In part two of this series on hospice design, Ila Burdette of Perkins+Will discusses how good design considers the needs of the patient and the family members to provide a variety of comfortable and appropriate settings for all types of gatherings.
Last week we explored strategies Perkins+Will uses in making friendly buildings to draw in all comers. Once users enter a well-designed hospice, the welcome is expressed in rooms tailored to make them feel at home. In fact, hospice programs include a little of everything, from quiet meditation rooms to multimedia conference centers, with secure medication servers and soiled utility rooms to boot. Thoughtfully selecting an appropriate mix of spaces and laying them out is an art that comes from understanding the users and their interactions.
Programming: Places to Talk
Think of the variety of conversations inside a hospice. A window seat or inglenook is a good place to comfort a child, but is probably not the right venue for a physician to deliver confidential news to a family. Families telephone distant relatives and provide updates. Memorial services can be large, joyous, and noisy gatherings. Visiting teenagers may want to quietly read or rollerblade in the garden. Toddlers chatter in supervised acoustically buffered playrooms.
Some groups only gather in formal conference rooms during the day; others get together for midnight snacks around a popcorn popper. A range of space sizes and types, both intimate and large, with appropriate levels of privacy and separation, will accommodate various family and community gatherings. Chapels, music rooms, libraries, sunrooms, kitchenettes/ dining rooms, and quiet rooms all play different parts. Locating them so each works for its specified use is the first step, but we also often find that some are naturally clustered and can open into each other to provide additional flexibility in sizing.
Laying Out Spaces: Perception is Key
Hospice layout depends on the relationship between the patient room and the spaces devoted to families, who are an essential but unpredictable part of palliative care. Each patient bedroom is required to provide overnight accommodations for one family member, but extended families can include many members.
Families come in every flavor. They can be close or estranged. They may have everything or nothing to say to each other. They may stay 24/7 or visit for only 10 minutes. There are two common threads: all families are under stress from impeding loss, and all want to be within earshot of their ill loved one. No matter how much a daughter needs a break, if she fears she will not hear her father’s call, she will not step away from his bedside.
Family living rooms immediately outside patient rooms are heavily used and greatly appreciated, especially when they incorporate features like exterior views and a variety of conversation, dining and quiet activity areas. On the other hand, living rooms that are physically just around corner or down a short corridor may not be used at all if they feel psychologically remote. Household or pod configurations do a good job preserving this key adjacency, and simultaneously breaking down the building mass.
Personalizing the Patient Room: Making It Their Own
A good patient room enables individual control, de-institutionalizes necessary medical features and provides livable space and storage allowances to generously house patients and families together. Since patients may spend several weeks in a residential hospice, they appreciate every opportunity to make rooms their own.
Millwork should be extensive enough for keepsakes, flowers, photographs and family items. Headwalls that disguise medical outlets and switches, and the judicious use of millwork colors and materials keep rooms from appearing institutional. Overhead ceiling fans, double shades (screening and/ or blackout), and individual room thermostats afford patient control. If reading lights are attached to beds, not headwalls, patients can adjust the bed locations.
Our plans often include private porches entered through double doors from the patient room so beds can roll outside. Beds for family members built into window seats preserve crucial nursing space around patient beds so the room remains uncluttered by pullout beds; the window seats also provide welcome additional seating during the day as well as storage beneath.
Next week in Part 3, we’ll discuss the ways hospice buildings can take advantage of landscaping to extend their programs outdoors.
Ila Burdette AIA, LEED BD+C is a Principal with Perkins+Will where she leads the firm’s research and design of senior living projects, including hospices, continuing care retirement communities, assisted living, skilled nursing, and Alzheimer’s facilities.