B.SAI CHARAN 09AR1035

HOSPICE CARE FOR TERMINALLY ILL PATIENT

TABLE OF CONTENTS:-

INTRODUCTION- Aim- Scope- Objectives- Synopsis- Methodology

LITERATURE CASE STUDY

CASE STUDY – 1

CASE STUDY – 2

CASE STUDY – 3

SUMMARISING THE DATA- Comparative analysis- Requirements and Area Statements

What is a hospice?

Hospice is a system which provides care to terminally ill patients at the end of their lives and also supports their families in the bereavement process.

It includes comprehensive nursing care as well as psychosocial and spiritual care for the patient and family.

Hospice is built on the nursing model which concentrates on care and comfort until death, in contrast to the medical model of care, which is based on cure.

Hospice emphasizes palliative rather than curative treatment; quality rather than quantity of life. The dying is comforted. Professional medical care is given, and sophisticated symptom relief provided.

The patient and family are both included in the care plan and emotional, spiritual and practical support is given based on the patient’s wishes and family’s needs.

Trained volunteers can offer respite care for family members as well as meaningful support to the patient.

Hospice affirms life and regards dying as a normal process. Hospice neither hastens nor postpones death.

Hospice provides personalized services and a caring community so that patients and families can attain the necessary preparation for a death that is satisfactory to them.

Those involved in the process of dying have a variety of physical, spiritual, emotional and social needs.

The nature of dying is so unique that the goal of the hospice team is to be sensitive and responsive to the special requirements of each individual and family.

Hospice care is provided to patients who have a limited life expectancy. Although most hospice patients are cancer patients, hospices accept anyone regardless of age or type of illness.

These patients have also made a decision to spend their last months at home or in a homelike setting.

HOSPICE

Synopsis

INTRODUCTION:-

The proposal to design a Hospice, responds to the need for a "third place" for patients during the final days of a terminal illness. This third place is an alternative to the home and the hospital. The patients often require care that is difficult for family members to accomplish at home. Furthermore, the hospital does not end itself to create the personal and welcoming atmosphere required for palliative care. Careful consideration is necessary to sensitively fulfil the physical, emotional and spiritual needs of both the patients and their families.

AIM:-

To achieve design solutions offering the destitute a few lost moments that let them live life their residue and reliance the grieved of their stress and depression with cozy and comfortable environment to endow with dignity of death

To create a caring atmosphere for those who are terminally-ill, creating an environment provide a pain free an dignified death through planning. A complex of supporting facilities in an ambience of light and serenity.

OBJECTIVES:-

Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting no longer responds to cure-oriented treatments.

Hospice care neither prolongs nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.

The goal of Hospice care is to improve the quality of patient’s last days by offering comfort and dignity.

Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.

Hospice addresses the all symptoms of a disease, the a special emphasis on controlling a patient’s pain and discomfort.

Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends.

Hospice offers a variety of bereavement and counselling services to families before and after a patient’s death.

Scope:-

The design will look in to the psychological aspects of patents and their individual needs.

The detail analysis of the requirements will be conducted to make sure the purpose is use full.

Climate and surroundings in act around the site shell form the basis of placement of various blacks.

Sensitivity and openness shell form the concept of design.

Design will involve the study of opportunities materials for the built form

Limitations:-

The final built form will comprise all facilities to support a hospice to function in totality, which involves a variety of shapes ranging from individual resting units to common spaces along with recreation areas.

Choice of material will depend on its physical character.

The design will be restricted to spaces and their ambience along with their impact. No direct involvement in to details of the machine technology used from treatment.

METHODOLOGY

METHODOLOGY

STAGE ONE

1. Description of research work

2. What is a hospice

3. History

4. Present day need of hospice

STAGE TWO

1. Literature study, Aims & Objectives

2. Case study - 1

3. Case study - 2

STAGE THREE

1. Site analysis

2. Concept

3. Design sheets

STAGE FOUR

1. Summary and conclusion

2. Bibliography

LITERATURE REVIEW & CASE STUDIES:-

SPACIAL REQUIRMENTS:-

WARDS

KITCHEN

DINING

MEDICAL TREATMENT ROOM

DRUG STORE AND RECORDS

LAUNDRY& HOUSE KEEPING

SLUICE ROOMS

WORKSHOP/ HOBBY ROOM

PHYSIOTHERAPY

MORTUARY

MEDITATION / QUIET ROOM

DAY CENTRE

NURSE CALL SYSTEM

SPECIAL BEDS

WASTE DISPOSAL

GENERATOR ROOM

STORAGE

CASE STUDY – 1

HOSPICE OF THE COMFORTER’S (HOSPICEHOUSE)-CENTRAL FLORIDA

More than 18,000 square feet of patient care area provides comfortable surroundings decorated with southern elegance.

