The Architecture of Release: Hospice Architecture

THE ARCHITECTURE OF RELEASE HOSPICE ARCHITECTURE

TABLE OF CONTENTS

Rejection of Convention Thesis Statement Who Does This Serve?

Physical Death Spirituality in Death Hospice Architecture Precedents The Site Kingman Island The Design - The Room - The Cluster - The Chapel - The Site - The Convent Aerials Return to the Room The Architecture of Release Dedication

01 03 05 11 16 21 40 50 59 63 69 74 84 89 92 95 99 100 101

REJECTION OF CONVENTION

Hospice is a philosophy and a type of care, which is not associated with an architectural typology. The result is most hospice inpatient facilities are designed by the rejection of certain architectural elements from hospitals, nursing facilities, and the home, and developing a design from what it is not.

The interpretation of home in conventional inpatient hospice facilities represents a utopian ideal of the home that is inherently nor ative t e l des di erent inter retations o the home as sites of family violence, intense loneliness, re ression, and ďŹ nan ial hardshi ndivid als hose lives have varied ro this nor ative nderstadin ay ďŹ nd spaces designed in this style upsetting, belittling, or even absurd.

Luigi, Safet Zec The Architecture of Release: Hospice Architecture

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REJECTION OF CONVENTION

os itals resent the individ al s body as a a hine to fit within a purely rational space. Edwin Heathcote, architect and author, laments, “at the exact moments we are most in need o eanin and s irit al li t, e find o rselves surrounded by the bleak expression of hygiene and e ien y r e istential ate ays are ani ested as service entrances.” 1 The philosophy of hospice is to ease the pain and symptoms of the terminally ill indivudual, while tending to their emotional and spiritual needs. This philosophy necessitates an inclusion of the architectural dimension, because spatial design is a vital element in granting the individual sensory experiences, allowing the individual the dignity of living as they are dying.

Edwin Heathcote and Charles Jenks, The Architecture of Hope: Maggie's Cancer Caring Centres, Frances Lincoln, 2010 Luigi, Safet Zec The Architecture of Release: Hospice Architecture

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THESIS STATEMENT

There is a need for a place where the abandoned - the incarcerated, the displaced, and the estran ed an re eive are, harity, o anionshi , and love in their ďŹ nal days, so they are able to live with dignity and to die with dignity. Conventional hospice care is predicated upon the idealized view of the home, or as a sterile environment. Rather than designing by what it rejects, hospice architecture should be designed by what it is, a sacred place an individual will have their last sensory experiences, a sacred space, serving as a gateway or a threshold from the here to the after. The architecture should stimulate all the senses and in doing so allow the individual to feel dignity while they remain in the world.

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THE INDIVIDUAL

“The person feels condemned to receive help and assistance from others, and at the same time seems useless to himself. he discovery of the salvific meaning of suffering in union with hrist transforms this depressing feeling. aith in sharing in the suffering of hrist brings with it the interior certainty that the suffering person completes what is lac ing in hrist s a ictions the certainty that in the spiritual dimension of the wor of edemption he is serving, li e hrist, the salvation of his brothers and sisters” “ he soul survives and subsists separated from the body, while the body is sub ected to gradual decomposition according to the words of the ord od ... ou are dust and to dust you shall return ” 2

2. Pope John Paul II. Apostolic Letter of His Holiness Pope John Paul II n the hristian eaning of uman Suffering Salvifici Doloris. Boston, MA: St. Paul Editions, 1984.

Poloniae, Victoria. Pope John Paul II. Oil Painting.

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WHO DOES THIS SERVE?

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THE DISPLACED

THE PEOPLE Based on combinations of several factors, these individuals are without a place to call home. In the U.S. the average life expectancy is around 55-58 years old FACTORS Mental illness, substance abuse, decline of servi es, e ono i hardshi s, la o a ordable housing, domestic violence, lack of employment opportunities - it is a vicious cycle that can be attributed to these and more factors CURRENT PROGRAMS most displaced peoples cycle between the hospital, the street, nursing facilities, and shelters until death. Often they die in the hospital or on the street

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THE INCARCERATED

THE PEOPLE In the U.S. around 2 million people are imprisoned in varying levels of incarceration local, state, federal - with 1 in 10 facing a life sentence, meaning death in the prison system FACTORS Life sentences for crimes, because of andatory senten in la s, habit al o ender laws, and the nature of the crime has led to a surge of inmates that are now approaching 55 & older CURRENT PROGRAMS “Compassionate release” grants sick and elderly in ates their final days o tside o a cell. Most states employ this program

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THE ESTRANGED THE PEOPLE The estranged can be categorized as the isolated, either selectively or by family dynamics, and the individual is often alone without human companionship FACTORS Family dynamics, loss of a spouse, divorce, mental illness, geographic isolation, living alone, lack of purpose, cultural barriers, and many other factors not stated CURRENT PROGRAMS The psychological and physical toll loneliness and isolation takes on the person is great and can be a contributing factor to rapidly declining health. Many of the estranged do not prepare for death and because of this are either found dead in their residence or hurt and sent to the hospital. The person may be alone even in their ďŹ nal days

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THOSE ADMITTED

The Displaced These individuals would be sent over from hospitals and clinics and need more attention and focus settling in.

