Post on 26-Apr-2023
HOLISTIC HOSPICE: AN EMOTIONAL REDESIGN
By
JAY SOLANKI
SUPERVISORY COMMITTEE:
PROF. NAME: STEPHEN BENDER, CHAIR
PROF. NAME: ALBERTUS WANG, MEMBER
A PROJECT IN LIEU OF THESIS PRESENTED TO THE COLLEGE OF DESIGN, CONSTRUCTION, AND PLANNING
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARCHITECTURE
UNIVERSITY OF FLORIDA
2020
A research project presented to the University of Florida Graduate School of Architecture in partial fulfillment of the requirements for the degree of Master of Architecture
4 HOLISTIC HOSPICE
TABLE OF CONTENTS
1. ACKNOWLEDGEMENT 5
2. ABSTRACT 6
I. OVERVIEW & PURPOSE 6
3. INTRODUCTION 8
I. THESIS STATEMENT 8
II. BACKGROUND 8
4. LITERATURE REVIEW 9
I. “VIEW THROUGH A WINDOW MAY
INFLUENCE RECOVERY FROM SURGERY.” 10
II. KEN WARPOLE 12
III. EDWIN HEATHCOTE 12
IV. ANNEMARIE ADAMS 13
5. THEORY 14
I. MEDICAL INSTITUTIONS 14
II. HOW TO IMPROVE WELL-BEING 16
III. HOLISTIC APPROACH 28
6. PRECEDENT REVIEW 29
I. VANKE PARK MANSION 29
II. MAGGIE CENTRES 30
III. EXTERNAL HOSPICE CARES 35
IV. LOCAL HOSPICE CARES 37
7. METHODOLOGY 38
I. EMPATHY MAPPING 38
II. EMOTIONAL SURRENDER 42
III. NARRATIVES 44
IV. PRIMARY MATERIALS 45
V. MATERIALS OF CONSTRUCTION 46
VI. MATERIALS OF VEGETATION 47
VII. ANTITHESIS 48
8. DESIGN PROCESS 50
I. CONTEXT ANALYSIS 50
II. SITE ANALYSIS 52
III. THE ARTIFACT 54
IV. SKETCHES 56
9. PROJECT 60
I. PROGRAMMING ELEMENTS 60
II. THE UNIT 62
III. THE MODULE 68
IV. THE SITE 73
V. FLOOR PLAN UG:1 74
VI. FLOOR PLAN L:0 76
VII. FLOOR PLAN L:1 78
VIII. THE MODULES 80
IX. THE FOREST 82
X. THE MUSEUM 84
XI. FAMILY HOSPICE AT LEGACY PARK 86
10. CONCLUSION 90
I. BACKROUND SUMMARY 90
11. BIBLIOGRAPHY 90
12. BIBLIOGRAPHY 96
13. LIST OF FIGURES 98
5AN EMOTIONAL REDESIGN
ACKNOWLEDGEMENTto my family for their unwavering support in allowing me to chase my passion
to my professors for continuously challenging me to new heights
to my grandparents for watching over me
JS
6 HOLISTIC HOSPICE
ABSTRACTChair: Stephen Bender
Cochair: Albertus Wang
Major: Master of Architecture
I. OVERVIEW & PURPOSE
This thesis uses holistic design ideology
to create a healing environment in a hospice
center. Hospice centers are frequently designed
as non-types without traditional architectural
standards. Typically, hospice centers attempt to
bring calmness and serenity to patients living
out their final moments; architecture should
respectively conform to these needs.
Visitors to hospice centers often bring
five predetermined emotions to the site:
dreadfulness, worry, discomfort, restlessness,
and isolation . The hospice center designed
for this project will help occupants confront
and accept these feelings. The proposed
center aims to heal the emotional fluster that
occupants experience.
The design will be anchored by a central
spiritual and sacred observance site. The
program is hosted on Princeton Avenue in
Orlando and will be woven into the urban fabric
of the existing museums rather than the city’s
medical fabric. Additionally, the building form
and topography is inspired by the infinity symbol
(∞) as a gesture of immortality. The goal of this
design is not to stage death for the patients
but to stage death for the patients’ loved ones.
The thesis project had the following design
objectives: a) “to die in a museum” instead
of “dying in a hospice/hospital”; b) spiritual
sacred space as an anchor connected to various
weaving moments of Zen and tranquility; c)
holistic design approach via sustainability,
green design, ecologically-positive materials,
and following the rhythms and principles of
nature; d) a “legacy gallery” of memoirs or
artifacts submitted by the patients; and e) larger
rooms that accommodate all occupants.
8 HOLISTIC HOSPICE
INTRODUCTIONI. THESIS STATEMENT
The thesis project adhered to the following
thesis statement: “The emotional comfort of
patients, families, and caregivers in hospice
centers can be improved by a holistic approach
in design.”
The hospice philosophy accepts death as
the final stage of life; it affirms life but does
not try to hasten or postpone death. Hospice
care treats the person and symptoms of the
disease rather than treating the disease itself.
The lack of a symbiotic design reinforces the
absence of integration for emotional comfort of
patients’ family & friends. Even though hospice
care facilities blend hospitality and residential
styles best-suited for patients, the experiences
and memories live on with family, friends, and
caregivers who are sharing a tragic and difficult
time. (See Figures 1-1 to 1-3.)
II. BACKGROUND
Early models of hospice design, rooted in a
traditional understanding of home, adopted
domestic ideals of comfort and familiarity.
More recently, an uprising of spaces employ
dramatic design elements to facilitate a more
symbolic engagement with the end of life.
Notwithstanding Annmarie Adams’s
observation that we know very little “about
what constitutes an ideal environment for end-
of-life care,” the narrative of formal progress
reinforces the sense that such an ideal exists
(Adams, 2016). Hospice care facilities are not
commonly looked at as a form of architectural
divination, per the CHF (Partners, 2017), due
to the growing need for such facilities. As
recent as the late-twentieth century, the designs
of hospice centers were often looked over.
Fast forward to today and there is over 9,000
centers, a number that has been doubled in
just 10 short years according to IBIS World
New York. As the world grows in population,
the demand for hospice centers continues to
grow. Eventually, architects and health care
professionals will have to address the issues
of where people will go to die. Are they dying
where they want to die or where they need to
die?
In particular, where do Americans die?
According to a study conducted by Sandford
Medical, 80% of people want to die at
home, and yet only 20% actually do. The
psychological distortion of those numbers is
not an oversimplification; there is a significant
disconnection between reality and fantasy.
Additionally, 30% of people die in hospital
intensive care units, and 60% of all people die
in pain. Every day in America, 10,000 Baby
Boomers turn 65, adding to the country’s aging
population. Plus, a large number of deaths
9AN EMOTIONAL REDESIGN
result from chronic conditions that require
long care (Where do Americans Die?, 2013).
Hospice facilities specialize in the nature
of death. Once patients enter hospice
care, they understand they might die at the
facility. According to a MEDPAC report to
Congress, 1 out of every 5 patients admitted
to hospice facilities are ever discharged
(Crosson, 2016). Therefore, hospice centers
generally emit predetermined emotions.
According to Dr. Munday, writing for
the Journal of Royal Society of Medicine, “to
understand why some people choose to die
in hospitals, we need only recognize that the
exercise of making peace with death might
be deliberately deferred. Still, most people,
given the option, say they would prefer to die
at home” (Munday, 2007). To understand the
underlaying notion of Munday’s statement,
it is important to note that in most cases,
patients want to prolong life and defer death.
As a result, many patients will opt to stay in
a hospital over a home on the small hope
that they will receive better care in a hospital
and will have a better chance of improved
health. A hospital is ultimately a symbol of
optimism, but a hospice center’s design
language and story often defers it to a place
of pessimism (Munday, 2007; Partners, 2017).
Figure 1-1. Hospital Bed
Figure 1-2. Emotional Conflict
Figure 1-3. Obstacles
10 HOLISTIC HOSPICE
LITERATURE REVIEW This thesis proposes a new type of hospice
facility that can incorporate a holistic approach
in design to its occupants. This holistic approach
will influence the building’s overall comfort in
an effort to negate disdain from typical centers.
This chapter will discuss several case studies.
I. “VIEW THROUGH A WINDOW MAY
INFLUENCE RECOVERY FROM SURGERY.”
Introduction to this quote:
“Records on recovery after
cholecystectomy of patients in a
suburban Pennsylvania hospital
between 1972 and 1981 were
examined to determine whether
assignment to a room with a
window view of a natural setting
might have restorative influences.
Twenty-three surgical patients
assigned to rooms with windows
looking out on a natural scene had
shorter postoperative hospital stays,
received fewer negative evaluative
comments in nurses’ notes, and
took fewer potent analgesics than
23 matched patients in similar
rooms with windows facing a brick
building wall.”
In 1984, Dr. Roger Ulrich (1984), a
professor of architecture at the Center for
Healthcare Building Research at Chalmers
University of Technology in Sweden, conducted
a published experiment titled “View Through A
Window May Influence Recovery from Surgery.”
He conducted an experiment with post-surgery
patients to determine how patients’ recovery
times were influenced by design factors. He
aimed to prove that a hospital’s setting has
negative and positive impacts on patients. He
placed two groups of patients in two concurrent
settings; one group of patients were in rooms
with windows pointed out towards trees and
other parts of nature while the other group of
patients had rooms with windows looking at the
side of building or a brick façade. Over time,
he used various degrees of measurements
to understand the emotional response of
patients as well as their physical stabilization
(Ulrich, 1984). Ulrich showed, using clinical
data, that patients with tree views had “shorter
postoperative hospital stays, fewer negative
evaluative comments from nurses, took fewer
moderate-to-strong analgesic doses, and had
slightly lower scores for minor postsurgical
complications.”
Ulrich’s conclusion stressed the importance
of incorporating nature into the design process.
(See Figure 2-1).
