Transitioning into the Community
How will I know when it’s the right time to move my loved one into a memory care community?
This is one of the most difficult questions to answer, as there is no “predetermined time” to make this transition. Every family is different, and much depends upon the resources you have available to you and your tolerance threshold for the unpredictable behaviors of an individual with Alzheimer’s.
Typically, families notice a decline in the health or functioning of the caregiver related to stress, lack of rest and making their own needs secondary. Others describe the evolving relationship as “becoming toxic,” with the caregiver experiencing reduced patience and increased frustration at the new limitations of their loved one. Simultaneously, the person with Alzheimer’s disease becomes increasingly non-compliant, agitated and frustrated from being corrected or sensing they are continually getting things wrong. Other considerations are affordability and availability of a desirable residential suite at the anticipated time of transition.
We encourage you to visit www.abesgarden.org to download a copy of “How to Evaluate the Quality of Residential Care for Persons with Dementia” (or call to request a printed copy). This guide provides an evidence based approach to evaluating care prior to and following your loved one’s move.
What is included in the monthly lease rate?
The resident’s lease rate is inclusive of all care, meals and programming. The family or guardian will be responsible for clothing and personal hygiene items, medications and linens.
Will there be annual increases in the lease rate?
There is an annual 3% cost-of-living increase to offset increased employee related, food, utilities and operational expenses. As a not-for-profit organization, we seek to be exceptional financial stewards, minimizing additional increases while maintaining excellence in all aspects of operation.
What are the suites like?
Each suite is furnished with evidence based, custom-designed furniture from Furnished Living, including: a therapeutic engagement center; a room supply storage unit with reminiscence panel; a bed with sidearm and memory foam, and cool-comfort gel mattress; a motion chair that locks in place when the user stands; a guest chair; nightstand; and armoire. Furnished Living is a company that has partnered with Abe’s Garden® to design a line of furniture for memory care communities. Additional details are available upon request.
What is the process to get on the wait list and/or to reserve a suite?
Abe’s Garden® is currently accepting wait list applications. A non-refundable $250 wait-list fee will be credited to your account when your loved one moves into Abe’s Garden®. Please contact Judy at firstname.lastname@example.org or 615.733.2682 for the wait list application or to schedule a tour of the Abe’s Garden® campus.
Once on the wait list, you will be notified when a suite becomes available. If the time is not right for a move, you can decline the available suite without losing your place on the wait list. We will call again when the next suite becomes available.
Reserving a Suite
When you’re ready to reserve a suite, you will provide a refundable security deposit equal to one month’s lease rate fee. Upon receipt of the security deposit, our licensed clinical social worker will contact you to schedule an assessment to begin the pre-admission process.
What is the Admission Criteria?
Residents and day/evening care participants will have a diagnosis of Alzheimer’s disease or a related dementia.
Abe’s Garden® is able to meet the individual’s cognitive, physical, medical and psychosocial needs. We will determine the most appropriate placement for that individual within the structure of the program or with the additional support of Independence Plus, hospice or another healthcare resource.
Residents and day/evening care participants will meet the Tennessee Standards for Assisted Care Living Facilities requirements. According to these standards, assisted-care living facilities are not allowed to admit anyone who has any of the following conditions:
- Requires treatment for stage III or stage IV decubitus ulcers with exfoliative dermatitis
- Requires continuous nursing care, defined as: “Round-the-clock observation, assessment, monitoring, supervision or provision of nursing services that can only be performed by a licensed nurse”
- Has an active, infectious and reportable disease in a communicable state that requires contact isolation
- Exhibits verbally or physically aggressive behavior that poses an imminent physical threat to self or others (based on behavior, not diagnosis)
- Requires physical or chemical restraints, not including psychotropic medications for a manageable mental disorder or condition
- Has needs that cannot be safely and effectively met in the assisted-care living facility
- Individuals receiving hospice care may not be admitted, though hospice may be provided following admission.
- Requires the following treatments:
- Nasopharyngeal or tracheotomy aspiration
- Nasogastric feedings
- Gastrostomy feedings
- Intravenous therapy or intravenous feedings
What is the Pre-Admission Review Process?