Some family may be expected, but limited because of situations and strained relationships that led to them living without a home The Incarcerated The incarcerated would be those individuals released on “compassionate relsease.� Little to no family expected because of the violent or heinous nature of the crimes committed that led to them originally being incarcerated The Estranged The estranged would be admitted by friends, estranged family, or by themselves. Some distant family to no visitors can be expected, because of strained relationships and the past

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GENERAL ADMITTANCE REQUIREMENTS A diagnosis of up to 6 months to live with documentation to support the diagnosis

A mental health assessment report or similar exam

A signed Do Not Resuscitate form (DNR)

PPD Skin Test Results

The need for hospice care after all aggressive treatment(s), like radiation, chemotherapy and surgery have been completed

A signed Health Care Proxy A medical history and physical exam or consultation (i.e. narrative report)

Financial need, but those able to pay and/or with insurance are not automatically dis aliďŹ ed ndivid al ir stan es are taken into consideration

The Architecture of Release: Hospice Architecture

A list of current medications A completed application form

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PHYSICAL DEATH

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PHYSICAL RESPONSE

The body goes through several stages in the dying process that not necessarily always occur in the same order. One stage may cause another stage to begin or multiple stages could be happening concurrently, as the body is an organism not a machine. It is from this fundamental truth that the hospice philosophy stems.

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PHYSICAL RESPONSE

Increase in Sleeping Hearing Loss Labored Breathing Loss of Appetite Convulsions Hypoxia Restlessness Cyanosis Incontinence Death rattle Odors Foam at the Mouth Heart Weakens

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EMOTIONAL RESPONSE

Anger about the loss of control they may feel over the process Depression and anxiety about end-of-life quality of treatment Fear about what dying may feel like and wondering what happens after death Sadness about leaving loved ones behind and confronting past regrets Emotionally withdrawing from others Embarrassment at inability to care for themselves Guilt and regrets about life choices

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PHYSICAL AND EMOTIONAL DEATH

Foam at the Mouth

Feeling of loss of Control

Loss of Appetite

Bewilderment Anxiety

Increase in Sleeping

Restlessness Fear Anger

Convulsions Death Rattle

Withdrawn

Death

Physical Death

Weakening Heart

Emotional Death

Depression

Labored Breathing Confronting past regrets

Cyanosis

Guilt

Hearing Loss Regrets

Hypoxia

Odors

Embarrassment

Incontinence

The physical and emotional stages to death that are nuanced and unique to each individual. This graphic represents the correlation between the physical and emotional The Architecture of Release: Hospice Architecture

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SPIRITUALITY IN DEATH

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SPIRITUALITY IN DEATH The being and essence of the individual are one until the point of death, at which time the soul returns to the Father. This thesis accepts Catholic doctrine and dogmas and the Thomistic metaphysical understanding of the structure of reality.

WINDING UP OF EARHTLY AFFAIRS he individ al sho ld have their a airs and this world NOTIFYING THE PRIEST he riest st be notiďŹ ed ar eno sacraments and rituals CONFESSION he eneral a no led

ishes in order and in doin so re are the selves to not be in

h in advan e o one s ondition to be re ared to ad inister the

ent o sin

aliďŹ es the individ al to be absolved

VIATICUM Reception of the Holy Eucharist which produces sanctifying grace in the soul

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SPIRITUALITY IN DEATH

EXTREME UNCTION The Anointing of the Sick, often mistaken as a statement of death, is administered THE “LAST BLESSING” The dying person professes his willingness to a e t all his s erin s in re aration or his sins and submits himself entirely to the will of God

"Into thy hands, Lord, I commend my spirit. O Lord, Jesus Christ, receive my spirit. Holy Mary, pray for me. Mary Mother of grace, Mother of mercy, do thou protect me from the enemy and receive me at the hour of my death" The Architecture of Release: Hospice Architecture

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SALVIFICI DOLORIS n the hristian

eanin o

an

erin

“ s a result of hrist s salvific wor , man e ists on earth with the hope of eternal life and holiness. nd even though the victory over sin and death achieved by hrist in his ross and esurrection does not abolish temporal suffering from human life, nor free from suffering the whole historical dimension of human e istence, it nevertheless throws a new light upon this dimension and upon every suffering the light of salvation.”

“It is suffering, more than anything else, which clears the way for the grace which transforms human souls.”

