By: Alexandra Cohl
Interview with Brad Smith: Memory Care, Dementia, and Multi-Generational Living
For this week’s post, I spoke with Brad Smith, the founder and principal of BSA PlaceCreation landscape architecture and planning. He shared with me about his mother’s experience living in an “accidental multi-generational” space associated with Dunklin Memorial Church in Okeechobee, Florida. Dunklin was founded in 1962 by Brother Mickey Evans and his wife Laura Maye and initially began as a rehab space for men dealing with alcoholism. Now, the camp treats more types of addictions and problems through a Christian-based lens and many of the men now on staff have gone through the program. While the families of these men can visit during the weekend, many have continued on for leadership training and have begun to live on the property, creating a multi-generational community. Thus, is the case for Brad’s 89-year-old mother, Cinda, who still lives on the property even though her husband has now passed away.
The community consists of about 150 residents, with around 50 of them men who are in the rehab program. Cinda is currently the oldest resident and is followed by a few other women close to her age, middle-aged parents and their teenagers, and parents with young children. While Cinda has one nurse who visits the community, a few particular residents tend to her care now that she has dementia and needs more assistance. In this interview, you’ll often see Brad mention Brenda and Dawn, two women whose ages range from mid-thirties to forties and who are both friends and caretakers of “Miss Cinda”. Her relationship with them showcases the way that these ongoing multi-generational relationships have impacted both generations for the better. Brad also offers insight into how for his mother this lifestyle has been beneficial to her memory care.
This interview has been edited for clarity and flow.
Hi Brad, thanks so much for talking with me today. Can you give me a few words about BSA PlaceCreation and how you came to develop P.L.A.C.E, the acronym for your company name?
Sure. The tag line that we use is that we're landscape architects and planners focused on enhancing well-being through the timeless design of sustainable exterior spaces.. Placemaking was pioneered by Andrés Duany, but our take on it centers on the PLACE acronym, combining planning, lifestyle, aesthetics, community, and economics to create places through the purposeful development of outdoor space. We also like to also look at the important relationship between indoor and outdoor spaces.
That's great. And you are also starting to collaborate with JSR Associates for a Residential Assisted Living project in Indiana. Can you tell me a little bit about that?
Well, that's a small individual household project on three residential lots, and we want to do four households. Rather than just slice that rectangular piece of property equally into four chunks, we want to create a planned unit development. We start by looking at the hand we’ve been dealt. Where are the big trees that are on the site? And, rather than just going in and doing wholesale clearcutting of those trees and plunking down four houses, how can we preserve those trees and build a little more densely in the open areas of the site? Do we (or do we not) preserve one of the swimming pools behind the existing residential house? But even more so, how can we position those households in such a way that we can create some interesting space between the buildings and what goes on indoors that might affect the relationship to the outdoor space? We want the residents to get outdoors and enjoy a garden setting and benefit from the whole idea of the restorative effect of nature. There is a wide body of research, of evidence, that the biophilic design principle is true and that we're all kind of hard-wired to have connections with other living things. So, how do we do that in a safe and thoughtful manner?
We had done landscape architecture for years, but when we first started doing memory care assisted living, I’d never experienced such research-driven design. We had a PhD researcher sitting at the table, and she and the architect had actually locked themselves in a memory care residence overnight because they wanted the immersion experience of what it’s like to live in in that kind of environment. We found that a lot of times with memory care, you have wandering issues, so often times there are walled garden spaces, and it’s the only option available for residents to get outdoors and to enjoy free movement. So, how do we create space that’s meaningful and that triggers life experiences that they have had? The answer to that depends on the population. You know, it’s not a one size fits all and it should be something that evolves and changes over time. Those spaces would change as the population changes. Much like a house. You have your own way of doing interior decorating. You do that outdoors. So, I’m getting off track a bit, but there is a memory component as well with this project in Indiana with Jane and her team.
Yeah, I would suspect so, especially if it is senior living focused. And I just think about my own grandparents and my grandpa, who’s kind of struggling with his memory now and I’m thinking about the space he lives in and how it’s either helping or not. I know today we are primarily speaking about your mother, who is close in age with my grandparents, and how she lives in an “accidental multi-generational” setting and how that has come into play with her own care and experience with dementia.