It cost approximately to build this much-needed facility to care for Central Floridians.

Hospice of the Comforter’s Hospice House is a place to live in peace with comfort and dignity (Hospice house, 2001).

The plan of the hospice of the comforter is shown in plan

The Hospice House has 16 comfortably furnished private care suites that accommodate overnight family visits.

Each warmly decorated room features cozy seating areas, lots of natural light and access to outdoor covered porches.

Two family gathering areas offer a place for patients and families to enjoy music, TV or conversation.

The facility also offers a welcoming family dining area; children’s play area and a

chapel. It is equipped with the latest technology for the convenience and comfort of the

patients and their families, including a sound masking system throughout the building (Hospice house, 2001).

This home-away-from-home is a warm, comfortable setting in which patients and their families receive the highest quality hospice care available in Central Florida.

This state of the art facility is the only free-standing inpatient Hospice House serving Orange, Seminole and Osceola counties.

It provides a warm, home-like atmosphere where patients can receivespecial care while being surrounded by friends and family members (Hospice house, 2001).

THE MERITS AND DEMERITS OF THIS CASE STUDY:-

The arrangement of the spaces in this facility is very compact and presents an interesting layout as shown.

It is worthy to note that the facility is under one roof, but in the tropical developing countries like Ghana, it would be better to spread the spaces out to aid in ventilation, lighting and fostering of culture by the introduction of courtyards in the design.

The facility has functional spaces such as dining areas, living areas and to foster interaction between both patients and their family members.

The patient rooms are making them very spacious and large enough to accommodate the use of wheelchairs.

Arrangement of furniture has been done to harness views into gardens’ Many patients choose Hospice of the Comforter during their final months of life so that they can have the feel of living in a homey environment, where family can come to visit so they can be in the presence of familiar surroundings and precious loved ones

CASE STUDY – 2

ST.OSWALDS CHILDRENS HOSPICE-GOSFORTH, NEWCASTLE:-

The play area as shown in has well defined soft and hard landscaped areas.

This is to aid in play and learn. Non-slip tiles are used to prevent children from slipping.

In the proposed hospice design, courtyard gardens as shown were incorporated in the design and well monitored and contained play area for the children was provided.

Different garden types were used to introduce variety and a conservatory as shown in was introduced so that users of the space could enjoy some sunlight especially those too weak to go outside.

Shown two types of bedrooms, incorporated into the interior design concept it will help stimulate the children as they stay indoors.

Tiles and carpeting were used as the major and basic floor finish within the interior spaces.

Large picture windows and French doors were used extensively so that users can have a clear view of the outside world.

Window and door treatment entails the use of curtain blinds and curtain fabrics are also used.

Blinds are used for the general areas and curtains for the bedrooms The proposed design houses a multi-sensory room for the children in the facility, has large windows to promote good lighting and ventilation within the facility.

Perforated fences were used to create semi-partial views. Courtyards and well defined landscaping were also incorporated in the design.

THE DESIGN OF HEALING GARDENS

Generally, designing healing gardens follows the same considerations used in designing any other garden. However, the following take on special meaning in healing environments functionality, maintainability, environmentally sound, cost effective and aesthetically pleasing.

Healing gardens must maintain the purpose for which it was designed. It is imperative because the garden needs to accommodate the limitations of the users of the space such as high immobility and the failure of some of the five senses. It is also important that the garden design be maintainable both for physical safety and therapeutic benefits.

At institutions such as hospitals, it is especially important that the garden be easily maintained because a poorly maintained garden could make patients lose confidence that they are being well taken care of by hospital staff Healing gardens should also be designed with materials that enhance the environment instead of causing harm to it .

If the garden is not environmentally sound for example using plants that could be toxic or poisonous, could be detrimental to the users of the space, especially those who are terminally ill.

Often times the funding for healing gardens is raised through donations. Therefore is it important that the garden design be constructed on a low budget in order, not to deplete the funds of the facility at any given time.

Finally, healing gardens are meant to provide pleasant surroundings to produce restorative effects for its users. The garden will not be successful if it is not visually pleasing.

PRINCIPLES OF DESIGNING HEALING GARDENS

The guiding principles for designing an effective healing garden include unity, simplicity, balance, scale, focal points and planting.

It is important to use the principles of design to create unity within the healing garden design. Simplicity is essential in designing healing gardens to keep the space easy to understand.

Many of the people using healing gardens are dealing with stress: it is important that the spaces are not designed to be busy to add any additional stress.