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SALVIFICI DOLORIS

“ hrist drew close above all to the world of human suffering through the fact of having ta en this suffering upon his very self. During his public activity, he e perienced not only fatigue, homelessness, misunderstanding even on the part of those closest to him, but, more than anything, he became progressively more and more isolated and encircled by hostility and the preparations for putting him to death” “ uman suffering has reached its culmination in the Passion of hrist. nd at the same time it has entered into a completely new dimension and a new order it has been lin ed to love... he ross of hrist has become a source from which ow rivers of living water. In it we must also pose anew the question about the meaning of suffering, and read in it, to its very depths, the answer to this question”

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HOSPICE ARCHITECTURE

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PHENOMENOLOGICAL DIMENSION

This thesis project is attempting to address an architectural issue that is not being addressed today. The architecture is inward focused, with attention to the individual’s room and the sensory experience of the dying individual who needs charity, compansionship, and comfort. The kind of state ent ade by the ar hite t re st re e t the gentleness of God’s mercy and the charity shown by loving people. Rather than being bold and dramatic, I think this project calls for humility, simplicity, and richness in sensory experiences.

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THE INDIVIDUAL’S SENSES

SPIRITUAL

SIGHT

SMELL

TASTE

TOUCH

SOUND The Architecture of Release: Hospice Architecture

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DAILY CARE MIND mental stimulation- communication with the patient - companionship - physical presence - lifting up and not belittling - counseling BODY comfortable clothing - keeping skin clean and moisturized - rotating positions every two hours “range of motion” exercises to prevent pain administering pain medication - massages aromatherapy - acupuncture - regular bathroom care and trips - “spa” experiences - scented baths SOUL prayer - meditation - contemplation - music conversation - chaplain direction - reading scripture - receiving the sacraments - mass - bringing peace - experiences in nature

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MOVEMENT THROUGHOUT ROAMING e ently ad itted residents, sta , and visitors should be able to roam free

CHAIR hose that are onďŹ ned to hairs and don t have the energy to move, but are able to go from bed to a chair

WALKER Individuals that are able to walk but need assistance and may or may not be able to go outside on uneven pathways alone

BED ndivid als that are onďŹ ned to the bed and no longer have mobility, meaning the bed must become mobile to experience outdoors

WHEELCHAIR Individuals who are unable to walk on their own and must be accompanied by care takers

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THE COMMUNITY For the individuals, this architecture becomes their residence, not a medical facility. In part, it’s up to the residents and the caretakers to make it so.

The architecture must strive to create places of interaction in order to stimulate place making for those who want the feeling of community.

“People who suffer become similar to one another through the analogy of their situation, the trial of their destiny, or through their need for understanding and care, and perhaps above all through the persistent question of the meaning of suffering” - St. Pope John Paul II Salvifici Doloris

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HOSPICE CARE TEAM Chaplain

Social Workers

Bereavement Counselors

Registered Nurses

Physician

Administration

ta

ro nds

Volunteers The Architecture of Release: Hospice Architecture

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PROGRAM SPIRITUAL bereavement counseling - chapel grieving rooms - meditation & prayer spaces

ARRIVAL “hidden” direct parking - protected entryway - entry sequence

PRIVATE bedroom - bathrooms - private outdoor space - overnight accomodations

COMMONS large and small community rooms activity rooms - dining - kitchen resource library - places for pets

NATURE views - natural light and warmth balconies and patios - biophilia gardens - outdoor contemplative spaces - indoor/outdoor spaces

SERVICE nurse’s stations - housekeeping building & grounds management employee rooms - storage - back of house

THE AFTER displaying - saying goodbye expressions of remembrance

The Architecture of Release: Hospice Architecture

TRANSITIONAL ayfindin arti circulation 28

lated thresholds

PROGRAM BREAKDOWN

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SPIRITUAL BEREAVEMENT COUNSELING Having a social worker or bereavement counselor available to comfort those who are in need of counsel, and need a dedicated space CHAPEL sa red s a e to elebrate GRIEVING ROOMS la e here the ra can be had

ass, rovide o

e otions and rie

ort, re rieve, and an es a e or all

an be e

ish to ďŹ nd it

erien ed, instead o sti ed, and a atharti e

MEDITATION AND PRAYER SPACES ither indoors or o tdoors, these s a es are or onte lataion, feel the need, but don’t want or feel comfort in a chapel

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erien e

editation, and re e tion or those that

PRIVATE BEDROOMS Providing privacy for the individual is important, especially for the end when most people want privacy in their ďŹ nal o ents o ortable bed ill be the last la e the individ al e ists so hile all the rnishin s are i ortant, the bed is the ost i ortant BATHROOMS alan in on the line bet een o cleanliness, and relief

ort and

edi al, the bathroo s sho ld allo

OUTDOOR SPACE rivate bal ony or atio or the individ al to easily a

the individ al riva y,

ess

OVERNIGHT ACCOMODATIONS Spaces for families and loved ones to stay overnight close to the resident in this time