Yes. For a story, I tell people that my 89-year-old mother is living in a drug and alcohol rehab facility and they are kind of like “Oh, my goodness!” She and Dad moved down there over 20 years ago. They had been commuting and would spend long weekends at Dunklin and then come back to their home in Palm Bay. Their focus was on the marriage relationship, and they worked with the men in the program and their wives over the weekends. Dunklin has a motel on the property, which is mainly provided so that the wives can come in with the kids for the weekend and hang out as a family with dad who is in the program, and then the rest of the week, the men are focused on the heart work (and physical labor) through the program. So Mom and Dad would drive down to Dunklin and they’d live in this hotel and they’d bring a coffee maker and all their stuff, and then they’d pack up and go back to Palm Bay, which is about an hour and a quarter up the road. Back and forth, back and forth. Every single weekend. And finally, they just decided to take the plunge and move to Dunklin. They customized a pre-manufactured modular home, which was brought in, and they added on a garage and a big screened porch. Dad passed in 2011 and Mom still lives there in her familiar and beloved surroundings, and is now the oldest lady on the property. She has progressively gotten more and more forgetful and she’s been diagnosed with dementia. It’s just been an interesting journey to figure out how to manage this because her greatest fear is to be thrown into some nursing home and have these old people just drooling in their wheelchairs. That just horrifies her. Her mother, my Granny, ended up in a very nice Life Plan Community, but I think the cry of Mom’s heart has been, “God, don’t ever let me become my mother.” (Granny, also had memory challenges toward the end of her life). So, we’ve really tried to keep her in place as long as possible. She’s very functional in her environment. We put webcams in. It was one of the first things we did, which was a great tool just to have eyes on the situation. She also has a phenomenal young woman serving as her physician, who has been so helpful to guide us as we learn to navigate living with dementia. And then, there are two very dear ladies, Dawn and Brenda, who have longstanding relationships with Mom and now serve as caregivers as well as friends. It is special because Mom served as a mentor and counselor to both of them in earlier days, and now they are giving back to her, even as the friendship remains.
Has she talked to you about this transition with her memory and whether having these women around has made it smoother or helped her deal with the changes?
That’s a great question because the answer is going to change over time. This is what’s so weird about dementia. She recently was hospitalized, and it was like everything got set back six months. All the progress that we’d made was lost. And she’s now emotionally dealing with the pain of losing the car and feeling stranded all over again, even though she had acclimated to that prior to being hospitalized. And, with Brenda, the Executive Director’s wife, and Dawn, her next-door neighbor, she had gotten into this great place where it was just kind of a rhythm. They look in on her to see how she’s doing, if she is drinking enough water, and go on walks with her for exercise. They take her on errands, and out for drives. You know, there’s that nuance of losing progress that has been gained, but in the brain and the kind of resetting backwards. That’s been a difficult thing recently, since her hospitalization, and it seems that some of the progress and normalcy that had been achieved with Brenda and Dawn has been setback. But in general, I think she knows they genuinely love her, and that they care deeply for her. She knows who they are (rather than having strangers come in as caregivers). That is a true blessing!
I don't know a lot about dementia, but I would think that having people around who can trigger memories of like, “Oh, I know this person,” helps them stay sharper or at least feel safer in their surroundings. So, I think that's really beautiful that she has that.
The familiar is so important to her. My sister and I are concerned that if we ever got to the point that we had to move her, we think she would tank. Like taking a plant that’s flourishing in the garden and you try to pot it up and transplant it, and it just droops. I’m fearful that's what would happen to Mom if she were to be removed from the familiarity of her home and the loving community there at Dunklin.
Yeah, I would imagine so. I know you’re not there every day, but I’m curious if you have a sense of what her day-to-day looks like living in this space.
