Back to the Garden
Abe’s Garden isn’t your typical Alzheimer’s care facility. There is sunlight everywhere. It has a quarter-acre organic garden, a courtyard with an outdoor grill and 50,000 bees producing 20 gallons of honey every year. Residents have their pick of regular activities such as seated yoga, karaoke and flower arranging, and they benefit from a steady stream of visitors, like the Nashville-area Boy Scout troop that recently dropped by to serve cookies around the facility’s outdoor fireplace. For founder Michael Shmerling, a scene like that is the fulfillment of a dream: Abe’s Garden is a heartwarming tribute to his father, Abram “Abe” Shmerling, and the city of Nashville, the community Abe loved and in which he served as a physician for 45 years.
It wasn’t until Abe’s Alzheimer’s diagnosis more than two decades ago that Michael, a prominent entrepreneur and investor, came to learn that care facilities are often a crushing mixture of boredom and restriction, with frustratingly under-trained staff. Casting a wide net, he found facilities with a worthwhile program or two, but they were exceptions rather than commonplace.
Shmerling wanted Abe’s Garden to incorporate the best practices he’d discovered around the country. Opening in the summer of 2015, a short drive from Vanderbilt University, the facility aims to educate families and caregivers about Alzheimer’s disease. One of the ways it does that is through a series of videos designed to help caregivers better understand the disease and how to provide comfort to people suffering from its effects.
The facility has also partnered with Vanderbilt to create what Shmerling hopes will be a facility on par with industry-leading hospitals and research clinics around the country. “What’s the Mayo Clinic of Alzheimer’s? Where is the Cleveland Clinic?” he explains. “I decided, with a lot of help, to try to create that place in Nashville.”
Shmerling spoke with Worth about his father’s legacy, the impact of Alzheimer’s on caregivers and ways in which we can ease the disease’s devastating effects.
Where did you get the idea for Abe’s Garden?
Purely from my experience with my dad. I was never in an assisted living facility or nursing home before his illness. He lived at home with my mother for about four and a half years. It got to the point where she could no longer take care of him and we were all of a sudden in the market to find a suitable place for my dad.
What did you find?
I visited a dozen different places in Nashville and surrounding areas. I was distraught over what I was witnessing in terms of the quality of the staff, the facilities themselves and, most importantly, the programming and what was going on inside—and my dad ended up going into one of these places. He was in four different facilities during the course of his illness, in addition to one-day programs, and his problem was not unlike the problem of many other people in these facilities: chronic boredom.
What was your response?
I was able at that particular time in my life to get involved in taking on something bigger, and so I started doing a lot of homework, researching other facilities across the country that had good reputations.
It turns out that very few places had the aggregation of best practices. This one had a great storytelling program; that one a very modern, newly designed facility with lots of sunlight. This one has a pet program that’s out of sight, while that one has a farm-to-table program. What I decided to do is to try to create a center of excellence in the country.
How were you able to use what you learned to help your father?
Abe’s Garden really was never created for my dad. He was too sick by then. I knew it would take me much longer than he had left to do it. I started this two years before he died in 2006, and we just opened two and a half years ago. I traveled around, sometimes accompanied by my wife, and borrowed the best practices that we found. So if you came to Abe’s Garden today, you’d see a facility that was designed to incorporate lots of sunlight everywhere, skylights, a farm-to-table program with a quarter-acre organic garden and geothermic heating and cooling. The training program is probably one of the best in the country.
What does the “garden” in Abe’s Garden mean?
My father was an amateur photographer, and his focus was flowers and gardens—he loved the outdoors. We like to say people come here to live, not to die. A garden is synonymous with life and growth and blooming and being outdoors. It just resonated with us—“That would be a good name.”
Why does this disease disproportionately affect women?
First, Alzheimer’s is the only leading cause of death that impacts more women than men; and second, women are far more likely to be the primary family caregiver.