A comprehensive assessment of each prospective resident or program participant will:
- Determine that the individual has a diagnosis of Alzheimer’s disease or related dementia
- Determine that the individual meets the Tennessee Standards for Assisted-Care Living Facilities
- Determine whether Abe’s Garden® can meet the individual’s psychosocial needs, as well as those resulting from his/her cognitive and physical health
- Generate useful care planning information regarding whether the individual should be admitted into the Abe’s Garden® residential or day/evening program
- Evaluate whether there are more appropriate placements or programs for this individual
The assessment will evaluate:
- Previous medical and psychological testing results and diagnoses
- Current cognitive functioning (using validated cognitive assessment tools)
- Communication abilities
- Current medications
- Current health status
- Physical functioning (e.g., ambulation, activities of daily living that he/she can do independently, those that require assistance and how much assistance is needed)
- Sensory capabilities
- Behaviors that are inappropriate or difficult for family members and current caregivers to address
- Personal background (e.g., occupation(s), education, hobbies, family information, cultural preferences, spiritual needs and preferences)
- Lifestyle preferences (e.g., time of day that he/she prefers to wake up, eat breakfast and bathe)
- Activity preferences and ability to participate and succeed in specific engagement opportunities
What do you mean by “Person-Centered Care?”
Person-centered care describes the Abe’s Garden® philosophy of providing care, delivering services and offering programming based on the interests and preferences of each resident, rather than the staff’s need to complete tasks. To do this successfully, we will need to be well informed about your loved one’s past activities, career, hobbies, and preferences in food, music, etc. Our staff will combine an understanding of who they were before dementia changed them with their current skills, interests and preferences. The focus will be on what they are able to do now rather than lost abilities, and their profile will be updated continually.
How will my loved one be engaged throughout the day?
We employ Montessori life skill principles that encourage them to care for our pets (e.g., feeding, walking and grooming them), prepare meals and snacks, and make flower arrangements for dining tables. Residents have opportunities to participate in discussion groups and reading programs, and to work with music, art and/or dance therapists who will engage them in programming to support self expression and interactions with others.
Additionally, our art, music and dance therapists, along with our engagement coordinators, create intergenerational programming, educational opportunities, reminiscing groups, physical fitness (organized walking, dancing, etc.), individualized, purposeful projects and 24/7 memory stations. Abe’s Garden® also offers driving tours, horticulture and dementia-specific computer programs to meet the broad interests and abilities of our residents.
Will he be able to bring his pet with him?
Abe’s Garden® has community pets for the enjoyment of residents, staff and visitors. If desired, supervised pet care will be included in your loved one’s care plan. Abe’s Garden® has selected pets with the assistance of a pet committee that includes a veterinarian and pet behaviorist. The dogs and cats are well trained, able to get along with each other and monitored for appropriate interactions with our residents, staff and families. Residents’ pets are welcome to visit in their individual, private suites, but cannot reside on campus.
How will you keep her safe?
As residents are not expected to call for help when they need it, staff check on them frequently. Care partner participation in engagement programming, as well as assisting with activities of daily living (ADLs), such as bathing, dressing and mobility support, will result in a clear understanding of your family member’s active and quiet times.
Additionally, the Abe’s Garden® leadership and design teams have created a campus with numerous elements that reduce the exiting impulse and subtly redirect residents who seek to leave the community.
You and the Abe’s Garden® team may determine the need for 1:1 care. In that instance, our team will develop an individualized plan with an ancillary fee.
How will you work with my loved one when he/she doesn’t want to participate in group activities?
The engagement center in each resident suite contains baskets in which personalized activities are placed to be used as an alternative to the multiple simultaneous, previously mentioned group activities.
The residential common areas feature centers with alternate activities customized for residents living in that household. Additionally, the daily schedule encourages residents to move seamlessly from breakfast to life skills engagement, to group or individual programming, lunch, quiet engagement, etc. As care partners learn your loved one’s patterns and rest times, encouraging participation will become personalized.
What happens when residents refuse to take a shower?
Most behavior has a cause; acting as a detective to determine what causes the resistance is the first step. Perhaps the bathroom is cold, or they are experiencing pain or discomfort when undressing or being bathed. Staff are trained in the evidence-based “Bathing Without a Battle” approach, in which there are many options for transforming a bathing battle into a pleasurable experience. Care partners are empowered to adjust the daily bathing time or even offer a waterless hygiene option.
Finally, walk-in/roll-in showers in each suite provide a preferable alternative to bathtubs or standard showers, which are often frightening and/or painful for people who have dementia.
What happens when they enter the last stages of their illness?
The evidence-based I’m Still HereTM approach keeps residents as actively engaged as possible, capitalizing on retained operational memory to maintain involvement in their ADLs. In the later stages of dementia, the engagement is more personal, focusing on sensory stimulation and comfort. Music, lights, fragrances, touch and taste are used. During meals, care partners will guide your loved one’s hands to help them feed themselves, and puréed food will be prepared to look appealing and similar to solid food.