12 HOLISTIC HOSPICE
II. KEN WARPOLE
Architect Ken Worpole (Figure 2-2) recalled
the “memories and mythologies” associated
with an inpatient stay: “long corridors smelling
of disinfectant; harsh neon lighting; wards and
individual rooms which are overheated and
under-ventilated” (Worpole, 2009). Worpole’s
experience reflects that of Maggie Keswick
Jenkes experience when she was diagnosed
with cancer; the horrible experience of her
diagnosis was overshadowed by a myriad of
memories that recall the extremities of the
facility, almost more than the diagnosis itself.
Name Verderber and Name Refuerzo described
mid-twentieth century hospitals as “machines
for occupation until death,” expressive of an
authoritarian “culture of denial” (Verderber,
2014). The background of the history of
hospitals plays an integral role in this subject,
as it looks specifically into what the perception
and stigma of these places created. Verderber
& Refuerzo also stated earlier that two types of
hospitals exist: the mega hospital and the mid-
size homes. These mega-hospitals were literal
machines.
III. EDWIN HEATHCOTE
Edwin Heathcote (Figure 2-3) lamented the
emotionally empty architecture that diminished
the sanctity of life’s thresholds, stating: “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 efficiency. Our existential gateways are
manifested as service entrances” (Heathcote,
2015). Heathcote, as Worpole and Jenkes did,
reinforced the ugly notion of what healthcare
has become: a machine, a lifeless sanctity to
churn between the threshold of life and death,
and a hygiene-crazed region.
13AN EMOTIONAL REDESIGN
IV. ANNEMARIE ADAMS
Adams (Figure 2-4) critiqued the
domestic template of palliative care spaces as
disguises that enclose death in conventional
envelopes, allowing society to avoid a direct
confrontation with mortality (Adams, 2016).
Adams proposed a very interesting outlook on
the staging of death in healthcare facilities,
specifically palliative care centers, including an
investigation into their functions. The current
architectural and societal template, or lack
thereof, of such centers allows society to avoid
confronting how death occurs. These centers
are designed to contain death in a neat and
tight manner although reality might be quite
different.
Figure 2-2. Ken WarpoleRetrieved from http://www.stokenewingtonliteraryfestival.com/snlf_speakers/ken-worpole/
Figure 2-3. Edwin HeathcoteRetrieved from https://www.ize.info/designer/edwin-heathcote
Figure 2-4. Annmarie AdamsRetrieved from https://www.mcgill.ca/ssom/staff/annmarie-adams
14 HOLISTIC HOSPICE
THEORYI. MEDICAL INSTITUTIONS
Notwithstanding Annmarie Adams’s
observation that acknowledges the very little
“about what constitutes an ideal environment
for end-of-life care,” the narrative of formal
progress reinforces the sense that such an ideal
exists (Adams, 2016). The uptake of “evidence-
based design” suggests that the social project
of staging death will eventually be subject to
“best practices.”
Figure 3-1. Archetypal Mega-Hospital Albert Kahn, University Hospital, Ann Arbor, MI.
Retrieved from https://placesjournal.org/article/end-stages-hospice-design/
The history of healthcare architecture
featured the archetypal mega-hospital (Figure
3-1), which was rational, technological, and
highly visible in the urban landscape. Architects
usually followed distinct templates: the mid-
century mega-hospital and the middle-class
home. In healthcare architecture of the early
1800s, a new understanding of medicine as
a science aligned with a modernist emphasis
on clean lines, hygienic surfaces, and overt
mechanical accoutrements (Adams, 2016).
As large hospital systems expanded over
time, this linear modernism was overlaid
with a labyrinthine quality, compounding an
atmospheric cold with the risk of getting lost.
In the redesign of hospice facilities,
the approach of holistic design is taken into
consideration. A holistic approach in architecture
integrates a built environment through
sustainability, green design, and ecologically
positive materials. Holistic architecture is
primarily associated with treating the whole
person through the built environment. It
promotes preventative medicine by maintaining
the health of all aspects of the self: physical,
mental, emotional, and spiritual. Harmony/
balance light and color relationship to our
surroundings green materials. The elements are
harmony/balance, light and color, relationship
to our surroundings, and green materials.
When applied to hospice facilities, these
elements will improve the comfort occupants.
Many architects have attempted to
define what is healthy regarding architecture.
For example, Reuben Rainey, a professor
emeritus of landscape architecture, led “The
Healing Landscape,” which explored the
design of “healing” environments for a wide
range of health care facilities. The patient-
15AN EMOTIONAL REDESIGN
centered designs ranged from family medical
facilities in Honduras to mental health
facilities to rooftop gardens for the UVA
oncology clinic (Ford, 2012; Schrader, 2014).
Several factors contribute to the negative
images of health institutions. Gary Evans
argued that it is about stress, specifically that
stress occurs when there is an imbalance of
environmental demands and human resources
(Evans & Cohen, 1987). This article develops a
preliminary taxonomy of design characteristics
that have the potential to challenge human
adaptive coping resources (McCoy, 1998).
Maurice B. Mittelmark refers to a concept that
Aaron Antonovsky introduced in his 1979 book
Health, Stress and Coping: The Starting Point
that “the illness consequences of psychosocial
factors howsoever these consequences might
be expressed” (Antonovsky, 1990, p. 75)
(Golembiewski, 2016). In his dissertation
project, Carlo Volf from Denmark’s Aarhus
School of Architecture puts more emphasis
on light. Unilateral exposure to sunlight often
fails, simply because it over-emphasizes the
sunlight. Instead, a balance between exposure
to sunlight and protection from sunlight is
suggested (see Figure 3-2) (N. Gorman, 2007).
Figure 3-2. Differences in light. Carlo Volf, Aarhus School of Architecture, Denmark. Retrieved from http://thedaylightsite.
com/renewed-focus-on-light-architecture-and-health/#sub-8089
16 HOLISTIC HOSPICE
II. HOW TO IMPROVE WELL-BEING
Before the failures and successes of
architectural healthcare can be explored, it is
important to determine what is ill-health and
how architecture correlates with it. Ill-health
is a condition of inferior health in which some
disease or impairment of function is present.
There are direct interrelationship between
architecture and health. The condition of
a body can be attributed to its surrounding
context. If you are in a dark gloomy room and
never leave, your health might not be great;
if you run and exercise every day, your health
might not be bad. There are certain nuances
and referendums that exist.
According to First Name Aked (2008),
there are five essential criterions to address
regarding improved well-being (see Figures
3-3 and 3-4):
i. Connect: The ability to craft and
retain social connections with others.
ii. Keep Active: Physical activity reduces
symptoms of mental and physical ill-health.
iii. Take Notice: Keeping an
awareness of not only yourself, but
others regarding thoughts and feelings.
iv. Give: It is healthier to give than
receive. To display altruistic behavior
leads to a more positive impact on one’s
happiness.
v. Keep Learning: Aspirations help
shape passion, which in turn helps shape
a purpose. A purpose can be modified by
the environment in which one is nurtured.
Each of these five criteria contribute to the
state of one’s well-being, which is arguably
the basis of this thesis interpretation. Can
architecture be addressed when answering any
of these five factors?
17AN EMOTIONAL REDESIGN
Figure 3-3. Link between Architecture & Health Retrieved from http://blog.vmdo.com.s124655.gridserver.com/?p=1923
Figure 3-4. Aked’s 5 points improved well-
beingRetrieved from https://neweconomics.org/uploads/files/five-ways-to-wellbeing-1.pdf
18 HOLISTIC HOSPICE
I. Connections
In any design, the architect usually takes
into account the idea of activating public spaces
not just for the residing occupants but for the
general community as well. Public spaces
create opportunities for people to connect and
can be a strong resource for improving well-
being for individuals. Some key factors that
come into play when creating a social space
include the following:
i. Location: Is it accessible? Is
it in proximity to other community
resources such as schools, markets,
and infrastructure? Can said resources
support encounters at the space?
ii. Compartmentalization: Can spaces
be set up for social interaction (such as places
to sit, park benches, and cafe tables)? Are
the spaces designate for social interactions
clear and obvious? (See Figure 3-5.)
iii. Adaptability: Are the spaces
able to activate without set
functions? Do the spaces encourage
spontaneity and impromptu activities?
iv. Homeliness: Can the space offer a
sense of safety and familiarity? Is there a
pleasantness or cleanliness in the area?
Does it feel sacred without feeling sacred?
v. Specialty: What are the unique
qualities? What the diverse aesthetics? Are
there any particular moments here that
might evoke memory or perhaps create one?
Cities like Orlando are incredibly
autonomous, which leads to a misguided sense
of public space. Is it a public space if the access
and means to such a space are not public (i.e.
driving there by yourself)? Rather, public spaces
work better when they are pedestrian-oriented
(example: almost any major European city).
The perception of pedestrian environments
being more congruent to social interactions is
adjacent to the idea of cultural conglomerations
due to the “playfulness” of the space. It is also
important that pedestrian scale is more intimate
when greenery or landscape is in play. It is also
associated with a range of health benefits.
Some examples of this include high-density
mixed-use development that encourages
walking and cycling, a separation of key
spaces, curvilinear lines over rectilinear lines.
19AN EMOTIONAL REDESIGN
Figure 3-5. Snohetta proposes New Museum Quarter in ItalyRetrieved from https://snohetta.com/projects/426-proposal-for-a-new-museum-quarter-on-top-of-the-virgl-mountain
20 HOLISTIC HOSPICE
II. Activeness
Architecture connects spaces with
occupants, and the ability to transpire physical
exertion (activeness) between points is a side-
effect. Physical activity like walking, cycling,
sports, and skiing are widely associated with
reducing ill conditions and the burden of
disease, disability, and premature death. The
access between spaces in place should not be
too lethargic, but it should increase feasibility
and usability within range. Some design
characteristics regarding well-being crossed
with physical activity include the following:
i. Simple access to physical
activity facilities such as sport
centers, gyms, CrossFit areas, etc.
ii. Convenient and pragmatic
locations, particularly in access to
places of work, shops, infrastructure,
transport, schools, and so on
iii. Areas of high residential density (which
refers back to the “Connection” theme)
iv. Mixed land use (programmatic
diversity)
v. Walkability in terms of convenience
and infrastructure
There is a noticeable correlation between
connection and activeness. Both are in
symphony with one another and let each take
their shine in the spotlight. Public spaces can
induce more physical activity, both spaces
work better in areas of mixed-program usage,
and so on. Although there are more benefits
to physical activity in an outdoor and natural
environment, exercising inside is an alternative
option if outdoor activity is not available. Some
examples of architectural conditions regarding
physical activities are: the provision of shared
exercise space, encouraging stair use through
the distribution (separation) of functions over
different floor levels, and creating attractive
experiences along circulation routes (views,
art, daylight, and greenery). (See Figure 3-6.)