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CONNECTIONS TO NATURE VIEWS More than just big windows, the architecture should frame in views to nature from the bed of the individual, so they can see the beauty up until they are no longer able NATURAL LIGHT AND WARMTH As the senses go, natural light turns into natural warmth and the individual is still able to experience life with the senses BALCONIES AND PATIOS The ability to walk out into the fresh air and bathe in the sun is so important for residents who can’t walk around outside but still crave the outdoors BIOPHILIA Introducing vegetation and plants in the appropriate manner can help those who aren’t mobile enough to go outside

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CONNECTIONS TO NATURE GARDENS Gardening can be a meditative and very contemplative act and should be provided for the residents who are able to take part OUTDOOR CONTEMPLATION SPACES Spaces of contemplation, mediation, and simply being outdoors provides a respite for the residents, family, vol nteers, sta or anyone ho needs it WATER FEATURES Water is an essential part of life and should be included in this project INDOOR/OUTDOOR SPACES a es that are a threshold bet een indoor and o tdoor s a es or are e ible to o en to the o tdoors is a ood ay to o en and e tend the li its o a s a e

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THE AFTER DISPLAYING Certain cultures practice displaying the body for a set amount of time to be mourned, either covered or open SAYING GOODBYE he la e sho ld have any di erent ays or the o ntiy to say oodbye to the individ al, ro ro essions to en ir lin the body to ro rayer, hants, or individ al are ells EXPRESSIONS OF REMEMBRANCE n e ression o re e bran e, or residesnts remembrance, and of love - Sculptures - Engravings - Plantings/Landscape - Knittings - Architectural Elements

ho have assed a ay as a sy bol o

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o

nity, o

ARRIVAL “HIDDEN” DIRECT PARKING he reality is that ar in st be rovided as ell as lose dro o or atients or elderly enterin the residen e ire t a ess is a ne essity, b t it sho ld be hidden to reserve the aestheti o the architecture PROTECTED ENTRYWAY n le ent eather rain, sno , seasonal han es a es enterin the ar hite t re di protected entryway prevents bringing the elements indoors

lt at ti es, so a

ENTRY SEQUENCE rote tin the indoors ro the o tdoors, es e ially ith residents ho are in riti al onditions rote ted entry ay, a el o in entry ay that has dire t ayfindin is ne essary

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ter the

COMMONS LARGE AND SMALL COMMUNITY ROOMS Flexible rooms that can be used for large or small group meetings and activities for residents who want to be together for companionship with other residents, volunteers, family, or others.

ACTIVITY ROOMS Since the architecture is also about celebrating the life of the individual, these rooms are for activities such as art, music, games, therapy, etc.

DINING Food is such an essential part of being human and having a dedicated table where bread can be broken, while still having the option for private eating in the individual rooms.

KITCHEN Opening the kitchen to residents who still have the desire to cook will give them dignity as their life comes to a lose bvio sly not all ill have the a ability or desire to oo , b t it an a e the orld o di eren e to those that do.

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COMMONS RESOURCE LIBRARY Having literature available, especially for the demographic who is most likely to use it, can provide comfort to the individual dying or the family accompanying them during this time PLACES FOR PETS For many people, a pet is like a child, so providing space for that bond to remain is so important. Whether that is an indoor space or an outdoor space depends on the individual and their wishes, however most regulations won’t allow interior spaces

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SERVICE NURSE’S STATIONS The centralized station where the nurses report to and from, do their tasks, and serves as a landmark within the residence. It should have quick access to the rooms so the residents get the quality care and the nurses can limit the amount of running around HOUSEKEEPING Cleanliness is a top priority, especially for those with compromised immune systems. Spaces for cleaning and cleaning storage is needed BUILDING AND GROUNDS MAINTAINANCE ni ortant servi e that needs stora e s a e as

ell as dedi ated roo s or the sta

STORAGE Storage for all medical supplies, necessary machines, and any other items needed BACK OF HOUSE

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TRANSITIONAL WAY FINDING ire t ayďŹ ndin is ne essary or ne residents, vol nteers, es e ially those e erien in e ory iss es ARTICULATED THRESHOLDS i ni yin a han e in s a e and ro ra

via arti

or ers, a ilies, and

lated thresholds, not

CIRCULATION

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rrent residents,

st door ays or si na e

CARE PRECEDENTS e cannot cure our patients, but we can assure the dignity and value of their final days, and keep them comfortable and free of pain."

- Rose Hawthorne Dominican Sisters of Hawthorne

Little Sisters of the Poor

r s e ifi a ostolate o n rsin hrist s si oor ho s er ro in rable an er or kindred diseases is at the heart of Mother ary l honsa s ni e ission

“The accompaniment and care of the dying is the summit of our vocation. It is a powerful witness of the culture of life. Consecrated hospitality is a witness to the mercy and compassionate love of the heart of Jesus.”

Sisters of Saints Cyril and Methodius

Sisters of Mary of the Presentation

“In the name of Jesus, Teacher and Healer, and sensitive of contemporary needs, especially justice and peace, we reach out in compassion to: Evangelize and teach; Care for the elderly, young, poor, sick, lonely, immigrants and wounded families; Work and pray for the unity of all Christians so that the os el vision o the in do ay be lfilled in us and those we serve.”