At the same time, the design should include a variety of form, texture, seasonal interest, and colour to provide sensory stimulation.

Not having enough interest can also be stressful to the users of the space.

DESIGN GUIDELINES OF HEALING GARDENS.

The design guidelines pertaining to healing gardens are paths and surfaces, spatial layout, treatment of surfaces and circulation.

PATHS AND SURFACES

Effective paths and surfaces for healing gardens have been researched into. The following discussion is based on the standards provided by Design five-foot minimum width at paths for one-way traffic to accommodate the turning radius of a wheelchair and seven-foot minimum width for two-way wheelchair traffic.

Figure illustrates this requirement for paths. Firm enough for wheelchairs and also cushion falls.

The paths leading to the healing gardens in the proposed hospice design was constructed with granolithic paving.

There is the need to limit grade changes in most highly used outdoor areas.

The slope of a walk must not exceed 5% or 1 foot of rise for 20 of feet length. Cross slope must not exceed2% or 1 foot of rise for 50 feet of length as shown in this design, all steep gradients will be filled up to enable the easy access around the facility.

Where slope does exceed 1:20, a support railing should be provided for those with unsure footing.

When dealing with healing gardens, building codes are necessary so one can have an

idea of where to start in terms of clearances.

They are often the bare minimum that should be allow for the patients, as the sound and sight of different forms of water provides a calming effect on people .

SPATIAL LAYOUT

The use of a good spatial layout provides a variety of spaces to accommodate different activities and different levels of privacy, from spaces that allow group activities to spaces that allow solitary contemplation.

It also creates a screen between people in the garden and any windows looking out onto the garden to avoid a "fish bowl" affect.

Spatial layout provides transition areas between public and private garden spaces thus providing users of the garden options for control of privacy as illustrated.

Design the garden away from noisy streets or mechanical elements such as air conditioners.

Where undesirable noises cannot be avoided, incorporate features such as a water fountains or wind chimes to mask the sound. This helps to reduce the level of noise pollution into the facility.

The layout of the garden should be easily "readable" to minimize confusion for those who are not functioning well. Paths should be clearly laid out.

Landmarks should be provided to help orient the users of the space. This can be done with elements such as sculpture, a profusion of flowers, or a water feature

It is recommended that a variety of sunny and shady areas for people with varying tolerances to light exposure be incorporated in the hospice design so that all the users of the facility can enjoy the outdoors.

Seating may be provided for those using the garden. Lightweight chairs are desirable in allowing users to move the seating wherever they wish.

Plenty of sturdy seating with backs and arms should be provided for those that need support for sitting for long periods of time. Water features should be provided throughout the gardens to aid in creating a soothing atmosphere

THE BENEFITS OF WATER IN HOSPICE DESIGN

Our bodies are seventy per cent water. Water contains vital elements that keep our bodies healthy, and also contains negative ions, which are released into the air when water tumbles or cascades from a waterfall.

Negative ions affect mood and the ability to concentrate, clean the air, and promote a sense of tranquillity and inner peace.

There are many reasons for using water in a hospice environment. They include stress relief, noise reduction and a natural humidifier.

STRESS RELIEF

Waterfalls are purchased for many different reasons, including; stress relief, to compliment interior decor, to create a soothing environment, or even for natural humidification.

Indoor waterfalls are a simple and stunning way to enhance the beauty of one’s home, welcoming guests with elegance (Enhance indoor Environmental quality).

NOISE REDUCTION

Indoor and outdoor waterfalls can reduce distracting and unpleasant noise from the surrounding environment.

This is especially useful for quiet areas and rooms. The sound of moving water promotes a sense of calm and covers the detrimental effects of noise pollution.

Home water features can be customized to suit one’s mood and style. Indoor water feature scan be personalized to match any decor.

Outdoor waterfalls can add tranquillity to any garden or landscape (Enhance indoor Environmental quality).

TECHNICAL STUDIES

To further aid in the design, studies were made into the technical requirements of spaces related to hospice design and construction.

These were on barrier free living, wheel chair usage and internal spaces. Figures show some of the facilities considered from Neufert (2000).

A specially designed environment for the disabled needs to be considered to accommodate wheelchairs, and allow sufficient space for moving around in safety taken from Neufert (2000), illustrated some of the standards considered.