Rather than focusing on ill health, the study
of well-being has emphasized the behaviors
that support a “flourishing” population. It is the
built environment characteristics that support
such positive behavior, which is a key point of
discussion (Steemers, 2015).
21AN EMOTIONAL REDESIGN
Figure 3-6. Tapis Rouge by Eva StudioRetrieved from https://www.archdaily.com/802993/tapis-rouge-emergent-vernacular-architecture
22 HOLISTIC HOSPICE
III. Taking Notice
We often fail to recognize the thought of notice on a person-to-person basis. Being mindful
and taking notice of someone who is struggling or is happy is critical to the social aspects on
interpretations and psychological deviations. This can also be translated into architectural terms as
well, meaning that a design intervention in a population is a behavior for which there is only recent
evidence. However, in a randomized control test, the provision of art, planting and landscaping,
wildlife features (e.g. insect boxes), and seating are examples of the kind of interventions that
resulted in significantly increased observations of people stopping to take notice (Berg, 2005;
Golembiewski, 2016).
The same study also showed that diverse types of open space (combining green as well as hard
landscaping) and a higher relative proportion of public to private space is also associated with
increased reported mindfulness. To further the point, some design criterion regarding notice also
include enjoyable circulation through diverse public spaces (Figure 3-7).
Figure 3-7. Copenhagen Zoo proposal by BIGRetrieved from https://www.archdaily.com/867991/bigs-designs-yin-yang-shaped-panda-enclosure-for-the-copenhagen-zoo
23AN EMOTIONAL REDESIGN
IV. Giving
Evidence suggests that people are less altruistic in urban than in rural environments, which
suggests that the integration of green space and contact with nature can be valuable. Although it
is difficult to observe altruism and its explicit relationship to design parameters, existing literature
suggests that self-reported altruistic behavior is more prevalent in neighborhoods that incorporate the
positive environmental and physical characteristics of space design (diversity, proximity, accessibility,
and quality) that have already been mentioned (see Figure 3-8). Design should be responsive to
user needs, behaviors, and requirements, offering users a freedom of choice and control over their
environment (Volf, 2013).
Figure 3-8. Benesse House Museum by Tadao AndoRetrieved from https://medium.com/tunaiku-tech/critical-regionalism-on-architecture-and-ux-design-84e7d65b4cc1
24 HOLISTIC HOSPICE
V. Learning
Educational research suggests that
the physical environment of the home and
classroom are mediating variables that
influence intellectual development. Both of these
spaces have similar notes on constructivism.
Traditional parameters suggest a home should
be clean and uncluttered, safe for play, and
not ominously dark, while classrooms follow
concurrent guidelines that are dictated by the
notion that it is the home multiplied by “x”
users and by “y” homes (one classroom should
feel like a home to many students that are used
to different homes environments) (Aked, 2008;
Steemers, 2015).
The distance and orientation of seating
in relation to others will influence the level of
interaction and dialogue. For example, in a
circle of seats, people facing each other will
converse more than people adjacent to each
other. Unobstructed eye contact is an important
variable, particularly in an educational context,
making a semicircle classroom seating
arrangement most effective (Aked, 2008;
Steemers, 2015).
However, evidence suggests that learning will
improve when comparing a poor environment
(a run-down and poorly maintained space) with
an adequate one (one that is “good enough”),
but more extravagant facilities (specialized
spaces or digital equipment) does not show
further improvements in learning (Volf, 2013).
The opportunity to engage in art, music, and
evening classes increases well-being and thus
such activities should be accommodated in
the design of homes (light, cleanable spaces
for art, soundproof spaces for music) and
neighborhoods (local communal spaces
for classes (Gorman, 2007). Architectural
conditions that promote learning include
acoustic separation, noise attenuated air
paths, furnishings, and diverse public spaces.
(See Figure 3-9.)
25AN EMOTIONAL REDESIGN
Figure 3-9. Bear Run Cabin / David Coleman ArchitectureRetrieved from https://www.archdaily.com/934432/bear-run-cabin-david-coleman-architecture
26 HOLISTIC HOSPICE
VI. Conclusion
Architecture can have multiple layers of
meaning; it can mean nothing, or it can provoke
someone’s most terrifying memory. Historically,
in the architecture profession, our buildings,
our concept, and our materials are associated
with death and illnesses. The profession must
strive to create better environments for those
suffering from ill health. To understand the
underlying problems of healthcare architecture
in regard to a patient’s health, we must first
understand health by virtue of Aked’s five
principles of wellbeing:
i. Connect: The ability to craft and
retain social connections with others
ii. Keep Active: Physical activity reduces
symptoms of mental and physical ill-health
iii. Take Notice: Keeping an
awareness of not only yourself, but
others regarding thoughts and feelings.
iv. Give: It is healthier to give
than receive. To display altruistic
behavior on others leads to a more
positive impact on one’s happiness.
v. Keep Learning: Aspirations help
shape passion, which in turn helps shape a
purpose. A purpose can be modified by the
environment in which one is nurtured in.
27AN EMOTIONAL REDESIGN
In accordance to the five principles of well-
being, the ideal prototype should embody
the following traits and characteristics:
Mixed-use healthcare building
i. Social pagodas and pavilions
throughout
i. Accessibility would be provided, but
walking circulation is more encouraged
ii. More greenery and water elements
i. The site should feel more natural
and concrete
ii. Special acoustic panels
i. Installing features that help liven the
space, or control the noise to tranquility
ii. Tall ceilings
i. More light
ii. More warmth
iii. The inside should feel like the
outside too via sunlight
iv. Mixed use facilities include
i. Physical activity center
ii. Rec room
iii. Cafe
iv. Sacred spaces for worship/religion/
spiritual means
v. Learning hubs
vi. Large connecting courtyards
28 HOLISTIC HOSPICE
III. HOLISTIC APPROACH
A holistic approach is primarily associated
with treating the whole person through the built
environment. When used in the architectural
design process, it integrates a built environment
through sustainability, green design,
ecologically positive materials, the rhythms
and principles of nature. The approach also
seeks to promotes preventative medicine by
maintaining the health of all aspects of the self:
physical, mental, emotional, and spiritual. The
core elements are harmony and balance, light
and color, relationship to our surroundings, and
green materials (Figure 3-10). This ideology
was chosen specifically due to the conclusion
of the in-depth analysis on how architecture
can influence one’s wellbeing. The design of
physical space has the ability to help comfort
occupants both spiritually and physically. There
is a direct correlation between the natural
environment and emotional healing.
Figure 3-10. Nest We Grow, Hokkaido, Japan Retrieved from https://grad.berkeley.edu/news/headlines/holistic-garden-japan/
29AN EMOTIONAL REDESIGN
PRECEDENT REVIEWI. VANKE PARK MANSION
Although this thesis project is about holistic
design and its effects on healthcare, this
particular precedent is not located in the
healthcare space. Vanke Park Mansion is a
low-density residential community constructed
in 2017 in Xian Shi, China. The designers
tried to reflect ritual sequence and Zen spirit
in a contemporary way. Though it’s function
and purpose reflect differently than from that
of healthcare buildings, it still addresses the
elements of holistic architecture (Figure 4-1),
including harmony and balance (tight-spaced
elements spared with distance from differing
elements), light and color (hues of color that
are cast by artificial lighting to help stimulate
natural lighting), relationship surroundings
(acts as multiple buffer zones of tranquility,
Zen, peace, bustle between communities, and
green materials (see Figure 4-2).
Figure 4-1. Vanke Park Mansion ‘Bustle’ Retrieved from https://www.archdaily.com/879195/true-love-vanke-huafu-
mansion-model-district-floscape-landscpae-design-company
Figure 4-2. Vanke Park Mansion ‘Elegance’ Retrieved from https://www.archdaily.com/879195/true-love-vanke-huafu-
mansion-model-district-floscape-landscpae-design-company
30 HOLISTIC HOSPICE
II. MAGGIE CENTRES
Maggie Keswich Jenkes was diagnosed
with cancer in 1993. Regarding her memories
of the health care facility’s lighting conditions,
she stated:
“So, we waited in this awful interior
space with neon lights and sad people
sitting exhausted on these chairs ... and
the nurse said, ‘Could you come in?’ And
then we saw this doctor from Edinburgh,
and we said, ‘Well ... how long have I
got?’ And he said, ‘Do you really want to
know?’ And we said, ‘Yes we really want to
know.’ And he said, ‘Two to three months.’
And we said, ‘Oh ...!’ And then the nurse
came up, ‘I’m very sorry dear, but we’ll
have to move you out into the corridor,
we have so many people waiting.’ So we
sat on these two chairs in the [windowless]
corridor trying to deal with this business,
having two to three months to live” -
Maggie K. Jenkes (Heathcote, 2015)
Maggie often wrote of how
healthcare buildings were mis-designed
and did not suit the needs of their
occupants. She explain that “Overhead
(sometimes even neon) lighting, interior
spaces with no views out and miserable
seating against the walls all contribute to
extreme mental and physical enervation”
(Heathcote, 2015). Maggie and her
husband Charles Jencks believed holistic
spaces could benefit the occupants and
were hopeful that the experience they
suffered did not happen to others. They
worked together with other passionate
individuals to create “a [more] relaxed
domestic atmosphere.” The fallout of her
death began what is now known as the
series of support centers called Maggie’s
Centre, which provides care for people
with cancer and their families
Figure 4-3. Maggie Keswick JenkesRetrieved from https://www.maggiescentre.org.hk/pdfs/a-gift-in-your-will.pdf
31AN EMOTIONAL REDESIGN
Maggie’s Centre Edinburgh
Richard Murphy
The first Maggie’s Centre opened in
Edinburgh in 1996 and is located within the
Western General Hospital on Crewe Road
(Figure 4-4). The center is housed in a converted
stable block. The conversion, designed by
Richard Murphy, was nominated for the 1997
Stirling Prize. The center was extended, again
by Murphy, in 1999.
