centers include the Mayo Clinic, MD Anderson, the Menninger Clinic and the Betty Ford Center. All of them have become centers of excellence because they partnered with major medical academic institutions. Those partnerships create a synergy that you can’t get if someone just constructs a freestanding building and says, ‘Let’s provide assisted living’ in it.’

“In the past, patients diagnosed with Alzheimer’s have essentially been warehoused,” he continued. “The assisted-living facilities don’t have the physical infrastructure or the training to handle those who have various forms of dementia. We are going to change that model with the expansion of Abe’s Garden.”

When the Abe’s Garden research center is completed in 2014, it will have three medical academic partners on-campus: Vanderbilt University Medical Center, Meharry Medical College and Rensselaer Polytechnic Institute.

A Trillion Reasons for Action

Abraham Shmerling provided medical services to underprivileged patients in South Nashville for 45 years. He was diagnosed with Alzheimer’s in 1995 and died in 2006 at the age of 79. Since his father’s death, Michael has devoted his life to helping families that are, or soon will be, affected by some form of dementia.

According to The Journal of the Alzheimer’s Association, Alzheimer’s disease is the sixth leading cause of death in the U.S., yet there are no residential facilities dedicated to serving its patients. One-in-seven people with Alzheimer’s disease live alone. More than five million people currently have Alzheimer’s disease, and someone is diagnosed with the disease every 68 seconds. There are 15 million unpaid caregivers in the U.S. who provide 17 billion hours of assistance each year.

In 2012, it will cost $200 billion to care for the five million people diagnosed with the disease. By 2050, it’s estimated that more than 15 million in the U.S. will have Alzheimer’s disease and the cost for their care will exceed $1.1 trillion.

Shmerling can see the tidal wave coming, and he’s determined to get out ahead of it.

The Charette

The goal of the charette was to give the architects the opportunity to collaborate with Alzheimer’s experts on the initial architectural designs; understand how to integrate evidence-based elements to ensure patient safety; develop programs for the cognitive and physical health, as well as emotional comfort of the residents; and find ways to safely create independence through routine daily activities.

The key to the charette’s success was that the architects approached the process with an open mind and a willingness to change the plans without feeling as though they needed to defend their designs. Instead, the architects challenged the experts to tear apart the schematics to identify what was done right, what was done wrong and what needed to be fixed.

As it turned out, the biggest “ah ha” moment didn’t involve the new residential building or research center but rather Abe’s garden. The experts explained to the architects that people with Alzheimer’s tend to wander so instead of one big garden, the area should be subdivided into a series of smaller ones. The experts said that, based on years of research, they’ve observed that Alzheimer’s patients who are exposed to multiple kinds of stimulation—visual, auditory and olfactory—tend to have a better quality of life. They recommended that the smaller gardens target each of these senses.

The experts also suggested that a family area be constructed. They told the architects that having an area with benches, picnic tables and things for kids to climb on would encourage family visits and, subsequently, more interaction with the medical staff.

Abe’s Garden isn’t just the name of the facility; it also describes a key element of the campus. The “garden” at Abe’s Garden produces between 200 and 250 pounds of fruits, vegetables and herbs annually. After the expansion, the garden is expected to produce more than 300 pounds annually.

“We Love This Concept”

So did the management team at Abe’s Garden consider the charette a success? The answer is a definitive yes, according to Shmerling, who plans to make it an annual event.

“We plan to have another charette in a year to revisit the things we came up with (at the first charette),” he said. “Every year, we want to review what’s working, what’s not working and continue to do this forever. We love this concept and that’s what makes us unique, the fact that these professionals have never been involved with anything like this and we’ve been in this field for 40 years. The concept of asking people what they think and what they think the best practices are makes good common sense.” One+

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