holistic hospice: an emotional redesign - UFDC Image Array 2

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


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).


Figure 2-1. Dr. Roger Ulrich’s study

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.


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-


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?


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.


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).


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


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.)


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.


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/


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


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


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.


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.


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.


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.)

40 HOLISTIC HOSPICE

Figure 5-1. Empathy Mapping

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.


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.


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).


Figure 5-5. 5 types of anthesis

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.


Figure 6-1. Context Mapping diagram | Orlando

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.


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).


Figure 6-3. Occupants & Narrative

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


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

58 HOLISTIC HOSPICE

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).


Figure 7-1. Proposed programming breakdown

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


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


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

66 HOLISTIC HOSPICE


Figure 7-9. Hospice Unit axonometric

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.


Figure 7-10. Module axonometric & overhead plan

70 HOLISTIC HOSPICE


Figure 7-11. Module section cut

72 HOLISTIC HOSPICE

Figure 7-12. Overall site plan


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


Floor Plan Level 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.


Figure 7-16. The Modules

82 HOLISTIC HOSPICE

IX. THE FOREST


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.


Figure 7-17. The Forest

84 HOLISTIC HOSPICE

X. THE MUSEUM


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.)


Figure 7-18. The Museum

86 HOLISTIC HOSPICE

XI. FAMILY HOSPICE AT LEGACY PARK


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.


Figure 7-19. Family Hospice at Legacy Park

88 HOLISTIC HOSPICE

FAMILY HOSPICE AT LEGACY PARK. THANK YOU

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


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


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.


THANK YOU

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


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.

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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


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

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