Figure 4-4. Maggie’s Centre EdinburghRetrieved from https://www.nhslothian.scot/GoingToHospital/Locations/WGH/Pages/
MaggiesEdinburgh.aspx
Maggie’s Centre Kirkcaldy
Zaha Hadid
The Maggie’s Centre in Kirkcaldy, Fife
(Figure 4-5) opened in November 2006 at the
Victoria Hospital. The building was designed
by Zaha Hadid and is her first built work in
the UK. The building emphasizes the transition
between the natural and the man-made and
on the transition period between the hospital
(where one undergoes treatment) and home
(where one finishes the recovery period). The
design emphasizes clear and translucent glass
with powerfully sculptural cantilevers. The
entrance façade is almost entirely made from
glass. On the north side, the roof extension
protects the entrance, while to the south, it
provides shade, resulting in a fusion between
form and function. Much thought has gone
into the layout of the building, with the kitchen
as the center of the building and an informal
atmosphere.
Figure 4-5. Maggie’s Centre KirkcaldyRetrieved from https://www.zaha-hadid.com/architecture/maggies-centre-fife/
32 HOLISTIC HOSPICE
Maggie’s Cancer Manchester
Foster + Partners
The design of the Manchester center (Figure
4-6) aims to establish a domestic atmosphere
in a garden setting and, appropriately, is first
glimpsed at the end of a tree-lined street, a short
walk from The Christie Hospital and its leading
oncology unit. Symmetrical in plan, the building
is largely arranged over a single story to match
the scale of its neighbors, but its roof angles
up at the center to create a slender mezzanine.
“The timber frame helps to connect the building
with the surrounding greenery – externally, this
structure will be partially planted with vines,
making the architecture appear to dissolve into
the gardens,” said the architect Norman Foster.
Figure 4-6. Maggie’s Cancer ManchesterRetrieved from https://www.dezeen.com/2016/04/27/norman-foster-partners-maggies-
centre-cancer-care-manchester-england/
In-depth look: Maggie Center Dundee
Frank Gehry
Frank Gehry’s first building in the United
Kingdom was the Maggie’s Centre at Dundee
(Figure 4-7). The center opened in September
2003 at Ninewells Hospital. Gehry’s design
was named “Building of the Year” by the Royal
Fine Art Commission for Scotland and was also
nominated for the 2004 RIAS Andrew Doolan
Award for Architecture.
Dr. Fionn Stevenson conducted a post-
occupancy evaluation of the Dundee Maggie
Center in 2007. The pilot study aimed to
evaluate visitor and staff responses, physical
building performance, and create a cross-
evaluative methodology for wide-use in small
scale healthcare buildings in order to improve
the briefing process (Stevenson, 2007). The
feedback follows as such:
i. The most positive impression of
the building was of the views outside,
which received the “highest rating of
any aspect of the design” and “There
were slightly lower ratings for functional
aspects such as layout, use of space
and meeting people’s needs” (pg. 15).
ii. The building also achieved a sense
of tranquility and calmness among the
33AN EMOTIONAL REDESIGN
occupants. However, despite the layout
being appreciated, the accessibility to
new occupants was a challenge. The
premise behind such centers is to find
as home-like a setting as possible; while
there will always be a sense of adjustment
needed, challenging layouts are not ideal.
iii. The views were “very meditative”
and “conducive to calm reflection
and awareness of a spiritual being.”
Visitors praised the wood aspects.
iv. “The building is a place where I have
moved from ill-health to health by visiting
regularly.” “The building/space and light
lend themselves to people feeling welcome
and safe –safe to explore difficult issues.”
Visitors praised the wood aspects. (pg 22.)
Figure 4-7. Maggie Center DundeeRetrieved from https://www.architectmagazine.com/project-gallery/maggies-dundee-5398
Maggie Centre Dundee conclusion
The conclusion of this facility brings
positives and negatives that can applied the
thesis project. Occupants enjoyed the scenic
views, the natural lighting as opposed to artificial
lighting, and the Zen-like qualities of the open
floor layout. The shortcomings of accessibility
issues for first timers is well noted. Overall,
the building functions as it should in terms
of a calm program; however, the evaluation
does not lead any directionality as to whether
the program cohesively works together. The
aspects of creating a calm environment did
not mix with any other variety of programs. The
researcher’s feedback ranges in the positives
of spatial quality, but there is no hierarchical
resonance with the function of the internals
spaces. It is possible that the researchers
surveyed a general audience, but certain data
was not presented. The study notes, “… This
leads to the building having a high ‘forgiveness’
factor, whereby people are willing to ‘forgive’
functional issues because of their appreciation
of other design qualities” (Leaman, 2001).
The Dundee center, while fulfilling some sort
of architectural ascendance, does not create a
cohesive programmatic identity.
34 HOLISTIC HOSPICE
Conclusion
Maggie’s Centers are not hospices, but rather meeting places for cancer patients to gather
knowledge and foster resilience. Despite this functional distinction, Maggie’s Centers are often
held as models for the entire field of palliative architecture, given their comparatively bold thematic
interest in the experience of mortality. Despite their relatively small physical scale, the buildings
qualify as “high visibility, look-at-me architecture” (pg. 253)(Adams, Fall 2016). These buildings,
in concurrence to Adams “see the tendency of advocates to describe palliative space primarily in
terms of what it is not.” The center’s architectural language can be described as a home, but not
really, a hospital but not really, a church but not really, and so on. It’s lack of spatial definition is of
protean quality; by not homing in specifically to one ideology, it should not be defined as palliative
architecture. One feature that unifies all the Maggie’s Centers is a commitment to progressive
aesthetic discourse. Collectively, they function as a cultural argument, that art and architecture
should play a central role in mediating society’s engagement with mortality.
35AN EMOTIONAL REDESIGN
Hospice of St. Francis, Titusville, FL.
St. Francis (Figure 4-8) is one of many
traditional hospice cares that connect adjacent
units by a hallway with artificial lighting in a
hospital-like setting. Their marketing efforts
boast a home-like atmosphere, but the reality is
little different. The colors are all flat throughout
the care, especially in the units. Only foyer
and lobby spaces have spatial qualities of the
building break; even then, the colors remain
the same throughout the site. The building itself
has much more artificial lighting than it does
natural lighting. The care also has a medical
institution feeling still stuck in the units—the
doors are too large, the color is dull, the
material diversity is lacking, and the lighting is
under-par.
Figure 4-8. Hospice of St. FrancisRetrieved from https://www.hospiceofstfrancis.com/services/care-center
WellStar Cobb Hospital, Austell, GA.
Cobb Hospital (Figure 4-9) takes a
familiar approach by incorporating the familiar
into its environment, without making distinct
architectural gestures, by using features that
are neither modern or contemporary. Unlike
St. Francis, Cobb Hospital uses small moves
to create a very traditional 1990’s American
home with traditional cabinets, fireplaces,
upholstered armchairs, vinyl wood flooring,
cases of brick veneer facades, and white exterior
trimming along all edges of the building. While
it lacks iconic or chaotic design, the simplicity
of this care is what lends a good name towards
itself.
Figure 4-9.WellStar Cobb HospitalRetrieved from https://www.wellstar.org/locations/pages/tranquility-cobb-hospital.aspx
III. EXTERNAL HOSPICE CARES
Traditionally, hospice centers have been a mix between healthcare and residential architectural
styles. The Maggie Centers were not all classified as hospice care facilities as they were mixed-use
buildings that truly embodied some sense of architectural grandeur. The following case studies
specifically reflect hospice care.
36 HOLISTIC HOSPICE
Zen Hospice Project, San Francisco, CA.
The Zen Hospice Project is a Victorian-style
apartment building on a tree-lined street that
has been renovated into a six-bed guesthouse
(Figure 4-10). Promotional materials highlight
the building’s large bay windows and high
ceilings, the idiosyncrasies of its various rooms,
and the cozy furnishings of its common spaces.
The organization’s founder, physician B. J.
Miller, gave a compelling TED Talk celebrating
sensory delight as the highest priority at the end
of life (Miller, 2015).
Figure 4-10. Zen Hospice Project
Retrieved from https://www.lionsroar.com/san-franciscos-famed-zen-hospice-closes-doors-
while-seeking-funding/
Saad Hospice Service, Mobile, AL.
Saad Hospice is a family-centric facility
(Figure 4-11). The company believes that
their patients highly value faith and family
toward the end of life. The site layout is filled
with interactions with nature, including trails,
porches, and outdoor dining. Saad also takes
pride in its “un-institutional” environment, as
the design is as approachable and familiar as
possible. Saad Hospice Service serves as close
precedent for this particular thesis project, as
it hits creates familiar, home-like, and natural-
filled settings for the occupants.
Figure 4-11. Saad Hospice ServiceRetrieved from https://saadhealthcare.com/core-services/hospice/
External Conclusion:
There is no “ideal environment” for end-of-life care at such centers. There are three sample settings
for each of these faculties: Home-like, medical institution, mixed non-type. There’s an opportunity
to craft a design that can be prototypical, symbiotic, and without a medical institutionalized feel.
