Hospice Precedent Analysis

The five design precedents I’ve focused on include more than just hospices. I’ve also included designs of other buildings used for health care because I’ve found most hospice design more focused on ticking of boxes than actual good design. Either that or it’s just really outdated.

Precedent Examples

The first example I’m including is Maggie’s Gartnavel by OMA. Maggie’s Cancer Care Centres are now scattered around the UK. When architect Maggie Jencks, wife of architect Charles Jencks, was diagnosed with terminal cancer in the mid 1990’s she found the gloomy NHS facilities anything but healing environments. It was Jencks’s belief that good architecture can help make a distressing situation more manageable. To date, fifteen Maggie’s Centres have been built in the UK, each by a leading architecture practice.

Maggie’s Garnavel was designed by OMA, Rem Koolhaas’s practice. The building is designed as a sequence of interconnected spaces. Outside walls are predominantly glass, both transparent and translucent. The translucent glass offers light & shadow with privacy – all things that become increasingly important the closer to the end of one’s life one gets. Maggie’s Gartnavel is designed around a central garden courtyard. Hospice designers seem to agree that garden and central open areas are an essential part of good hospice design.

Aires Maleus Arquitectos’s House for Elderly People is designed to be something between a hotel and a hospital. The designers understand the need for both a social life and solitude and so have included spaces within the complex that allow for both. Whilst most hospices tend to shy away from corridors, wanting to create spaces that are more open, Residências Assistiadas welcomes the corridor, seeing it as an analogy of the path into life, turning time into form. To illustrate this, a line of light, recessed into the ceiling, follows the path of the main corridor.

Estudio Entresitio have designed three health centres with the same floor plan for three different sites. The buildings differ in the materials that have been used. Usera’s centre is clad in perforated metal panels with a gold finish, San Blas’s concrete construction with horizontal timber casting is finished with blue tiles, and Villeverde is finished with varying degrees of translucent panels from opaque through to transparent.

These buildings offer privacy from the outside and an openness within. The design is loosely based on a grid form that allows for both public and private spaces within. Courtyards throughout provide light and create a feeling of openness so that corridors are not just uninterrupted, visually limiting walls.

WE’s Cancer Care Centre in Denmark is designed around a figure 8. The space is divided into three parts: user facilities, common zone, and staff area. Once again, courtyards and gardens are an integral part of the design. Rooms are light and warm. Timber is used on the ceiling and the floor. The inside and outside are indistinguishable in parts, adding to the design’s atmosphere of openness.

The Maitri AIDS Hospice in San Francisco is especially interesting to me. Like my own site, this one is in the inner city and is adapted from a former garage. Unlike my site of 488m2 the Maitri AIDS Hospice is 4,450m2. That’s a huge difference.

Kwan Henmi Architecture have designed a space that, once again, revolves around a central courtyard. The interior is designed to have a residential feeling with lots of soft furnishings included. Patients are welcome to bring their own furniture and other personal items for their bedrooms.

Spaces & Services Required

Last Thursday I was lucky enough to be given a two and a half hour tour of Mercy Hospice on College Hill in Ponsonby. This provided me with invaluable information on what spaces and services are required to best run a hospice.

In Hospice Architecture, Stephen Verdeber writes that there are seven different areas to take into account when planning a hospice. My own visits to hospices have given me examples of the rooms that fall within these areas.

  1. Site & context
    close to hospital care
    parking
  2. Arrival spaces
    reception
    ambulance bay
    expressions of remembrance
  3. Residential milieu / common spaces
    family rooms
    kitchen / dining room
    resource library
    art therapy room
    aromatherapy room
    dayrooms
    activity rooms for children
  4. Residential milieu / private spaces
    bedrooms
    bathrooms
    nurses’ station
    staff kitchen
    drug room
    hydrotherapy room
    laundry room
  5. Transitional spaces
    circulation paths
    elevators
    chapel / meditation room
  6. Connections with nature
    gardens
    courtyards
    large windows
  7. Administration / total environment
    sluice room
    cleaner’s cupboard
    storage
    offices
    bereavement counselling room
    backup power generators

That is a LOT of rooms. At this stage, I’ve no idea how I’m going to fit all of those spaces into my small site (and it seemed so big to start with).

Lighting

Natural daylight is essential for mental well-being. However, more is not better. When patients first enter hospice they are often drawn to natural daylight but as their health diminishes they often seek out darker spaces to retreat to. Private spaces especially need to be designed so that both natural and artificial lighting can be controlled by the resident.

Refracted light through recesses and skylights is a good way to bring light into a space without being drowned in it. Directional wall-fixed lighting helps to create a more tranquil atmosphere than overhead lighting whilst leaving the ceiling free from glare. Hospice patients spend a lot of time on their backs in bed looking at the ceiling. Overhead florescent lighting or strong halogens are not comfortable to be staring at for any length of time.

Plumbing

Every bedroom needs its own bathroom. This includes a sink, toilet, and shower with floor waste. NZ regulations state that all hospital rooms (and hospice falls within that category) must also have basins within the bedrooms. Taps should have motion sensors for operation as strength is reduced.

Larger hospices will have full kitchens and laundries but many smaller facilities house these offsite. Family kitchens need dishwashers and sinks for both food and for cutting flowers. The art therapy room will need a sink and running water. The hydrotherapy room, depending on the type of bath may need special plumbing. Walk in baths, with doors, need especially large wastes so water can drain quickly allowing the patient to stay warm. Even if laundry is done off-site a small laundry should be available to families who may be staying with their loved one. A sluice room and a cleaners’ room are needed for keeping everything clean and sparkly. At the very least, plumbed cleaners’ cupboards should be available on every floor.

Ventilation Requirements

Bedroom windows should be easily operated by patients. Remote control operation would be optimal. Each bedroom also needs to be individually controlled. As people’s health declines their temperature can fluctuate. As the body shuts down they can feel very cold so it’s important that they are able to turn the heat up if they want. Once the patient dies, it’s important to keep the room very cold so that family can come and visit and say goodbye before they body is transferred to the funeral home.

Although hospice have a policy of no resuscitation, oxygen still needs to be available in all rooms for those with respiratory disease. Piped oxygen can be expensive to install and maintain so individual bottles within rooms may be a better option for smaller facilities.

Summary

“Each moment takes on greater importance, each sensory experience a special meaning. A window is not just an opening for light and air; it frames a vista of the last sunrise. A door is more than a functional entrance; it brings in friends and family members.”
– Cynthia Leibrock, Design Details for Health.

It’s important that one’s last days are comfortable. This comfort can come from a soft bed, time spent in the garden, the sound of a crackling fire or one’s favourite music, a loving touch. Personal photographs can trigger comforting memories.

What’s most important is that the patient, and their family, feel cared for. An environment that is tranquil and calm – a shelter from the storm.

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