Well, just the other day I called her. I looked on the camera to see what’s going on and she had a mixer out and she was baking away. She loves her baking, and she’s got her group of women she meets with weekly. She calls them her "W.O.W. women.” Women of Wisdom. They are the older women on the property. They just get together and they have this prayer time together. They’ve just developed an incredible relationship through doing this together over the years. So, that’s a big deal for her to have that socialization on Fridays. My sister’s son went through the program, and he’s moved back to Okeechobee and he’s taken on the role of doing the grocery shopping for her. So, there’s that weekly interaction with him. There’s a lot of time where she just kind of putters around and works in her garden. Dawn will take her to go exercise and they'll go down to one of the big buildings that has an area that they can walk in. She goes to church on the property and rides her little cart down there on Sundays. For a long time, she worked as a receptionist at the front desk one day a week and she would bake cookies. The men in staff training would scarf ‘em down. We told her that because of COVID that she doesn’t need to be in that kind of environment at eighty-nine with all of the comings and goings of the office environment. She still thinks she works up there every Thursday because she’s done it for so long. I keep trying to talk to her about still baking the cookies. She wants to feel like she’s useful and that she’s got something to contribute. She’s often told me, "I just, I don’t how other people do it that are my age living by themselves with neighbors that they don’t know and they’re just isolated. And I’ve got this incredible community of people around me. I just can’t imagine anything other than this."
Has her experience impacted the way that you think about landscaping and what you are creating for other seniors who are moving into new spaces?
That’s a great question. Probably in terms of person-centered design, yeah. But, I’ve never really thought about that. I think the fact that we’re not just creating “cool designs,” but rather are designing for people is important. We think about: Who are these people? What’s important to them? We had one project that we did in Sarasota and a lot of the residents came from the Midwest and would vacation for years at the beach. The leadership team wanted us to develop a memory care garden that would be evocative of the beach, and so we set up different zones within the garden that might be reminiscent of the progression from the parking lot through the dunes and out to the beach at an oceanfront park. But, you also have to understand what’s going on inside the head of a person who’s living with dementia. This is where the research aspect comes in. We deal with occupational therapists and gerontologists who provide insights to us. For example, did you know that the shade patterns from an overhead structure like a pergola can be very disconcerting to someone living with dementia? I didn’t. Or, take depth perception: two different colors on the floor might make it seem like I’m stepping into a hole if I had dementia. You have to understand what goes on in the mind and how the mind changes over time. It’s not just forgetfulness, which is mainly what Mom’s reality has been--just a short-term memory loss--whereas for others it’s a whole other ballgame. So, trying to understand that and understand what’s meaningful to the person living with dementia is paramount when designing outdoor spaces for them.
How has it affected you outside of work and what do you notice about this multi-generational lifestyle that might be missing from other places?
Let me share with you from a personal perspective. My wife and I just three years ago moved from where we’d been for thirty-six-years. We bought a little bungalow in a historic district and renovated it. We live in this really cool neighborhood that’s walkable, close enough to walk to downtown and go to a restaurant. Next door, we have a dear young couple and their three-year-old son who we’re like grandparents to. You’ve got a little bit everything here in our neighborhood and it’s not like your typical homogenous gated community where everybody’s in the same socioeconomic bracket or the same race or ethnicity. That’s what makes it such a great neighborhood. To me, what’s important is relationships and rootedness in a community; that you don’t just pull the car into the garage door and the garage door goes down and you don’t even know your neighbors. I think that’s too much of America today. It’s great for seniors to be able to age in place, which is what Mom has done; it’s familiar. The worst thing would be to yank the rug out from under her. Instead, we’ve had to just modify her familiar reality so that it’s safe. But on a broader level, it makes me think about where do we want to plant ourselves as people? What kind of community? How am I intentionally being a neighbor? How am I building bonds of relationship with my neighbors and building community wherever I’m planted? Is this place conducive to fostering community or not? And if it’s not, do I need to move? Do that early enough so that when you’re to the point that you are later in life, you’ve established a network around you. That’s the overarching principle of what’s happened with Mom. She’s been a part of the community and now that community is helping her to stay safely in her familiar environment. And it’s rich. You can’t always just replicate that in the market through design and through your typical IL/AL/Memory Care, Skilled Nursing continuum. But, if we want to, how do you do that? That’s a huge question for us as a culture. If you can’t get that aspect of community and relationship organically in your neighborhood, you might want to ask if those elements are part of the DNA of the culture of the place that you are considering (for you, or for your loved one) – it is essential to well-being!