37AN EMOTIONAL REDESIGN
IV. LOCAL HOSPICE CARES
Orlando, the city in question, has a small number of hospice care centers. Cornerstone Hospice
Care at Orlando Health is one of few examples. The features of the hospice include a medical-
leaning environment, constricted patient rooms, dull colors all over, more artificial lighting than
natural lighting, and a low uninteresting ceiling. The patient rooms closely resemble hospital rooms
(Figure 4-12). Based on this example, it seems that Orlando needs new architectural interventions
for hospice care patients and their loved ones.
Figure 4-12. Cornerstone Hospice Care at Orlando Health.Retrieved from https://cornerstonehospice.org/hospice-care/
38 HOLISTIC HOSPICE
METHODOLOGYI. EMPATHY MAPPING
To begin this thesis project, it was important
to understand how people respond in hospice
environments. As stated earlier, hospices are
a specialized area of healthcare where death
is a pronounced formality. In order to address
emotional behaviors during the schematic
process, the empathy map reveals how all
occupants respond to the hospice’s daily
function. How one perceives an architectural
space is a very important aspect of this
particular facility type. The researcher created
an empathy mapping diagram to understand
such feelings. The researcher asked a sample
size of people affiliated with hospice in a variety
of occupations the following questions:
• What do you see here?
• What do you hear in a hospice
facility?
• When you hear the word Hospice, what
do you think about?
• What did you hear while you were
walking around in this facility?
• What emotions were embraced or
ignored here?
• Did anyone do anything you expected
or didn’t expect?
The questions resulted in the following
responses:
i. First, what does someone see when
they go into a hospice facility? One
might expect to see medical equipment
laying around, an aura of sadness
that darkens the air, the rooms and
hallways stench of a palpable sanitize
scent, a lack of natural sunlight, and
caregivers that seem lost in thought.
ii. Second, what does one hear inside a
hospice facility? Common sounds include
an occupant frantic or stressed about a loved
one, expressions of vulnerability among
staff who have been working far longer
than anticipated that week, or unexpected
sounds from someone in their last moments.
iii. Third, how does one’s feeling
affect their thought process in such an
environment? The idea of hovering
death specifically hardens five emotions:
dreadfulness, worry, discomfort,
restlessness, and isolation. These emotions
also influence worry about one’s legacy
on earth, loneliness, concern for finances,
and so on.
39AN EMOTIONAL REDESIGN
The responses revealed a plethora of answers, feelings, and perhaps more questions. A
thorough observation of the feedback leads to two assimilation of categories upon which to place
all the aforementioned variables into – pain and gain.
The Pain
The pain of the mapping revealed
multiple ideas, but a primary drive emerged
that influenced this thesis project: people
enter this specific site with predetermined
emotions. Typically, as architects, there is a
general consensus that crafting and forging a
space should invoke a new sense of emotional
response by the viewer. In this particular
setting, the hospice center, all occupants enter
with some, if not all, of the five emotions as
outlined above. Because these are also some
sort of pre-existing condition, the treatment
of them should follow what hospices would
normally do—treat the quality of mitigation
rather than trying to heal it. Just as patients’
illnesses will be managed in a hospice center,
occupants’ emotions will also be managed,
too. (The following section will further develop
why there is a strong need to resonate with
these predetermine emotions.) Other pains
include how occupants will need to face that
they had one life before entering the facility
and will have a different life after leaving.
The Gain
The gain of the mapping crafts a diverse
array of ideas to program by creating a state-
of-the-art hospice facility that is not a hospice
facility in form. This allows an opening to
change the narrative to “you are not dying
in a hospice; you are dying in a _____.”
There is also a need to integrate nature as a
viable building material, as well as allow it to
be the anchor of a new experience for one
last time. Finally, a hospice facility has three
main occupants (patients, family/friends, and
caregivers). The separation and unity of the
three need to be tightly controlled so that the
function remains but the form does not so that
all may have private and personal spaces.
The Output
The overall output of this empathy
mapping is as follows: to create a healing
environment not only for the patients, but for
family, friends, and staff by emotional design
in order to implement a strong sense of legacy.
(See Figure 5-1.)
42 HOLISTIC HOSPICE
II. EMOTIONAL SURRENDER
Architecture typically embraces offerings
of new experiences and emotions through
space design. However, in hospice centers,
people come to the site with preconceived
emotions: dread, worry, discomfort,
restlessness, and isolation. This diagram
(Figure 5-2) depicts five dark emotions being
held together by colorful yet temporary
moments in a cyclonic manner. Via lines
entering from beyond the canvas, it illustrates
that the emotions are brought in and almost
begin to overwhelm the colorful moments.
The empty void in the middle is formed by
the congruence of realizing the validity and
trueness of these emotions. This diagram
represents a simple idea: you can temporarily
run away from the dark emotions that one
brings to a hospice facility, but they will
remain as long as you remain on site. It is
okay to feel these dark emotions in a hospice
facility. This project will act to bring clarity and
realization to these emotions via a shift the
programmatic narrative
Figure 5-2 Emotional Surrender Diagram
44 HOLISTIC HOSPICE
III. NARRATIVES
“Dying in a hospital”
The empathy mapping and the emotional surrender diagrams suggest that there needs to be a
shift in the form of the building without reassessing the function. In order to address emotions and
implement a holistic approach, it is imperative to change the directionality of this project to morph
the traditional (and likely untraditional) hospice space into a different medium. Typically, medical
facilities are located near others of its kind and create a medical district in cities that become
part of the urban fabric. To dissimilate from this narrative, this particular hospice needs to be in a
different fabric of the city. Due to the nature of the business and in coherence with some guidelines
(Verderber, 2014), the hospice needs to be in vicinity of the medical district. As this project is set
in Orlando, Florida, the site selection becomes a more important component of the schematic
process. The program needs to be anchored in a new district and allow the form of programs in
that area to help dictate and mold this new hospice facility. The program will shift the narrative from
the medical institution to another institution.
45AN EMOTIONAL REDESIGN
IV. PRIMARY MATERIALS
Three Primaries
In their survey of modern hospice design, Verderber and Refuerzo cautioned that there are “no
magic formulas,” but they do not hesitate to offer surprisingly specific guideline (Verderber, 2014):
i. Color
i. “Above all, avoid yellow and dull, bland hues in the hospice setting” (pg. 66)
ii. Dimensions
i. “Private bedrooms should be 20-25 percent larger in size than the typical hospital
room. Provide interesting ceilings with recesses, barrel vaults, and indirect lighting” (pg. 69)
ii. Material
i. “Wood is of the earth, a tree grows with time, and its age rings are visible, symbolizing
the change of season. Wood therefore possesses therapeutic value in the palliative care
experience” (pg. 80)
46 HOLISTIC HOSPICE
V. MATERIALS OF CONSTRUCTION
Verderber and Refuerzo’s guidelines touch upon some items in regard to a holistic approach.
Specific items should be used to achieve congruent tranquility (Figure 5-3). The building will use five
types of materials the construction:
i. Channel glass will allow public
settings to become private at night
due to the opacity factors of the glass.
ii. Dr. Ulrich’s (1984) research suggests
that the incorporation of nature into the
program is important because it positively
influences patients’ recovery. The main
appeal of timber frame is the timeless
beauty of exposed large heavy timbers. A
timber frame structure is a work of art in
that each piece of timber is precut. Timber
frame construction can help reinforce the
idea of using nature to help heal. By using
this method, the building can integrate
nature with other construction methods.
iii. Vault gestures are important for a
small and important reason. Bedridden
patients look to the ceiling many times,
and to look at a low and disdainful ceiling
is almost an insult to them. Livening up the
scene and introducing unpredictable yet
calm movements above their heads make
can a positive impact on their health.
iv. Linear panels are secondary wood
components specifically selected as
control rods to adjust how much sunlight
can enter a space at any given time.
v. As stated by Reuferzo’s guideline
of avoiding yellow and dull colors, this
particular palate of colors can collectively
create calm and exciting moods.
47AN EMOTIONAL REDESIGN
Figure 5-3. Five types of materials of construction
VI. MATERIALS OF VEGETATION
The site includes five types of vegetation that are locally grown and can bring a bright and airy
environment to the site. Figure 5-4 illustrates the five types, which specifically thrive in Orlando’s
climate zone. The site will flourish with variations of these vegetations to bring nature into the
design.
Figure 5-4. Five types of materials of vegetation
48 HOLISTIC HOSPICE
VII. ANTITHESIS
The antithesis precedents simulate what
kind of settings, gestures, or connections
should be visible in order to “sustain” the
predetermined emotions. The following five
antithesis precedents can be a moment for
each of the emotions:
• Dread—Clear pathways. Example:
bending buildings to allow new motions
of circulations; cutting under buildings
rather than through them.
• Worry—Tranquil spaces. Example: the
connection between a calm body of
water to the sturdy wood frames of a
building; hovering silent nodes.
• Discomfort—Breathe: populating
spaces that overhang trees that give out
oxygen, allowing the space to feel more
alive.
• Restlessness—Organized: interjecting
columns to hoist programs over an
organized walking path.
• Isolation—Larger than life: small
moments along the site that allow for
secondary programs to take place
around an iconic piece.
These small moments of antithesis
precedents are scattered throughout the
site. They do not combat the predetermined
emotions, nor do they offer some sort of
escape; instead, they offer moments of relapse.
The feeling occupants carry with them onto the
site is something unlike other programs. To
allow the occupants discourse or a getaway
from those emotions would be a disservice to
their time at the hospice facility. The need to
understand and envelope those existing feelings
and bring them to the surface is the primary
drive behind this narration of the center, as
opposed to traditional hospices that care only
about the patient’s ease of mind (Figure 5-4).
50 HOLISTIC HOSPICE
DESIGN PROCESSI. CONTEXT ANALYSIS
Orlando was chosen as the city to
explore this project due to the low number
of hospice facilities across the metropolitan
area. The analysis for Orlando was completed
concurrently with the “emotional surrender”
diagram. The basis of selecting a specific area
began with this mapping. To begin, five major
criteria were extracted from the city’s datum:
• Major roads – Highways and roads
• Major distracts – Medical distract, art
district, cultural distracts
• Building densities – Areas of activeness
vs. areas of quietness
• Waterways – In juxtaposition with
building densities
• Greenery – Unused sites of Orlando
When all five of these factors were
layered onto a map of Orlando (Figure 6-1),
there revealed a giant fabric of Orlando with
districts as patches being connected by little
bits of weaving threads of roadway. In this
chaotic figure, one particular area becomes
interconnected with all five of these factors and
is an interesting collision point between two
meshing districts. This area is Princeton Street,
which is roughly 3 miles north of the downtown
Orlando area.
