Successful Hospice House Design

by Richard B. Borrelli and Douglas W. Whitney

Designing a hospice facility is a sacred assignment. It is not only a place to keep a terminal patient comfortable, it is also a place where patients and their families will visit, reminisce, comfort each other, and ultimately, say goodbye.

Today, there is less focus on the clinical aspects of hospice care and greater understanding of the need to create a peaceful, nurturing environment for patients and families. This trend is encouraging small, well-appointed centers that focus on living, not the ending of life. Here are some key best practices in hospice house design:

Comforts of Home. In designing hospice rooms, we take as many cues from the hospitality industry as we do from acute care. Furniture should be plentiful and scalable; colors both cheerful and soothing. Acoustics need to accommodate privacy, so that resting patients won’t be disturbed by family visits in the next room. At the same time, a hospice room must also be able to accommodate the realities of palliative care. A lot can be accomplished by the use of movable furniture and equipment, well-designed storage options, and surfaces that are easy to keep clean, all within a well-considered layout. Patient rooms often include regional materials to create a sense of home, of the familiar, and hopefully to evoke positive memories.

Links to Nature. Connection to the outdoors is something that has become important. This goes beyond designing rooms with access to daylight and natural views. At WBRC’s recent hospice project, Sussman House, Rockport, Maine, the design includes physical access to private outdoor patios, as well as multiple gardens and walking trails. Common sense and clinical research both tell us that nature is a healer. So views of nature, access to the outdoors, and controlled natural light are all must-haves in today’s design schemes.

Focus on Today’s Family. American culture has made great strides in bringing the dying process back to what it once was — a family-centered journey. Multiple generations will likely be at the bedside of hospice patients, and each has different needs. Everything a multi-generation family would need at their home — a kitchen, living room, bathrooms, TV, Internet access, even things like a high chair — should be in a hospice home. At Sussman House, a glassed-in den allows children to play, read, or watch TV safely, with acoustical separation from the main gathering room.

Discretion and Sensitivity. Given the higher-than-normal percentage of deaths in a hospice setting, it is imperative to provide discreet methods for the removal of these patients postmortem. Strategies that keep this removal quiet and private must be part of the facility’s master plan. For example, a separate, screened rear access door is part of Sussman House’s successful design.

Caring for Caregivers. In order for a hospice house to be successful, staff needs be given as much consideration as the families visiting their loved ones. Staff members often become attached to their patients and families and can take quite an emotional hit from the continued losses of their charges. Space for them to escape from the stress and have a private conversation is critical to maintain emotional equilibrium. At the same time, as with any residential care facility, staff should have a visible line of sight to patients whenever possible.

Ask the Experts. One of the simplest and most overlooked ways to come up with creative solutions to the particular challenges of hospice design is to visit other hospice facilities and ask what works and what doesn’t.

Richard B. Borrelli, AIA, NCARB, is a firm principal and healthcare director at WBRC Architects · Engineers.
Douglas W. Whitney, AIA, NCARB, LEED AP, is the firm’s president/CEO.
Sussman House, part of Pen Bay Healthcare, was constructed by Wright-Ryan.