“SMP Health System, sponsored by the Sisters of Mary of the Presentation, is a Catholic Health System which, in its diversity of programs and facilities, consists of people ho are and a e a di eren e r on ern is for all people, but the poor and elderly have a special claim on us. From our limited resources we provide services characterized by excellence, compassion, and personalized concern.”

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HOSPICE DE ARK ENTRANCE COMMONS CHAPEL INDIVIDUAL ROOM

Spirituality

Program

Individual Room

- Beds: 14 - 4 acres/ 25 parking spaces - Open threshold to chapel - Common porch connecting rooms - Enveloped by nature - Understated entryway

Context The Architecture of Release: Hospice Architecture

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Conclusions

CARE DIMENSIONS HOSPICE HOUSE

Spirituality

Program

Individual Room

- Beds: 18 - 12 acres - Informal, nondenomenational chapel/meditation space - Surrounded by nature - Spacious room with living room amenities

Context The Architecture of Release: Hospice Architecture

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Conclusions

HOSPICE LAGRANGE ENTRANCE COMMONS CHAPEL INDIVIDUAL ROOM

Spirituality

Program

Individual Room

- Beds: 16 - 3.8 acres - Rooms are clustered with a central community space - Informal, nondenomenational chapel/meditation space - Adjacent to nature and a satellite hospice - Central courtyard

Light

Context The Architecture of Release: Hospice Architecture

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Conclusions

KAPLAN FAMILY HOSPICE HOUSE

Spirituality

Program

Individual Room

- Beds: 20 - 12 acres - Rooms have large outdoor patio and threshold - Informal, nondenomenational chapel/meditation space - Surrounded by nature - Communal space in circulation Context The Architecture of Release: Hospice Architecture

Light 44

Conclusions

SEIREI-MIKATAGAHARA HOSPITAL HOSPICE ENTRANCE COMMONS CHAPEL INDIVIDUAL ROOM

Program

Spirituality

Individual Room

- Beds: 27 - 2.9 acres - Rooms are staggered, creating patios along a spine of courtyards - Understated, simple rooms - Urban and satellite hospice - Small meditation space Context The Architecture of Release: Hospice Architecture

Light 45

Conclusions

ST. LEONARD’S HOSPICE ENTRANCE COMMONS CHAPEL INDIVIDUAL ROOM

Spirituality

Program

Individual Room

- Beds: 20 - 4.5 acres - Rooms are arranged along the edge and bend d a ent to field and residential neighborhood

Context The Architecture of Release: Hospice Architecture

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Conclusions

THE PICKENS CENTER

Spirituality

Program

Individual Room

- Beds: 36 - 9 acres - Spacious rooms that allow the bed move to an outdoor patio - Landscape design integrated with water feature - Adjacent to a residential neighborhood Context The Architecture of Release: Hospice Architecture

Light 47

Conclusions

HOSPICE PRECEDENTS

Central and open chapel

Connection from room to outdoors

Outdoors as a room and communal space

I extracted certain elements I found successful in the existing conventional hospices.

A respite destination in nature

Outdoors as a room and communal space

What I found lacking though, was an sense of the sacred in the room and a connection to the human body.

Natural lighting favored in circulation

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CHAPEL PRECEDENTS

Seashore Chapel

Chapel for San Giorgio Maggiore

Kapelle Salgenreute

Women’s Dormitory & Meditation Building

Chapel Ruhewald Schloss Tambach

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Nossa Senhora de Fátima Chapel

Church on the Water

Vatican Chapel

THE SITE

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SITE CRITERIA The priority of the site should be the sensory experiences provided because this project serves as a sacred la e and a ďŹ nal destination or the residents t isn t a ro riate to have a site the bli intera ts ith, be a se this is s h a rivate and individ al e erien e o the h an bein PRIVACY e l sion, reedo

ro

noise, and li ited edestrian tra

ACCESS TO NATURE en land, ater, and ve etation that serves as a threshold reatin a rivate real PROXIMITY ro i ity to individ als served in l din senior a art ents, retire ent o and ore as ell as ro i ity to ysel to visit the site SCALE o ortably ďŹ ts the ro ra visitors to roa

o

,

nities, hos itals, e eteries,

s and lenty o o tdoor s a e or the residents, areta ers, and

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COMPARING PRISON POPULATIONS MARYLAND

WASHINGTON, D.C.

VIRGINIA

Total Population - 30,752

Total Population - 2,448

Total Population - 65,848

Life Sentences - 3,141

Life Sentences - N/A

Life Sentences - 2,577

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COMPARING HOMELESS POPULATION MARYLAND

WASHINGTON, D.C.

