“You matter cause you are you, and you matter to the end of your life. We will do what we can, not only to help you die peacefully, but also to live until you die.”
— Dame Cicely Saunders
There is a limit to cure, but there is no limit to the care, when there is no cure, a hospice provides limitless care. Hospice is the care for severely ill people and the ones whose time is limited irrespective of age. Most hospitals cannot admit such patients as the beds cannot be occupied for an indefinite time because terminality is unpredictable.
Hence, hospices provide such patients with good nursing, home environment, and personal integrity. It ensures a psychologically stable state for them and their families.
The purpose of hospice design should be to make these patients live their life to the fullest before the Big Adios. Research in hospice design is very important for improving the quality of care, quality of experience for the patient’s hard time, and understanding of the patient’s mental state at the end of life. However, there are many challenges in designing a hospice.
Contemplating on the learnings from researches and some good case studies of hospice design, these are the guidelines for designing hospice care:
1. Quality of Light
The proper balance of natural lighting combined with artificial lighting helps in maintaining proper vision, regulates sleep and circadian rhythm with improved mood and psychological state. Artificial lighting should have the provision to control the glare and contrast because different patients require different ambient lightings. Older people require increased light levels as less light reaches their retina.
There should be maximum access to natural lighting through windows and skylight in all the spaces with control on the light intake through curtains, shades, and blinds.
Lighting also has profound effects on mood, emotions, and wellbeing. Bright light triggers both positive and negative emotions. Psychologically, light impacts our depression scores and cognitive performance, such as reaction time and activation.
For example: Centre For Cancer And Health / NORD Architects
2. Thermal Comfort
All the spaces of the hospice should be checked for comfortable thermal levels. Patients and their families should be provided with adjustable temperature control. Thermal discomfort induces agitated behaviour and an unstable psyche state in patients. Sun direction for windows should be checked properly, and heat blocking curtains need to be ensured. Heated blankets and warmers should be continuously available to patients.
The construction material and interior material of the hospice building are very important for thermal consideration. Temperature control through Air conditioners all the time is not healthy for patients, so materials with inherent cooling properties such as stone walls, brick walls with hollow space in between, etc., should be considered for constructing a hospice.
- The Benziger Hospice Home by Srijit Srinivas – Architects, Thiruvananthapuram, India
- Hospice House, Hospice of Spokane by ALSC Architects North Washington, WA.
3. Access to Nature and Views of Artistic Paintings & Installations
Psychologically it has been proven for a long time that nature calms our body, helps in healing faster, and connecting spiritually with life. So, hospice spaces should be designed with direct access to nature or by developing outdoor natural elements such as bird feeders, ponds, and landscaping such as flowerbeds, and greenery.
Design should ensure access to such features through patios with doors that are easily navigable by patients in wheelchairs or through large windows overlooking the beauty of nature as vantage points for bed-ridden patients. Apart from this, Sheltered outdoor spaces should be designed around the hospice campus for the enjoyment and gathering of the patients and family members.
Walls should be adorned with one or two Artistic paintings that are purposefully created to calm a person’s mind with light and soothing colour palettes and patterns. The ceiling should also be minimal with light patterns, if required, to relax a patient’s mind. These positive distractions can improve a patient’s psychological state by releasing happy and healing hormones and reduce their sufferings.
For example: Urban Hospice / NORD Architects
4. Colours and Patterns
Colours are powerful tools to influence the psychological reactions of a person, and they are infused with healing power to help patients in their actual recovery. Colours can affect a person’s mood, feelings, and emotions, as also said by the artist Pablo Picasso: “Colours, like features, follow the changes of the emotions.”
In a closed space, colours also make the room space look larger and spacious.
Using soft and soothing colours such as pastels and neutral colours with low saturation creates a peaceful and relaxing environment. Dark colours create agitation and blood rush in a person. Beddings, furnishings, and curtains should not be loaded with busy patterns that can trigger emotional distress but simple and soothing patterns for settling the mood.
Certain colours have been associated with different triggers in the human brain, such as:
- Blue symbolizes the sky and is associated with a soothing mood. It is often said that it lowers the heart rate, blood pressure and allows the body to calm down. Blue also de-stresses the brain and helps in sleeping well.
- Green impacts a person’s cell structure and is good for heart and blood problems.
- Pink and white are considered to be healing colours by nurturing through their calming tones.
For example: Urban Hospice / NORD Architects
5. Relaxed Atmosphere with Natures Sound or Positive sensory Stimulation
A hospice environment should be created to feed positive stimulation to all of the senses of a person.