The statistics are alarming. Nearly two in three Americans with Alzheimer’s, approximately three and a half million, are women. And at the age of 45, women have a one-in-five chance, compared to one-in-10 chance for men, that they’ll develop Alzheimer’s in their lifetime.
According to the CDC, nearly two-thirds of dementia caregivers are women, which is shockingly high. These women are taking on the physical, emotional and financial burdens of caregiving, sometimes for more than 10 years. It impacts their health, careers and other relationships. That’s why it’s a pillar of the Abe’s Garden model to support these women in both traditional and innovative ways.
How Is Abe’s Garden a model for others who are considering starting a foundation?
Abe’s Garden partnered with Vanderbilt University School of Medicine, and my wife and I and another family endowed a chair there. They recruited Dr. Laura L. Dugan, a world-class scientist specializing in geriatric neurology, from the University of California, San Diego. She accepted the position, moved to Nashville, and today she’s head of geriatrics for all of Vanderbilt. She is really one of the first, if not the first, strictly Alzheimer’s-related faculty members with an endowed chair tied to a major medical institution as a part of the clinical research group.
So finding the right partner was critical?
Correct. One of our donors told me something that really resonated with me: “This is a wonderful project. I don’t know if you have the money to do this all by yourself, but even if you do, don’t. Because if you try to do it alone, it will live with you—and it will die with you.”
With Vanderbilt, there is a continuity plan. Their researchers are doing important work that’s contributing to the population. We disseminate the information largely through conferences and published information and video and all kinds of sources. We’re an open book.
We’re also experimenting with things. We have a club, which is a day-night program. Our goal is that people can come to drop Dad off at 4 o’clock in the afternoon, not just in the morning, and pick him up in the afternoon. He can stay overnight. That’s really, really helpful for caregivers. To give rest to the people who have to take care of these folks at home is so important. They get worn out.
So it’s not just the patients you’re caring for.
A lot of people have Alzheimer’s and just deal with it in their family. The family members feel helpless and overwhelmed. Abe’s Garden gives them a sense of, “By gosh, there is something we can do about it.”
How Can Abe’s Garden be replicated?
Parts of it would be easy to replicate. If you spent some time here, you would see music and art activities, gardening, dance, movement, every day—seven days a week, with options all day long, different activities. You don’t have to sign up: We learn the habits, and the likes and dislikes, and so we make sure people are busy during the day with activities.
The residents are not overprogrammed like you would do with a teenager. That’s not the mission. But at night they sleep better because they’re tired. It’s not sitting in front of the TV all day, sleeping half the day. Many of them develop a real passion for these activities. It’s really that simple.
And what has been the response from the Alzheimer’s community?
The wait list is longer than the number of beds. These last years can be happy days; they don’t have to be fraught with agitation and depression and chronic boredom, which is what my dad experienced.
How has your father’s life influenced your philanthropy?
My dad was a very modest guy. His parents were immigrants in Georgia, where he grew up. He opened the first racially integrated medical practice in Nashville in 1958. We think he had one of the first African American registered nurses at a white doctor’s office in Nashville. She worked with my dad for 40 years. African Americans and whites had to sit together in the waiting room. If you didn’t want to sit together with people of a different race, you needed to find another physician.
He was in a poor area of town this whole time. He never collected his receivables. That’s just the way he grew up, and he instilled that spirit in all his kids. It’s one reason why we have an access-to-care fund at Abe’s Garden: to ensure we have a diverse population in the facility and that it’s not about who can pay and who can’t pay.
It is a private-pay facility, but we have a fund that subsidizes people who can’t pay. We also have a policy: No one’s asked to leave. If you run out of money, you won’t be asked to leave. That’s how we honor his legacy, because it would tear him apart if he knew we operated any other way.
Do you have any particular rules that have emerged from that influence?
I try to practice philanthropy as a leader. Lead by example. That’s why I didn’t put my last name on the facility. It’s not about Shmerling, it’s about Abe. If you don’t know the first and last name, it’s OK. That’s the kind of thing I would teach my own kids and hopefully that is what’s in the family DNA.
—With Samuel Steinberger