VIRGINIA

Total Population - 6,561

Total Population - 6,521

Total Population - 5,783

Chronic Homelessness - 1,295

Chronic Homelessness - 1,688

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Chronic Homelessness - 881

SITE SELECTION Site

Hospices

Homeless Shelter

Nursing Homes

Hospitals

Correctional Facilities

Cemeteries

Mortaury Services The Architecture of Release: Hospice Architecture

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SITE SELECTION Site

Hospices

Homeless Shelter

Nursing Homes

Hospitals

Correctional Facilities

Cemeteries

Mortaury Services The Architecture of Release: Hospice Architecture

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SITE SELECTION Site

Hospices

Homeless Shelter

Nursing Homes

Hospitals

Correctional Facilities

Cemeteries

Mortaury Services The Architecture of Release: Hospice Architecture

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PUBLIC TRANSPORTATION ACCESSIBILITY

Site

Bus Stop

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WHY NOT ELSEWHERE? IN THE CITY os i es in the ity don t o er the a ess to nat re or se l sion that this site o ers the lo ations in the ity or individ als ho ant this se l sion

his is an alternative to

RURAL ral hos i es don t o er the a essability or the dis la ed or in ar erated, so trans ortation to a re ote site on t be as easy as to the o ts irts o the ity PROXIMITY he ro i ity to those served in ho eless shelters, senior a art ents, retire ent o n rsin ho es, orre tional a ilities, and ysel NATURE bo nti l a

ess to nat re

ACCESSIBILITY ords a ess or the daily o

here residents, are ivers, and visitors an roa tin o the sta and visitors

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nities, hos itals,

KINGMAN ISLAND

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KINGMAN ISLAND

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KINGMAN ISLAND

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KINGMAN ISLAND

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THE DESIGN

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SEQUENCING TRANSITIONAL

TRANSITIONAL

HOSPICE AND CONVENT

Shown dignity and love by caregivers tethering the residents to life while hinting at the divine. . .

Admission

Getting comfortable in the new place

Physical death

The after

Sensory experiences serve as a vessel to the Divine. . .

HOSPICE AND CONVENT

TRANSITIONAL rin in

- Make each space sacred by using the sensory experiences as a vessel to the divine; using the known to get to the unknown

la ness and lďŹ e to the site

- Introduce native vegetation to the site through layering, so it becomes natural yet maintained from being chaotic

- Design by nature, time, movement, and canon

rin nat rally ďŹ ltered river ater thro the building

eo le brin o tside in en es in, so reality di tates this is not a blank canvas to impose beliefs or ideaologies

ath ays han e in s ale and

h the site and into

ateriality to re e t thresholds The Architecture of Release: Hospice Architecture

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- Abide by canonic rules for Catholic sacred space design

SITE SEQUENCING

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LISTENING TO THE SITE

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DEVELOPING AN ARCHITECTURAL LANGUAGE TIME - COSMOS The architecture raises the gaze upwards to the heavens, the timekeepers - sun and moon - and the changing skies. This is expressive of inwards looking upwards, or the individual contemplating themselves in relation to God “God has made everything appropriate to its time, but has put the timeless into their hearts so they cannot find out, from beginning to end, the work which God has done.”

- Ecclesiastes 3: 11

NATURE - EARTH The architecture champions the horizon, framing in nature, and an intimate human scale. This is expressive of inwards looking outwards, or the individual contemplating themselves in relation to others and the world.

“Ever since the creation of the world, his invisible attributes of eternal power and divinity have been able to be understood and perceived in what he has made.”

- Romans 1: 19-20

MOVEMENT - CYCLES The architecture provides respite from immersion in the outoors, leaving the individual from sheltered to exposed. This is expressive of outwards looking inwards, or the individual contemplating themselves.

“For ‘In him we live and move and have our being,’* as even some of your poets have said...

- Acts 17: 28 The Architecture of Release: Hospice Architecture

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PARTI

THE ESSENTIAL In investigating what is essential in a room I realized it was 3 elements: rest, cleansing, and an element separating the two. Architecturally, rest is represented by the bed, cleansing by the bath, and privacy by the wall. These three elements are what structure the spatial dimension of the individual’s life while in the hospice room, especially when they reach a stage of being onďŹ ned to the bed A simple parti was made more dynamic by adding a curve to the wall, as a reference to the rolling hills of the site and to the nature of the human body The Architecture of Release: Hospice Architecture

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THE ROOM

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VIEW FROM THE BED

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VIEW FROM THE PATIO INTO THE ROOM

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VIEW FROM BED

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VIEW FROM BED THROUGH SKYLIGHT

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CLUSTER PLAN

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CLUSTER SECTION A - A

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VIEW FROM ENTRY TO ATRIUM

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CLUSTER SECTION D - D

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VIEW BETWEEN ROOMS

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CLUSTER SECTION B - B

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CLUSTER SECTION C - C

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VIEW FROM PATHWAY AT INTERSECTION

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VIEW FROM PATHWAY TO GATEHOUSE

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VIEW FROM PATHWAY THROUGH GATEHOUSE

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CHAPEL PLAN

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CHAPEL SECTION

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VIEW FROM PATHWAY TOWARDS CHAPEL

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CHAPEL ENTRANCE

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VIEW OF CHAPEL

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SITE PLAN

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VIEW OF APPROACH TO CONVENT

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CONVENT ENTRANCE

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CONVENT PLAN

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VIEW OF CONVENT COURTYARD

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CONVENT SECTION A - A

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CONVENT AERIAL

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GATEHOUSE AND CLUSTER AERIAL

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CLUSTER AERIAL

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CHAPEL AERIAL

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VIEW FROM THE BED

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THE ARCHITECTURE OF RELEASE

There is a need for a place where the abandoned the incarcerated, the displaced, and the estranged can receive care, charity, companionship, and love in their ďŹ nal days, so they are able to live and to die with dignity. Conventional hospice care is predicated upon the idealized view of the home, but that foundation falls apart when the idea of home is not a welcoming place. Rather than designing by what it rejects, hospice architecture should be designed by what it is, the last place an individual will have sensory experiences. The architecture should stimulate all the senses, including the sense of the sacred, and in doing so allow the individual to feel dignity while in the world, until they are ready to go . . .

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This thesis is dedicated to the loving memory of

Robert E. Picardi August 27, 1930 November 5, 2018 The Architecture of Release: Hospice Architecture

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REFERENCES

LITERARY REFERENCES Adapting Your Practice: Recommendations for End-of-Life Care for People Experiencing Homelessness”, Health Care for the Homeless Clinicians’ Network, 2018.

“A Guide to Understanding End-of-Life Signs and Symptoms,” Crossroads Hospice, 2020. https://www.crossroadshospice.com/hospice-caregiver-support/end-of-life-signs/ Ahuja, Nitin, “End Stages,” Places Journal, May 2018. https://doi.org/10.22269180515 Aoun, S. M., Breen, L. J., & Howting, D., “The Support Needs of Terminally Ill People Living Alone at Home: a Narrative Review”, Health Psychology and Behavioral Medicine, 2(1), 951–969. https://doi.org/10.1080/21642850.2014.933342.

Baggett, Travis P, O’Connell, James J., Singer, Daniel E., and Rigotti, Nancy A. “The Unmet Health Care Needs of Homeless Adults: A National Study.” American Journal of Public Health, Vol. 100,7 (2010): 1326-33. doi:10.2105/AJPH.2009.180109 Brown, Michael. “Hospice and the Spatial Paradoxes of Terminal Care.” Environment and Planning A: Economy and Space 35, no. 5 (May 2003): 833–51.

Clark, David. “End-of-Life Care around the World: Achievements to Date and Challenges Remaining.” OMEGA - Journal of Death and Dying 56, no. 1 (February 2008): 101–10. doi: 10.2190/OM.56.1.i.

LITERARY REFERENCES Delany, Joseph. "Preparation for Death." The Catholic Encyclopedia. Vol. 4. New York: Robert Appleton Company, 1908. 4 May 2020 “HCH Clinicians Can Help Homeless People Die with Dignity”, Healing Hands, National Health Care for the Homeless Council, Vol. 8, No. 1, February 2004.

Heathcote, Edwin, “Architecture and Health,” in Ed. Charles Jencks, The Architecture of Hope: Maggie’s Cancer Caring Centres (London: Frances Lincoln, 2015), 56.

Jean PhD, Melissa, “Patient-Centered Care: Case Studies on End of Life,” Healing Hands, National Health Care for the Homeless Council, Vol. 22, No. 1, 2018.

John Paul II, St. Pope. Apostolic Letter of His Holiness Pope John Paul II On the Christian Meaning of Human Suffering: Salvifici Doloris. Libreria Editrice Vaticana, 1984.

John Paul II, St. Pope. Apostolic Letter of His Holiness Pope John Paul II On the Value and Inviolability of Human Life: Evangelium Vitae. Libreria Editrice Vaticana, 1995.

Kessler, David. The Needs of the Dying: a Guide for Bringing Hope, Comfort, and Love to Lifes Final Chapter. New York, NY: HarperCollins, 2007.

LITERARY REFERENCES “Kingman Island and Heritage Island Planning and Feasibility Study Act of 2016,” Department of Energy & Environment, 2017. https://doee.dc.gov/publication/kingman-island-heritage-island-planning-feasibility-study Lamers, MD, William and Willner, MD, Hank, “Signs of Approaching Death,” Hospice Foundation of America, 2017. https://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal-Illness /Signs-of-Approaching-Death Lawton, J. (1998), Contemporary Hospice Care: the Sequestration of the Unbounded Body and ‘Dirty Dying’. Sociology of Health & Illness, 20: 121-143. doi:10.1111/1467-9566.00094.

Lynch, Thomas. The Depositions: New and Selected Essays on Being and Ceasing to Be. New York: W.W. Norton & Company, 2020.

Lynch, Thomas. The Undertaking: Life Studies From the Dismal Trade. W.W. Norton & Company, Inc., 1998.