Under what conditions would my loved one have to move out?
It is our goal to support our residents in staying at Abe’s Garden® throughout the course of their illness. We work with a home health agency should your loved one need additional care, and hospice care will be available as end of life approaches. A limited number of circumstances necessitate a move to a skilled nursing facility or hospice residence. Examples include: behaviors or health issues that create an unsafe environment for others, such as a contagious illness or combative behavior that cannot be safely managed; inability to meet the Tennessee Standards for Assisted-Care Living Facilities *; or inability to meet his or her needs appropriately. Relocation decisions will be made by the entire care team, with a satisfactory plan finalized prior to initiating any changes.
*A copy of this document is available upon request.
Care Partners, Nursing and Medical Team
How do you hire and retain quality care partners?
Abe’s Garden® has a career path and a novel, improved compensation model for direct care employees. Care partners are empowered to make decisions for their residents’ care, and they participate in engagement activities in addition to assisting with ADLs. They benefit from a set weekly schedule rather than frequently changing schedules, which are common in senior residential care settings. These approaches to staffing allow us to reward and revere these employees and make Abe’s Garden® a desirable place to work. This also reduces burnout, call-outs and turnover, and supports the longevity of our staff, which is the best practice for our residents.
What kind of training/credentials do they have?
Abe’s Garden® employs a full-time professional educator, who is a gerontologist with more than 30 years of experience in the field of aging with an emphasis on curriculum and program development. This individual oversees employee training, as well as community and family education initiatives. Every employee receives dementia and person-centered care training. Direct care employees receive additional ongoing training with pre- and post-tests along with an evidence-based approach to skills integration, including a competency-based demonstration of skills. Sample training topics include best practices in dining, bathing, pet care and visual and performing arts.
What kind of nursing and medical care is available?
A RN nurse manager is on site or on-call 24/7. Additionally, a RN or LPN is available to manage and distribute medications from 11:00 p.m. – 7:00 a.m. (medication schedules will be coordinatedwith your family member’s physician). The nurse manager is involved in the initial and ongoing assessment process and assists in the management of health-related issues including diabetes and heart disease. Additionally, the organization has contracted for weekly on-site appointments with a nurse practitioner overseen by a physician experienced in working with individuals with dementia. A licensed podiatrist will visit the campus regularly, and we are also exploring a mobile dental unit to address dental hygiene needs. If at any time healthcare needs exceed what we can safely manage or our licensing permits, we will work with you to develop a plan for your family member.
The Club and Respite Care
What is The Club?
The Club at Abe’s Garden® is an extension of our residential program for those who still reside at home.
Your loved one will have the same thorough review as our residents, enabling the staff to appropriately program to meet their needs. Similarly, a care plan will be established and updated every six months, or as needed, to determine appropriate programming. Through participation in The Club, your relatives may join our residents in all programming that meets their interests and capabilities.
Monthly membership plans are available for five days per week (Monday through Friday), three days per week (Monday, Wednesday, Friday), two days per week (Tuesday and Thursday) or drop-in (based on availability). Early arrival, late stay and an evening program are also available.
Understanding there may be unforeseen circumstances, an overnight stay may be possible if a suite or suitable recliner is available. Respite care may be available for a brief stay by Club participants. This service will be based on availability as well as other individual factors. Separate fees will apply.
Relationship with Vanderbilt University Medical Center
What is Vanderbilt’s role with Abe’s Garden®?
Abe’s Garden® is developing best practices for dementia care through its collaboration with Vanderbilt Center for Quality Aging. This partnership allows Vanderbilt to develop a joint research program targeting improvement in the quality of care provided to residents. In addition, three Abe’s Garden® benefactors established the Vanderbilt University Abram C. Shmerling, M.D. Chair in Alzheimer’s Disease and Geriatric Medicine. This faculty member is providing opportunities for Vanderbilt to lead and direct key partnerships for applied research on dementia, as well as overseeing other initiatives designed to provide quality, on-site medical care.
This relationship, in addition to those in development with Northwestern University Feinberg School of Medicine and other major medical centers and universities, provides the promise of additional collaborative opportunities.
What kind of research is being conducted at Abe’s Garden®?
Initial research is focused on best practices in dementia care, observing daily care, resident participation and how environment influences participation.
Will my family member have to participate in research projects?
Requests for studies that include human subjects require a rigorous process of informed consent from the family or power of attorney before a resident is enrolled. Your family member has the right to be excluded from any or all research studies.