AREA STATEMENT:-

DERIVED STANDARDS

KARUNASHRAYA

Site area ----- 5 acres

Build up area 15- 20Single-20sq.mtDouble-16sq.mt

3530.25 sq.mt

No of bedsNote :- all rooms must be attached with wc’s

15-35 sq.mt 554 common wards(102.10sq.m)12 patient in each ward

Kitchen 20-50sq.mt 45 sq.mt

Dining 10-25sq.mt Food served on beds

Medical treatment room

15sq.mt Treatment on beds

Medical Store and records

12- 15 washing machine and driers

50 sq.mt

Laundry and house keeping

6-15sq.mt 45 sq.mt

Sluice room 25sq.m 50sq.mt

Hobby room 15sq.mt 36sq.mt

crèche 15-30sq.mt 25sq.mt play area

Physiotherapy 15sq.m Done on beds

Mortuary 20sq.mt

Counselling 8-13 sq.m 30.6sq.m/day care centre

Meditation/quiet room

15 sq.m 36sq.m

Staff teaching 12-18sq.m 30sq.m

Reception 16sq.m 80.77 sq.m

Day care 25 sq.m 30.6 sq.m

Family room 20sq.m Used as hobby room

Nurse cell system Bell on beds with supervision

Bells and supervision

Phone Every room cordless

Every room cordless

Special beds For contagious diseases

Single rooms used or patient(no i. c.u)

Waste disposal Colour coding Waste bins kept in sluice room and sent out for disposal in vans

Generator rooms 5sq.m 8sq.m

Width of corridors

1.8sq.m 1.8sq.m

Ramp 1 in 12 1 in 12

Store and wall chair

15sq.m

No of nurses and helpers

3/15 beds 11/15 beds

Sill hight Should provided view from the beds

0.75sq.m

Flooring Non slippery Mosaic

Colour of wall and type

Pastels of blue and green

White plastered

Toilets attached to wards

9sq.m Toilets with bath12sq.m

Ventilation Natural cross ventilation

Good enough provided

Live case study: KARUNASHRAYA (non-local):-

HISTORY:-

THE BANGALORE HOSPICE TRUST WAS SET UP IN OCTOBER 1994 BY THE INDIAN CANCER SOCIETY (ICS), KARNATAKA BRANCH AND THE ROTARY BANGALORE INDIRANAGAR (RBI).

ICS IS A VOLUNTARY ORGANIZATION WORKING WITH CANCER PATIENTS SINCE 1952. ICS KARNATAKA BRANCH WAS ESTABLISHED AS A NON-PROFIT ORGANISATION AT BANGALORE, INDIA IN 1988. ITS MAIN ACTIVITIES INCLUDE EDUCATION ABOUT THE DISEASE IN ORDER TO REMOVE THE FEAR OF CANCER, AS WELL AS CONDUCTING OF CANCER DETECTION CAMPS MAINLY IN THE SLUMS IN BANGALORE.

RBI WAS SET UP IN 1981, AND NOW HAS AROUND 100 MEMBERS. RBI ACTIVELY EXECUTES COMMUNITY SERVICE PROJECTS, CONDUCTS CAMPS, RUNS COUNSELLING CENTRES, AND PROVIDES ASSISTANCE TO CHARITABLE AND SOCIAL INSTITUTIONS.

KARUNA SHRAYA FOUNDATION WAS LAID ON JUNE 23 1996,AN CAME TO OPERATION STAGE ON 1999 1ST MAY .

FROM 1999 KARUNASHRYA SERVED 11000 PATIENT’S WHICH MACKS THEM LIVES IN DIGNITY AN DIES IN DIGNITY.

THERE WILL BE 90 TO 100 INPATIENT PER MONTH AN 40 TO 45 DEARTHS PER MONTH IN THESE HOSPICE

KARUNASHRAYA ADMITS THE PATIENTS ONLY IN THE LAST SATAGE OF THE LIFE

LOCATION: -

KARUNASHRYA, Old Airport-Varthur Main Road, Marat hall Kundalahalli Gate, BANGALORE, INDIA.

TOTAL SITE AREA:-

5 ACEARS

TOTAL BUILDUP AREA:-

1.5 ACEARS

Dignity in death:-

The doctors who visit Karunshraya offer voluntary services. Volunteers from Karunashraya visit slums in the city and offer services to cancer patients like nursing care and counseling.

The terminally ill are brought to Karunashraya, and their families are offered help to fight anxiety and depression.

The hospice also takes care of the last rites of patients who have been abandoned by their families.

CONCEPT:- There are different concepts used in this design.

With the layout, there was a smooth flow of activities through various spaces, simple and clearly demarcated layout and incorporates nature in and around the buildings.

For the interior, the spatial and furniture arrangement further enhanced the concept of inhibited circulation through the spaces.

The colour, lighting, scale, treatment of the spaces, and finishes also depicted the concept of lightness within the spaces.

For the exterior, the use of hard and soft landscaping, water features, good façade treatment, sounds from birds and water, the wind and rustling leaves will all aid in the design.