- The visuals, as discussed, should be designed with the objects and attributes that lessen the perception of pain and bring tranquillity. Visuals that make patients feel like a home environment should be incorporated, such as space for idols of patients and family religious beliefs, space for books, flowers, etc.
- Music and sounds of nature reduce stress, soothes pain, and helps in healing. So Patients should be provided with the soothing and serene music and sound of their preference. The designer should be mindful that the sound does not disturb the other patients in the adjoining room or space.
“Music, art, and poetry therapies are becoming popular forms of patient care in hospice settings as forms of reflection and expression of life experiences and reviews.” (Wlodarczyk, 2009)
- Rooms should be graced with positive aromas of fresh air, fresh flowers, natural wood, keeping in mind the specifics of patients in terms of odour.
- Construction material and materials of interior elements should be chosen with great care to align with the psychological understanding of tactility. Finished and hygienic material for objects and furniture while Cotton clothes for interior furnishings have proved to be the most hygienic material for health care.
For example: Karunashraya, Bengaluru, India
6. Location of Hospice and Noise Control
The location of the hospice should be chosen intelligently and carefully. It should be located in remote areas, away from the city and far from traffic disturbances with serene beauty and a green environment.
If due to any conditions, a hospice in the city area should be employed with sound-absorbing surfaces all-around an artificial environment needs to be created. Also, the rooms of individual patients need to be soundproof to prevent the unwanted noise of staff conversations, equipment mobility, etc.
For example: Hospice of the Central Coast, Monterey, California
7. Circulation Space
The circulation of Hospices should be simple and directory with bold signages so that the patients do not face any difficulty in finding any space and their rooms.
In-patient circulation space should be segregated with the attendees and staff circulatory path. It would ease the transition. Long corridors should be avoided and wide circulation paths and spaces need to be created for accommodating activities on the pauses and allowing the flexible movement of the people.
Also, the widened space will allow wheelchairs and hospital beds of patients to move and turn in hassle less manner. For the vertical circulation, Steps are to be completely avoided for patients and lifts should be equipped with the necessary nursing equipment.
For example: Maggie’s Centers
Hospice rooms should be designed to respect the privacy of each patient and their family. Therefore single occupancy rooms should be the first preference of creating spaces, and further designing multiple suites with necessary partitions, screens and clear signage, and demarcation of patients’ territory. Family needs private space for conversations, confidentiality, and grieving.
These factors of privacy needs are to be specifically taken into consideration by designers and architects while designing a hospice.
Some patients also need multi- bedrooms to alleviate the feeling of loneliness and isolation. It keeps the patient’s mind active and sane by the interaction and visual connection with other people. Hence different configurations of private, semi-private, and public rooms should be created.
For example: New Building of a Hospice in Witten by Krampe-Schmidt Architekten BDA
9. Finishes with low maintenance
Hospice furnishings and objects surfaces should be finished with durable and easily cleaned materials so that it does not require heavy maintenance. Cleaning and maintaining all the surfaces are essential in such health care systems.
Personal hygiene of every patient needs to be ensured, such as bidets, shower stalls, etc., for a caregiving system during baths and toilets. A separate room for the support system that changes daily clothes and linen stocking should be designed.
For example: Urban Hospice, Denmark
10. Home Environment with Social Interaction
Last but very important factor to consider with all the other factors of hospice design is facilitating a home environment to the patient with the support of family presence and social engagement with other people in the hospice. Shared spaces and common spaces for community engagements and gatherings should be created to encourage connections among people and create a friendly and congenial environment.
Comfortable and flexible seating options should be provided in common areas and living rooms to socialize with others, interact and relax. Ramps should be provided for outdoor strolling to patients. Hospice should also have other common spaces such as an outdoor patio and dining space with soothing nature experiences. There can be a quiet and meditative area for prayer, spiritual reflection for patients and their families.
For example: Arcus Center for Social Justice Leadership.
The end-of-life experiences are very precious for a person and, more importantly, their last memories with their loved ones to the patient’s families. Designing a supportive and congenial environment with unique experiences for these people can be challenging and, at the same time, satisfactory work. Sponsors, designers, and architects should make informed decisions to create every single space very intelligently and psychologically efficiently.
The above comprehensive list of guidelines is intended to kick the thought of a coherently designed space for such people. These demonstrate that designers possess the skill to give them the most gregarious experiences of their life.