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
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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 normative. It excludes different interpretations of the home as sites of family violence, intense loneliness, repression, and financial hardship. Individuals whose lives have varied from this normative understading may find 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
ospitals present the individual s ody as a machine to fit within a purely rational space. Edwin Heathcote, architect and author, laments, “at the exact moments we are most in need of meaning and spiritual uplift, we find ourselves surrounded by the bleak expression of hygiene and e ciency... ur existential gateways are manifested 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 estranged can receive care, charity, companionship, and love in their final 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. The discovery of the salvific meaning of suffering in union with Christ transforms this depressing feeling. Faith in sharing in the suffering of Christ brings with it the interior certainty that the suffering person ‘completes what is lacking in Christ's afflictions’; the certainty that in the spiritual dimension of the work of Redemption he is serving, like Christ, the salvation of his brothers and sisters” “The soul survives and subsists separated from the body, while the body is subjected to gradual decomposition according to the words of the Lord God ... ‘You are dust and to dust you shall return’” 2
2. Pope John Paul II. Apostolic Letter of His Holiness Pope John Paul II On the Christian Meaning of Human Suffering: Salvifici Doloris. Boston, MA: St. Paul Editions, 1984. Poloniae, Victoria. Pope John Paul II. Oil Painting. The Architecture of Release: Hospice Architecture
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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 services, economic hardships, lac of afforda le 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 mandatory sentencing laws, ha itual offender 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 inmates their final days outside of 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 final 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 ualified. Individual circumstances are taken into consideration
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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 individual should have their affairs and wishes in order and in doing so prepare themselves to not e in this world NOTIFYING THE PRIEST he priest must e notified far enough in advance of one s condition to e prepared to administer the sacraments and rituals CONFESSION he general ac nowledgment of sin ualifies the individual to e a solved 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 accept all his sufferings in reparation for 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
eaning of uman uffering
“ s a result of Christ's salvific work, man e ists on earth with the hope of eternal life and holiness. nd even though the victory over sin and death achieved by Christ in his Cross and Resurrection 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.” “ t is suffering, more than anything else, which clears the way for the grace which transforms human souls.”
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SALVIFICI DOLORIS
“Christ drew close above all to the world of human suffering through the fact of having taken 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” “Human suffering has reached its culmination in the assion of Christ. nd at the same time it has entered into a completely new dimension and a new order: it has been linked to love... The Cross of Christ has become a source from which ow rivers of living water. n it we must also pose anew the uestion about the meaning of suffering, and read in it, to its very depths, the answer to this uestion”
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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 statement made y the architecture must re ect 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 ecently admitted residents, staff, and visitors should be able to roam free
CHAIR hose that are confined to chairs 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 Individuals that are confined to the ed 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. “ eople 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 uestion of the meaning of suffering” St. ope ohn aul Salvifici Doloris
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HOSPICE CARE TEAM Chaplain
Social Workers
Bereavement Counselors
Registered Nurses
Physician
Administration
taff
rounds
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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
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TRANSITIONAL wayfinding articulated thresholds circulation 28
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 sacred space to cele rate mass, provide comfort, reprieve, and an escape for all who wish to find it GRIEVING ROOMS place where the raw emotions and grief can e experienced, instead of sti ed, and a cathartic experience can be had MEDITATION AND PRAYER SPACES ither indoors or outdoors, these spaces are for contemplataion, meditation, and re ection for those that feel the need, but don’t want or feel comfort in a chapel
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PRIVATE BEDROOMS Providing privacy for the individual is important, especially for the end when most people want privacy in their final moments. comforta le ed will e the last place the individual exists so while all the furnishings are important, the ed is the most important BATHROOMS alancing on the line etween comfort and medical, the athrooms should allow the individual privacy, cleanliness, and relief OUTDOOR SPACE private alcony or patio for the individual to easily access 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, volunteers, staff or anyone who needs it WATER FEATURES Water is an essential part of life and should be included in this project INDOOR/OUTDOOR SPACES paces that are a threshold etween indoor and outdoor spaces or are exi le to open to the outdoors is a good way to open and extend the limits of a space
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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 place should have many different ways for the communtiy to say good ye to the individual, from processions to encircling the ody to group prayer, chants, or individual farewells. EXPRESSIONS OF REMEMBRANCE n expression of remem rance, for residesnts who have passed away as a sym ol of community, of remembrance, and of love - Sculptures - Engravings - Plantings/Landscape - Knittings - Architectural Elements
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ARRIVAL “HIDDEN” DIRECT PARKING he reality is that par ing must e provided as well as close drop off for patients or elderly entering the residence. irect access is a necessity, ut it should e hidden to preserve the aesthetic of the architecture PROTECTED ENTRYWAY Inclement weather rain, snow, seasonal changes ma es entering the architecture di cult at times, so a protected entryway prevents bringing the elements indoors ENTRY SEQUENCE rotecting the indoors from the outdoors, especially with residents who are in critical conditions. protected entryway, a welcoming entryway that has direct wayfinding is necessary
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fter 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 close. viously not all will have the capa ility or desire to coo , ut it can ma e the world of difference 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 n important service that needs storage space as well as dedicated rooms for the staff STORAGE Storage for all medical supplies, necessary machines, and any other items needed BACK OF HOUSE
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TRANSITIONAL WAY FINDING irect wayfinding is necessary for new residents, volunteers, wor ers, families, and current residents, especially those experiencing memory issues ARTICULATED THRESHOLDS ignifying a change in space and program via articulated thresholds, not ust doorways or signage CIRCULATION
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CARE PRECEDENTS "We 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
ur specific apostolate of nursing hrist s sic poor who suffer from incura le cancer or kindred diseases is at the heart of Mother ary lphonsa s uni ue mission.
“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 gospel vision of the ingdom may e fulfilled 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 who care and ma e a difference. ur concern 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
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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
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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
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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
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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
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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