FUNCTIONAL RELATIONSHIP :-

Water body and greenery show the functional relationship between the spaces. This helps in the smooth and effective transition between the interior and exterior spaces.

NATURAL VENTILATION :-

The use of courtyards, large operable windows to facilitate cross ventilation, aids in the adequate ventilation of the spaces especially the patient areas.

The direction (south-west and north-east) and speed of air flow which determines the cooling effect of natural ventilation has been exploited very well by the structure and form employed.

This is possible due to the fact that the openings of the habitable areas were placed on the north- south elevations of the buildings.

WATER BODY

GREENARY

BLOCK PLAN :-

The facility occupies about 30% of the site and the other 70% for landscape which includes, open pavilions, healing gardens and courtyards and future development.

The soft landscaped part of the site provides the ideal setting for natural therapy and can also be used to create a serene and warm atmosphere.

STRUCTURE / FORM OF DESIGN: -

The structural system employed here is the load bearing post and beam system. The varying building heights also promote good ventilation and gives good views. the amount of solar heat received by the surface of the structure has been minimized by the thoughtful manipulation of the following:-

Shape and orientation of the building plan with respect to the path of the sun.

The parts of the building exposed to the sun.

MATERIAL: -

Most of the materials used ware natural materials like stone.

Flooring (red mud tiles for corridor ceramic tiles in patient rooms.

Walls(most of the walls are stone walls internal walls with brick )

Ceiling(no specified treatment for ceiling flat ceiling)

Furniture

DRAINAGE :-

With grate pre-sloped was used for the drainage because it is easily cleaned and maintained.

SERVICES:-

Water and Electricity:-

Electricity has been provided from the mains, which run along the main street.

Water from the boreholes will have to be treated and pumped to serve the facility.

Solar power is using for electricity

Minimum amount of air conditioning has been used at the administrative area.

Service ducts for rainwater have been provided through fins.

Waste bins have been neatly provided at vantage points to keep the hospice clean.

Points for extra installations of sockets have been made available at several points in the design to make it an efficient one.

Sewerage waste and effluent from the sanitary areas will be channeled into a bio-digester with a soak away.

It does not require any dislodging. The space required for the bio-digester is also 20 times less than the septic tank.

COURTYARDS AND LANDSCAPING:-

Emphasis was placed on the use of courtyards in the design to aid the ventilation of the internal spaces, create meeting places to meet and interact, and create semi-private and private areas for the patients.

The design makes extensive use of landscape elements such as fountains, ponds, rockeries and statuaries, greenery and pavers.

This is due to the fact that a serene and environmentally interactive space is needed in such a hospice facility to enhance peaceful and tranquil experience of patients and their families.

The main entrance to the facility is shrouded with heavily shaded trees.

To the right of the entrance is a high pressure pumped rock waterfalls with stepping stones leading to it.

AREA STATMENT:-

SPARK HOSPICE SPARK HOSPICE

Site area 5 acres Counselling 30.6sq.m/day care centre

Build up area 3530.25 sq.mt Meditation/quiet room

36sq.m

No of bedsNote :- all rooms must be attached with wc’s

554 common wards(102.10sq.m)12 patient in each ward

Staff teaching 30sq.m

Kitchen 45 sq.mt Reception 80.77 sq.m

Dining Food served on beds

Day care 30.6 sq.m

Medical treatment room

Treatment on beds

Family room Used as hobby room

Medical Store and records

50 sq.mt Nurse cell system Bells and supervision

Laundry and house keeping

45 sq.mt Generator rooms 8sq.m

Sluice room 50sq.mt Width of corridors

1.8sq.m

Hobby room 36sq.mt

crèche 25sq.mt play area

Physiotherapy Done on beds

Mortuary 20sq.mt

Ramp 1 in 12

No of nurses and helpers

11/15 beds

Sill height 0.75sq.m

Flooring Mosaic

Colour of wall and type

White plastered

Toilets attached to wards

Toilets with bath12sq.m

Ventilation Good enough provided

REFERANCE:-

www.hospicefoundation.org www.hospicenet.org www.hospice-cares.com www.scu.edu/hospice www.hospiceinfo.org www.hospice.com www.hospicecare.com www.hospiceworld.org www.webring.org/egi- bin/webring?home&ringhospice www.bannerhealth.com www.jei.com/cg-healthcare www.coping.org/relations/healing.htm www.palliative.org www.cape.org

SPACIAL INTER-RELATIONSHIP :-

ARCHITECTURAL DESIGN THESIS

2013

REPORT ON

SPARK HOSPICE

B.SAI CHARAN

09AR1035

INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR