One-on-one with…Andrew Sandler, PhD

Abe’s Garden is starting to bear the fruits of its labors. The 42-bed memory care facility opened its doors in 2015 and is already changing the landscape of memory care. The Nashville, Tennessee-based nonprofit has partnered with The Hearthstone Institute and has implemented the “I’m Still Here” training model developed by John Zeisel, PhD. Abe’s Garden is also the first senior residence in the nation to partner with a major medical university to conduct clinical research and establish an endowed chair in Alzheimer’s and geriatric medicine. I Advance Senior Care’s Senior Editor Nicole Stempak spoke with CEO Andrew Sandler, PhD, MHA, MA to learn more about the purpose-built memory care community that’s giving residents purpose, too.

How did visiting other memory care communities influence and inspire you?

We visited several communities that were doing a great job demonstrating how to apply person-centered care in areas including engagement, dining, day/evening care programming and pet programs. Unfortunately, though, person-centered best practice approaches are not being implemented in most American memory care communities. Programming in these communities did not look significantly different from programing in their non-memory care parts.

How do you define a dementia center of excellence?

A center of excellence studies, implements and shares best practices. Additionally, it systematically evaluates outcomes and makes improvements where necessary. It must always question what it’s doing and try to get better. Abe’s Garden pursues this approach in interior, landscape and architectural design; engagement; workforce development; activities of daily living care; behavioral, cognitive and physical health; and family support.

What do best practices look like in the future?

Research has shown the traditional way of training staff in classroom settings is ineffective and is a contributor to high turnover rates. New training strategies need to be implemented so we’re not putting adult learners in a room for 30-60 minutes and expecting them to learn and apply the material with residents. Competences should be evaluated by staff observations and not simply with a written test.

Nearly all assisted living and nursing home communities evaluate the success of their programs by staff documentation. Research has demonstrated that this staff documentation is often erroneous. Future best practices will identify improved ways to accurately evaluate the delivery of person-centered ADL care, resident engagement and staff compliance with tasks such as providing snack and meal assistance.

What’s your approach to training?

Staff training at Abe’s Garden is rigorous from the outset and never ends because there are always caregiving skills that can be improved. Ongoing training incorporates the Vanderbilt Center for Quality Aging weekly staff training model, which is based on brief sessions of 10 minutes or fewer. These sessions focus on one key area the clinical leadership team identifies as in need of improvement, such as making eye contact with a resident, the preferred method to invite residents to engage in group activities or how to cue residents during mealtime. After each 10-minute training session, relevant staff are observed to determine if the approach has changed. Then we provide feedback when we meet during the next weekly training huddle. 

The staff find it beneficial to get feedback immediately. The feedback they’re given isn’t disciplinary, it’s instructive. Most of it is positive because they’re doing it correctly. They’re motivated to get better because successfully completing the career ladder is dependent on demonstrating these competencies and results in increased hourly pay. We think a team approach is the best way to provide personal-centered care. That’s why everybody—cooks, housekeepers, care partners, nurses and life engagement staff—are required to complete the career ladder.

Why did you hire a full-time professional educator?

We knew the ability to provide quality person-centered care in a community of individuals with dementia is directly related to the effectiveness of the staff training program. The only way we could develop this program is to hire somebody with that kind of expertise. Beverly Patnaik, director of staff training and community education, was living here in Nashville and eager to lead the initiative. We’re very lucky to have her because her assistance and the development of this career ladder and the competency program has just been invaluable. It’s a program we continually tweak and improve.

What advice do you have for readers?

We were fortunate to be able to build a community with best practice architectural, lighting, interior design and courtyard features. Communities that can’t change those variables can still improve the way they teach their staff and the way they evaluate the care they’re providing. Person-centered care doesn’t have to cost more money. If you don’t train your staff effectively, you’re going to have high turnover and that’s expensive.

Sandler will speak at the Institute for the Advancement of Senior Care's Spring Memory Care Forum on May 22-23 in Philadelphia. Learn more and register for the event at

Topics: Alzheimer's/Dementia , Articles