52 HOLISTIC HOSPICE
II. SITE ANALYSIS
Princeton Street is also where two particular
districts diverge. Between the medical district and
the museum district, a large 150,000 square
foot plot of land is open for an architectural
intervention. It was important to determine if the
intervention—the thesis project—would be a
part of the medical district fabric or the museum
district fabric. Earlier during methodology, it was
established that the project needed a shift in
narration to reflect the emotional capacity one
can have when entering the site. And so, the
context of the site allows the form to be dictated
outside of the traditional medical capacity that
hospices follow. This hospice facility will border
the medical and museum districts, but it will
address the museum fabric. The narration will
change from “dying in a hospital” to “dying in a
museum” because of the site.
The site analysis (Figure 6-2) shows a breakdown of the existing context around the vacant
lot including the five aforementioned factors. In addition, small vignettes help break down more
factors that need to be take into account for the layout of the planned programmatic space.
The site mapping diagram shows that optimum lighting will be from east and west,
so the program’s most important spaces (hospice units) will be hosted with glasses.
Princeton Street is the most traffic heavy street in this map. In an effort to mitigate
that traffic, entrance to the site will be on sublevel streets away from Princeton.
53AN EMOTIONAL REDESIGN
Figure 6-2. Site mapping diagram: Princeton Street
As this site neighbors two districts, it was imperative to have the pedestrian traffic be accessible
for those coming from the museum district. This pedestrian access allowed for a stronger
connection and created an opportunity for this program to be a part of the museum fabric. Edge
conditions allow for the program to have a stronger connection with one district than the other.
In the previous point, the pedestrian access into the site is described as a soft edge, whereas
a hard edge will be located on the north and east side of the site towards the medical district.
54 HOLISTIC HOSPICE
III. THE ARTIFACT
By selecting a site locked into the medical
and museum fabrics, the narrative of a hospice
building changes and takes in something new.
In a negotiation with the five aforementioned
emotions, it was important to change the
narrative of the hospice in conjunction with
the interlocking fabrics. The narrative changed
from “dying in a hospital” to “dying in a
museum.” By allowing this site to be plugged
into the weave of a different institution, the
program can be designed differently, can shift
emotional entrances, and can allow flexibility
in existing designs.
The building has four groups of
occupants: patients, their family and friends,
the caregivers, and an artifact. This narration
follows three stages: day of admission, days
in hospice, and day of passing (the artifact is
different). The overall journey of each revolves
around directing the comfort can be influenced
so long as each respective comfort level is at
its optimum. Several challenges include the
patient’s new settings, the family’s dual realities
in conflict, and the many faces of the caregiver.
The artifact is a regular item of the patient that
we ask to share their spiritual journey with
them. This item acts as a spiritual token or art
piece that is displayed in various places at the
site. The artifact would take a journey from
being outside the hospice unit during the stay,
then be on display in the memoir gallery in
the connector building, then in a sacred space
near the museum entrance. Finally, it would
eventually return home to a loved one as a
unique sacred item (Figure 6-3).
56 HOLISTIC HOSPICE
IV. SKETCHES
The design sought to create and enforce some sort of legacy per the empathy mapping. The
infinite gesture was a start, especially for circulation reasons. Ideas such as creating moments of
forests for walkability, trenched in a clear lake touching the building programs were sought after.
This was done in effort against the antithesis mottos (Figure 6-4).
Figure 6-4. Sketches by Midterm
57AN EMOTIONAL REDESIGN
The infinite gesture turned into more of a symbolic idea; rather than use the curves to house
components, there became a clear opportunity to use the spaces of void instead. The openings
became the central node where the core modules would be placed, and then the rest of the programs
were offset to geometrically fall in line. The buildings and programs were allowed to overlap while
using their overlapping median thresholds to create moments of serenity. The museum spaces
would allow people to observe art from below their feet, as well as between actual programs, to
place an emphasis on the importance of these artifacts via an intimate form of view through journey
(Figure 6-5).
Figure 6-5. Sketches by Final
60 HOLISTIC HOSPICE
PROJECTI. PROGRAMMING ELEMENTS
The most important programmatic elements
were to first and foremost establish more home-
like units than traditional medically inhabited
units. Many units in hospitals or facilities
similar have a typical low square footage and
usually no true form of lodging for guests.
The introduced hospice unit in this project
contains a minimum of two bedrooms, one full
bathroom, and a living room, all of which are
ADA accessible. Other large-scale program
pieces include a central forest (for tranquility
and exercising purposes), a legacy gallery (to
house the traveling artifact), and sacred spaces
for emotional reconnection (spaces that are
specifically implemented for addressing the
surrendered emotions, in conjunction with the
legacy galleries). Additional traditional spaces
will include recreational and actives spaces
such as gyms and physical activity spaces as
well as staff rooms, lounges, and volunteer
rooms.
The smaller scale programs are specifically for
hidden uses because the scale of programming
also dictates the occupation of each; the larger
scale programs are for patients and other
occupants, and the smaller scale programs are
suited for staff. Therefore, many of the back-of-
house programs are situated in smaller rooms,
both for medical purposes and for general
building purposes (Figure 7-1).
62 HOLISTIC HOSPICE
II. THE UNIT
The entire intent of the project begins with
these units; they are the driving force behind
the design. The most essential design decision
was to include rooms for lodging and activities.
Traditional hospice facilities typically account
for one patient, a handful of guests, and two
caregivers (Verderber, 2014). The spaces
do not these factors in terms of mobility and
accessibility. Therefore, the conscious decision
to create a true sense of home was initiated.
Each hospice unit contains 2 bedrooms (one
for the patient and one visiting guests), one full
bathroom, one living/gathering room, and a
patio; all are fully furnished. A key number of
design gestures were implemented in order to
achieve the holistic approach and institutional
shift that were ascertained earlier, as outlined
below.
Curvilinear Roof
As stated earlier by Refuerzo, interesting
ceilings are very important hospice settings
because patients, especially bedridden patients,
can spend hours staring at the ceiling (Refuerzo,
2003). The roof is split into two portions; the
general slope for the unit increases up to two
feet tall, while the second roof is just above
the patient’s room, which inversely slopes. The
surface area of the roof is covered with red
cedar wood, while the patient ceiling contains
mesh drapery with illuminated stars (Figure
7-2).
Figure 7-2. Curvilinear roof
63AN EMOTIONAL REDESIGN
Interior Walls
The interior walls of the unit will be painted
with bright pastel colors. The interior wall
that separates the patient room and the guest
room will house a glass wall that is transparent
enough for the patient and guests to see one
another. The glass wall also accommodates
medical flexibility. Should a caregiver need
to conduct a procedure, the family can watch
from their room, while allowing the caregiver
the freedom to do their task. Additionally,
it is critical for family members to be able to
maintain a line of sight with the patient. The
window also has privacy screens as well (Figure
7-3).
Figure 7-3. Interior Walls
Red Cedar Beams and Timber Frame
Wood is used as the primary construction
material to reinforce the inclusion of nature as
a healing tool. The use of wood also places
a strong emphasis on ecologically positive
materials via a holistic approach in design
(Figure 7-4).
Figure 7-4. Red cedar beams
64 HOLISTIC HOSPICE
Floor and Patio
The design allows occupants to have their
own private space outdoors. The patio lays
over a body of water that also wraps around
an underground level designated for the
caregivers and staff (Figure 7-5).
Figure 7-5. Floor & patio
Glass Panels
The glass panels follow the curve of the roof,
which align with solid wood rods that automate
to allow sunlight into the unit without becoming
too bright (Figure 7-6).
Figure 7-6. Glass panels
65AN EMOTIONAL REDESIGN
Furnishings
The design includes all amenities found in
typical small homes. Furnishings are color
coordinated in accordance to the pastel walls
and timber frame construction (Figure 7-7).
Figure 7-7. Furnishing
The Artifact
To create a new identity for this type of
facility, the design notion to allow a spiritual
token to follow the journey of the patient was
implemented. The tokens’ first stage is right
outside the exterior wall of the unit, right in the
communion space. The artifact shown in Figure
7-8 is a Llama doll, as submitted by a patient.
This doll will show up again throughout the
journey of the site.
Figure 7-8. The Architect
68 HOLISTIC HOSPICE
III. THE MODULE
Each circular module has six units; they act as part
of a whole. The module is comprised of two floors, each
used for different crowds, functions, programs, and varied
circulatory patterns. The ground floor is designated for
semi-private areas, including the hospice units, while the
underground floor is used for the caregivers and other
members of the facility staff. The common connection
space between the two floors is a communion space.
The underground floor is an open floor layout for flexible
space for the nurses, administrators, and staff. All medical
equipment (barring urgent ones) are on this floor. A hidden
stair and elevator provide staff circulation between the two
floors; the circulation also allows staff to move deceased
bodies away from the units without them entering public view.
The central communion space between the units acts
as a “safe space” that embodies a tree canopy. The ceiling
is a cylindrical barrel vault with green glass protruding
through the wooden sticks (tree). Additionally, as the conic
ceiling collapses inwards, it shifts into a gutter system that
allows for the sound of rain to enter the space as a sound
acoustic for peaceful vibrations (Figure 7-10).
The separation of these three spaces opens up different experiences: Home-life ambiance and
privacy, central space to experience emotion without straying far, and dividing the narratives as well
as allowing the caregivers to have two different identities: one in the view of occupants, and one
for themselves. Take note of the unit spacing, the fluctuating height of the ceilings, the glass wall
separation, the waterway that surrounds the nursing stations, the tree as the module centerpiece,
and entrance of light from almost all directions.