McGann, Sarah. “Spatial Practices and the Home as Hospice.” The Australasian Medical Journal, Vol. 4,9 (2011): 495-9. doi:10.4066/AMJ.2011.931

LITERARY REFERENCES McNeil, Ryan, and Manal Guirguis-Younger. “Illicit Drug Use as a Challenge to the Delivery of End-of-Life Care Services to Homeless Persons: Perceptions of Health and Social Services Professionals.” Palliative Medicine 26, no. 4 (June 2012): 350–59. doi:10.1177/0269216311402713.

Nellis Ph.D, Ashley, “Still Life: America’s Increasing Use of Life and Long-Term Sentences.” The Sentencing Project, May 3, 2017. https://www.sentencingproject.org/publications/still-life-americas-increasing-use-life-long-termsentences/ “NHPCO Facts and Figures”, National Hospice and Palliative Care Organization, July 2018.

Niedzielski, Oksana K., Gary Rodin, Debbie Emmerson, Job Rutgers, and Katherine M. Sellen.

“Exploring Sensory Experiences and Personalization in an Inpatient Residential Hospice Setting.”

American Journal of Hospice and Palliative Medicine® 33, no. 7 (August 2016): 684–90. doi:10.1177/1049909115624398.

Poyner, Heather Larson, “The Art of Dying: Sensory Therapies Help Ease the Mind, Body, and Soul of Hospice Patients,” Kenosha News, November 14, 2016. https://www.kenoshanews.com/life/health/the-art-of-dying-sensory-therapies-help-ease-the-mi nd/article_1e7bb5a2-b1a1-5391-8616-4dcf6f50719a.html

LITERARY REFERENCES Sawyer, Wendy and Wagner, Peter, “Mass Incarceration: The Whole Pie 2020,” Prison Policy Initiative, March 24, 2020. https://www.prisonpolicy.org/reports/pie2020.html Seiji Hayashi, Contributor. “How Health and Homelessness Are Connected-Medically.” The Atlantic. Atlantic Media Company, January 25, 2016. https://www.theatlantic.com/politics/archive/2016/01/how-health-and-homelessness-are-conne ctedmedically/458871/.

The Council of Economic Advisors, “The State of Homelessness in America,” 2019, https://www.whitehouse.gov/wp-content/uploads/2019/09/The-State-of-Homelessness-in-Ame rica.pdf “The Sisters who Treat the Untreatable,” The New York Times Company, 2020. https://www.nytimes.com/2016/05/15/magazine/the-sisters-who-treat-the-untreatable.html The United States Interagency Council on Homelessness, “Homelessness Statistics by State,” 2019, https://www.usich.gov/tools-for-action/map/#fn[]=1500&fn[]=2900&fn[]=6100&fn[]=10100&fn[]=1410 0&year=2017&all_types=true

LITERARY REFERENCES Ulrich, Roger, Quan,Xiaobo, Zimring, Craig, Joseph, Anjali and Choudhary, Ruchi, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity”.

The Center for Health Design, September 2004.

Verderber, Stephen, and Ben J. Refuerzo. Innovations in Hospice Architecture. Abingdon, Oxon; New York, NY, Routledge, 2006.

Worpole, Ken. Modern Hospice Design: the Architecture of Palliative Care. London: Routledge, 2009.

ARCHITECTURAL REFERENCES Architectenbureau, Hospice de Ark, 1999.

Architects’ Collaborative for Public Facilities, Seirei-Mikatagahara Hospital Hospice, 1997.

Andrew Berman Architect, Chapel for San Giorgio Maggiore, 2018.

Bernardo Bader Architekten, Kapelle Salgenreute, 2017.

EGA Architects, Care Dimensions Hospice House, 2018.

EGA Architects, Kaplan Family Hospice House, 2018.

Foster + Partners, Vatican Chapel, 2018.

MESA, The Pickens Center, 2015.

Nix Mann and Perkins and Will, Hospice LaGrange, 1996.

ARCHITECTURAL REFERENCES Plano Humano Arquitectos, Nossa Senhora de Fátima Chapel, 2017.

Sacher.Locicero.Architectes, Graz / Paris, and Gerhard Sacher, Chapel Ruhewald Schloss Tambach, 2018.

Tadao Ando Architects, Church on the Water, 1988.

Vector Architects, Seashore Chapel, 2015.

Walllasia, Women’s Dormitory & Meditation Building, 2018.

INTERVIEWS Fr. James Lease, St Catherine Laboure Parish, Harrisburg, OďŹƒce of Ecumenical and Inter-religious Aairs, in discussion with the author, and email correspondence with the author, February, 2020.

Rev. Jude DeAngelo OFM Conv., University Chaplain and Director of Campus Ministry at The Catholic University of America, in discussion with the author, March 2020.

Joelle Purdy, Hospice Social worker, in discussion with the author, April, 2020.

Trystan Chricton, student leader of Homeless Food Runs at The Catholic University of America, email correspondence with the author, April, 2020.