73AN EMOTIONAL REDESIGN
IV. THE SITE
The module acts as the nucleus of the
entire site, as it dictated the rest of the site’s
directionality. By using the units as parts of
a whole, the geometry of the unit becomes
circular; this allows for programs to be housed
in the offset figures of the existing geometry.
Note the connection of walkways on the site
that circle the units with smaller spaces created
on the walkways’ edges. The south side of the
site contains the central forest space to offer
moments of escape from the stressful events
that may occur in the units.
An underground one-way access road is
located in the northeast corner of the site. This
underground ramp is strictly for urgent vehicles
(ambulance, hearses, etc.). Its activities are
hidden from public view.
The medical district is located to the north
of the site. The entrance to the north side of
the site is granted via vehicular access. The
museum district lies to the east of the site. The
entrance to the east side of the site is granted
via pedestrian access. Both of these entrances
are museums spaces and are the only public
access points into the site (Figure 7-12).
74 HOLISTIC HOSPICE
V. FLOOR PLAN UG:1
The first floor of the
site focuses on aspects of
healthcare staff and their
respective facilities. This
floor is hidden from public
view as it is below ground,
and is only accessible by
an underground ramp or
secure stairs/elevators.
The ramp driveway is only
used by urgent vehicles
(ambulences or hearse).
The nursing station
is an open floor layout,
on opposing ends with
a corridor connecting
both modules. There are
waterways that surround
the nursing stations, to
allow interesting light to
enter the spaces.
There are also
M/E/P facilities as well
as sanitation and storage
spaces. (Figure 7-13).
Figure 7-13 Floor Plan Level UG-1
76 HOLISTIC HOSPICE
VI. FLOOR PLAN L:0
Museum entrance
addressing museum
fabric Medical entrance
for vehicular traffic and
guests’ Central forest for
walkability in an “isolated”
area Sacred Space
museum space for the
memoir gallery Central
communion spaces
directly across from one
another. Gym/Rec for
occupants (not for non-
visitors) Ramps up to the
second floor (Figure 53)
Figure 7-14 Floor Plan Level L:0
78 HOLISTIC HOSPICE
VII. FLOOR PLAN L:1
Sacred spaces are
viewable from the second
floor Cafe/Museum
spaces on the second floor
the communion spaces
are above the second-
floor cutoff (to emphasize
the need for interesting
ceilings)(Figure 54)
Figure 7-15 Floor Plan Level L:1
80 HOLISTIC HOSPICE
VIII. THE MODULES
In Figure 7-16, starting top left going
clockwise:
i. “Day Render” shows the natural
vegetation that grows and envelopes
the modules of the site. The trees
are of various types and colors.
ii. “Night Render” depicts the
contrast between the dark and light
spaces. Note that the primarily lit
areas are the patios, the tree canopy
space, and the meandering bridge.
iii. “Nurse and Family” depicts a
caregiver giving treatment to a hospice
patient in their own room. The loved ones
watch from their own room, so as to not
disturb the nurse doing the procedure.
iv. The Tree Canopy is one singular
column that ends in the center of the
communion space (the link between the
hospice units), while starting the units
themselves. The canopy is primarily
composed of red cedar and various other
woods with green glass bridging the pieces
together. This space is a semi-private area
for the in-patients and families of the
hospice units.
82 HOLISTIC HOSPICE
IX. THE FOREST
In Figure 7-17, starting top left going
clockwise:
i. Patient sitting in solace in the forest.
ii. The forest acts as an “isolated
island” on the site. The purpose is to
give something to the occupants without
removing themselves from the site. This
particular moment acts as one of the
antithesis to predetermined emotions.
iii. Overhead look of water,
nature, and wooden walkway.
iv. Child running off in the forest, lost
in innocence.
84 HOLISTIC HOSPICE
X. THE MUSEUM
In Figure 7-18, starting top left going
clockwise:
i. Using timber frame construction
as artistic poles and connecting various
glazings to create art walls and a maze.
ii. Sacred space of various
artifacts underneath one’s feet.
iii. Entrance to site via the medical fabric.
iv. Another sacred space between the
museum and the forest. One looks down
and might see the llama doll that was
outside the hospice room. (See Figure
7-8.)
86 HOLISTIC HOSPICE
XI. FAMILY HOSPICE AT LEGACY PARK
In Figure 7-19, starting top left going
clockwise:
i. Overview of hospice in
conjunction with the infinite walkway.
This long walkway acts as a natural trail.
ii. Meandering building cutting
into the site. This building houses
a cafe and museum on the second
floor, while allowing the museum
entrance on the first floor to discharge
into the module area on the site
(restricted to visiting guests of patients).
iii. Hospice in nature.
iv. View from meandering building to
the hospice module.
90 HOLISTIC HOSPICE
CONCLUSIONI. BACKROUND SUMMARY
A study conducted by Stanford indicated
that 80% of people die in some type of medical
institution. This particular thesis examined
hospice centers. Hospice care is a type of
medical institution that primarily involves
treating the person and symptoms of a disease
rather than treating the disease itself. The
quality of life is the priority over the quantity
of life. Generally, patients are admitted into a
hospice center for end-of-life care.
Several cast studies highlight the design
faults in current hospice care centers. Hospices
typically fall in three design categories: home-
like, mixed, and medical. There is an opportunity
to craft a design that can be prototypical,
symbiotic, and without a medical institutionalized
feel. Architectural standards currently lack of a
symbiotic design that reinforces the absence
of integration for the emotional comfort of the
patients’ loves ones and = caregivers. The
existing sample styles do not take into account
that the experiences and the memories from
such settings can impact the family, friends,
and caregivers who share the common spaces
and the common difficult situations. Out of this
realization, the following thesis topic emerged:
The emotional comfort of patients,
families, and staff in hospice centers can be
improved by a holistic approach in design.
A holistic approach in architecture
integrates the built environment through
sustainability, green design, ecologically
positive materials, and the rhythms and
principles of nature. This exploration is
important because the design of the physical
space has the ability to spiritually and physically
comfort occupants. The natural environment
is directly correlated to emotional healing.
These criterions can amplify positive emotional
response as seen in the following case studies:
i. Roger Ulrich’s (1984) “View through
a Window May Influence Recovery from
Surgery” compares two sets of patients:
one with “tree views” and one with “wall
views.” Those with tree views had better
diagnoses, including: fewer infections,
reduced pain, shorter hospital stays.
ii. The study of Cornerstone Hospice
Care at Orlando Health illustrates the
typical conditions at local hospice cares:
medical-leaning environment, constricted
room, dull colors, artificial lighting, and a
low uninteresting ceiling.
The goal of this thesis was to propose
91AN EMOTIONAL REDESIGN
a new hospice facility that uses aspects of
holistic approach to improve the emotional
comfort of not only the patients, but of their
families, friends, and caregivers as well.
The design process focused on addressing
predetermined emotions, programmatic
juxtapositions, and institutional narrative shifts.
FAMILY HOSPICE @ LEGACY PARK
The project began with empathy mapping
in an effort to understand how people feel,
think, see, and perceive themselves while
in typical hospice facilities. This mapping
revealed that temporary occupants enter the
site with predetermined emotions, two differing
realities, and all occupants entering a building
that welcomes bereavement. The overall
proposition that came from this mapping was
to create a healing environment for all the
occupants by emotion design.
Architecture typically embraces offerings
of new experiences and emotions through
space design. However, in this type of facility,
people come to the site with the following
five preconceived emotions: dread, worry,
discomfort, restlessness, and isolation.
The next step was to diagram the
aforementioned emotions. The five dark
emotions are held together by colorful yet
temporary moments in a cyclonic manner.
The diagram illustrates, via lines entering from
beyond the canvas, that the emotions are
brought in and almost begin to overwhelm the
colorful moments. The empty void in the middle
is formed by the congruence of realizing the
validity and trueness of these emotions. This
diagram represents a simple idea: Occupants
can temporarily run away from the dark
emotions that one brings to a hospice facility,
but they will remain
This project will bring clarity and realization
to these emotions by helping to shift the
narrative of the program. After the emotional
diagram was complete, the search for a site
began. One of the criteria was in order to
achieve some sort of reassembled emotional
cognizance, it was imperative to find fabrics in
Orlando that collided. The main criterion to
follow were major roads, major districts, and
density of buildings vs. waters vs. greenery. This
mapping revealed open spaces of fabric, but
there was one area of greater interest between
all five of these criteria on Princeton Street
roughly 3 miles north of downtown Orlando.
This area was selected not only because all five
criteria intersected here, but because there was
an opportunity to place a traditional medical
program in a familiar fabric while allowing it to
shift and latch itself onto a different narrative on
a new colliding fabric. A mini-analysis showed
92 HOLISTIC HOSPICE
the density of Princeton Street as a traffic
corridor, so it became essential to use side
streets as entrances. Next, allowing pedestrian
traffic from the museum fabric to enter the site
from the east face. Then creating hard edges
against Princeton and the medical districts to
enforce the soft edges from the museum fabric
to shine. By selecting a site locked into the
medical and museum fabrics, the narrative
of a hospice building changes and takes
in something new. In a negotiation with the
earlier acclaimed emotions, it was important
to change the narrative of the hospice in
conjunction with the interlocking fabrics. The
narrative changed from”dying in a hospital” to
“dying in a museum.” Allowing this site to be
plugged into the weave of a different institution
allows the program to be designed differently,
shifts emotional entrances, and allows flexibility
in existing designs. The next step was to craft
the narratives for the building’s occupants:
patients, their family and friends, the caregivers,
and an artifact. This narration follows three
stages: day of admission, days in hospice, and
day of passing (the artifact is different). The
overall journey of each can be influenced so
long as each respective comfort level is at its
optimum. There are various challenges along
the way, such as the patient’s new settings,
the family’s dual realities in conflict, the many
faces of the caregiver, and so on. The artifact
is a regular item of the patient that we ask to
share their spiritual journey with them. This
item acts as a spiritual token or art piece that is
displayed at various stages of the site. It would
be placed outside the hospice unit during the
stay, then be on display in the memoir gallery
in the connector building, then in a sacred
space near the museum entrance, and then
would eventually return home to a loved one
as a unique sacred item.
The site programming includes large
home-like units, a central forest, sacred spaces,
museum and gallery spaces, and various other
large- and small-scale spaces. The holistic
approach incorporates earth-filled materials
such as wood, which will be complemented
by transparent glazing (soft gesture), as
well as bright pastel colored interiors.
The entire design begins with a new largely
furnished hospice unit, which includes two
bedrooms, one bathroom, and one living room
unit with a patio. The unit features a curvilinear
roof, glass panels, colorful pastel walls, red
cedar beam timber frame construction, and full
furnishings. There are six units in one circular
module and two modules on the entire site.
Each module contains two floors as well. The
bottom floor is an open floor flexible layout
for nurses. The top floor is for patients. The
connection space between both is a central
communion space between the units acts as
93AN EMOTIONAL REDESIGN
a “safe space” that embodies a tree canopy.
The module acts as the centerpieces of the
entire program; this dictated the rest of the
site’s directionality. This is a site plan of the
project in real life. You can see the mirror
entrance of the museum district vs the parking
opening/concrete against the medical district.
The site contains gestures to create a
balance between private spaces (such as
undeground nursing stations with a concurrent
urgant care entrance) and public spaces (such
as a central forest for walkability in a seeminly
isolated area). Additionally, the stitching of the
museum and medical fabrics of Orlando came
in congruency here to this particular site and
allowed for the existance of a new narrative,
one of which is an amalgation of the fabrics.
There was also an intention to incorporate as
much nature as possible, as a healing tool,
in every frame of the site from timber frame
construction as artistic poles, to create art walls
and mazing, interlocking tree canopy nodes,
and a multitude of vegatiation across the site.
By performing all these gestures and
moves in such a large site for a select number
of individuals, the goal of creating more
emotional resonance between all occupants
can be achieved. Allowing spiritual tokens to
recreate the setting of a typical hospice into
more of a museum shifts the predetermined
emotions off balance, as they are now entering
a different setting. With those predetermined
emotions addressed differently and with care,
it is the intent of this design project to craft
stronger memories and experiences during the
events than by remitting those emotions.
94 HOLISTIC HOSPICE
FUTURE STEPS
The work on this project should lead to further investigations on how to stitch together the
fabrics of Orlando. A hospice facility is able to link together the medical and museum districts. What
other programs could stitch this city together?
Most importantly, this project should lead to conversations discussing why the architectural
realm does not engage in design for hospice care. As a profession, why do we fear designing for
the end of life? An appropriate quote comes to mind; Nuland stated:
“The presumption that sickness and death must involve spiritual uplift, let alone one that is
deliberately mediated by art or nature, may be as much a cliché as cheap hospital curtains and
mass-market flowers. Recognizing the commonality of our desires to stage our last acts properly can
make any particular vision of those final hours seem not all that special.” (Nuland, 1995)
Nuland is right. The conversation piece needs to shift. It is not just about designing for the
patient; there are many other factors that need to hold up in the same regard. That conversation
must follow the endgame of this thesis: Is it about staging death of the patient. It is about aiming to
stage death for the loved ones of the patient.
96 HOLISTIC HOSPICE
BIBLIOGRAPHY
Adams, A. (Fall 2016). The architectures of end-of-life care. Change Over Time, 6(2), 248-263.
Ahuja, N. (2018). End stages. https://placesjournal.org/article/end-stages-hospice-design/
Berg, A. V. (2005). Health impacts of healing environments: A review of the benefits of nature, daylight, fresh air and quiet in healthcare settings. Groningen: The Architecture of Hospitals’.
Ford, J. (2012). Architecture students explore links between design and health. May 2012 from https://news.virginia.edu/content/architecture-students-explore-links-between-design-and-health
Francis J Crosson, M. (2016, June). Hospice services: June 2016 report to the Congress on Medicare. http://www.medpac.gov/docs/default-source/reports/chapter-11-hospice-services-march- 2016-report-.pdf
Golembiewski, J. A. (2016). Salutogenic architecture in healthcare settings. In M. B. Mittelmark, The handbook of salutogenesis (pp. 267-276). Sydney: Springer. Heathcote, E. (2015). Architecture and health. In C. Jencks (Ed.), The architecture of hope: Maggie’s Cancer Caring Centres (p. 56). London: Frances Lincoln. J. Aked, S. T. (2008). Five ways to well-being: The evidence. London: New Economics Foundation. Leaman, A. (2001). Special issue on post-occupancy evaluation. In Building and Research Information, 29(2). Taylor Francis Online. https://www.researchgate.net/profile/Ian_Cooper4/publication/28578990_Post-occupancy_evaluation_-_Where_are_you/links/546f26d90cf2d67fc0302832.pdf McCoy, G. E. (1998). When buildings don’t work: The role of architecture in human health. Journal of Environmental Psychology, 18(1), 85-94. Miller, B. (2015). What Really Matters at the End of Life. TED Talk. Munday, D. (2007). Choice and place of death: Individual preferences, uncertainty, and the availability of care. Journal of the Royal Society of Medicine, 100(5), 211-215. Gorman, N. (2007). Designer schools: The role of school space and architecture in obesity prevention. Obesity, 15(11), 2521-2530. Nuland, S. B. (1995). How we die: Reflections of life’s final chapter. New Haven: Chu Hartley LLC Partners, L. R. (2017). Final chapter: Californians’ attitudes and experiences with death and dying. https://www.chcf.org/wp-content/uploads/2017/12/PDF-FinalChapterDeathDying.pdf
97AN EMOTIONAL REDESIGN
Refuerzo, V. A. (2003). Innovations in hospice architecture. New York: Taylor & Francis Schrader, R. M. (2014). Architecture as medicine. The UF Health Shands Cancer Hospital. More information is needed. Charlottesville: University of Virginia Press Steemers, K. (2015). Architecture for well-being and health. http://thedaylightsite.com/architecture-for-well-being-and-health/ Stevenson, F. (2007). A post occupancy evaluation of the Dundee Maggie Centre. Dundee, Scotland: Architecture & Design Scotland. Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421. Verderber, S. (2014). Residential hospice environments: Evidence-based architectural and landscape design considerations. Journal of Palliative Care, 30(2), 69-82. Volf, C. (2013). Light, architecture and health: A method. Aarhus: Aarhus School of Architecture. Where do Americans die? (2013). https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/ Worpole, K. (2009). Modern hospice design: The architecture of palliative care. London: Routledge, Taylor & Francis Group.
98 HOLISTIC HOSPICE
LIST OF FIGURESFigure 1-1. Hospital bed 9
Figure 1-2. Emotional conflict 9
Figure 1-3. Obstacles 9
Figure 2-1. Dr. Roger Ulrich’s study 11
Figure 2-2. Ken Warpole 13
Figure 2-3. Edwin Heathcote 13
Figure 2-4. Annemarie Adams 13
Figure 3-1. Archetypal Mega-Hospital. Albert Kahn, University Hospital, Ann Arbor, MI 14
Figure 3-2. Differences in light. Carlo Volf, Aarhus School of Architecture, Denmark 15
Figure 3-3. Link between architecture and health 17
Figure 3-4. Aked’s five points improved well-being 17
Figure 3-5. Snohetta proposes new museum quarter in Italy 19
Figure 3-6. Tapis Rouge by Eva Studio 21
Figure 3-7. Copenhagen Zoo proposal by BIG 22
Figure 3-8. Benesse House Museum by Tadao Ando 23
Figure 3-9. Bear Run Cabin by David Coleman Architecture 25
Figure 3-10. Nest We Grow, Hokkaido, Japan 28
Figure 4-1. Vanke Park Mansion “Bustle.” 29
Figure 4-2. Vanke Park Mansion “Elegance.” 29
Figure 4-3. Maggie Keswick Jenkes 30
Figure 4-4. Maggie’s Centre Edinburgh 31
Figure 4-5. Maggie’s Centre Kirkcaldy 31
Figure 4-6. Maggie’s Cancer Manchester 32
Figure 4-7. Maggie Center Dundee 33
Figure 4-8. Hospice of St. Francis, Titusville, Florida 35
Figure 4-9. WellStar Cobb Hospital, Austell, Georgia 35
Figure 4-10. Zen Hospice Project, San Francisco 36
Figure 4-11. Saad Hospice Service, Mobile, Alabama 36
Figure 4-12. Cornerstone Hospice Care at Orlando Health. 37
Figure 5-1. Empathy mapping 41
Figure 5-2. Emotional surrender diagram 43
99AN EMOTIONAL REDESIGN
Figure 5-3. Five types of materials of construction 47
Figure 5-4. Five types of materials of vegetation 47
Figure 5-5. Five types of anthesis 49
Figure 6-1. Context mapping diagram: Orlando 51
Figure 6-2. Site mapping diagram: Princeton Street 53
Figure 6-3. Occupants and narratives 55
Figure 6-4. Sketches by midterm 56
Figure 6-5. Sketches by final 57
Figure 7-1. Proposed programming breakdown 61
Figure 7-2. Curvilinear roof 62
Figure 7-3. Interior walls 63
Figure 7-4. Red cedar beams 63
Figure 7-5. Floor and patio 64
Figure 7-6. Glass panels 64
Figure 7-7. Furnishings 65
Figure 7-8. The artifact 65
Figure 7-9. Hospice unit axonometric 67
Figure 7-10. Module axonometric and overhead plan 69
Figure 7-11. Model section cut 71
Figure 7-12. Overall site plan 72
Figure 7-13. Floor plan level UG-1 74
Figure 7-14. Floor plan level 0 76
Figure 7-15. Floor plan level 1 78
Figure 7-16. The modules 81
Figure 7-17. The forest 83
Figure 7-18. The museum 85
Figure 7-19. Family Hospice at Legacy Park 87