The Building Program

THE PROGRAM ANALYSIS AND DEVELOPMENT

Program Analysis
There is a certain mystique when dealing with the issue of death. But, although palliative care involves the most complex of needs, it is for this care that the most CAN be done. Medical care is not my expertise, and therefore, I will not argue on that point of view. However, architecturally, I feel that more can be done. There is much that can be done in order to improve the environment in which people diagnosed with terminal illnesses live their end-of-life in.
I have had two very informative meetings that have greatly helped me in formulating the program for this thesis. The first was a workshop that I attended on March 29, 2000. At this workshop, there was a video that was shown. The video was filmed in the Palliative Care Unit at the Royal Victoria Hospital and shows the life in this care unit. Through interviews with staff and family members, and patients also, the video has given me many ideas of what should be included in the program. The second meeting was with a Ms. Linda Crelinsten, Assistant Director, Program Development of Palliative Care McGill at the Royal Victoria Hospital who took the time to lead me on a tour through their Palliative Care Unit. Some of her personal comments and views have also helped me refine this program.

Thoughts
from the
Palliative Care Workshop
29/03/2000
Important aspects regarding palliative care:
One of the most basic needs regarding palliative care is getting rid or at the least controlling the pain of the patient. However, the patient's needs do not end there. It is also essential to emphasize on enjoying the moment, the here and now. Being with their family, as well as being strong for them is important to the patient.
Architectural
Interpretation
Family Rooms

Furthermore, the role of the caregivers is also to support the patient and their loved ones. This support should be dealt with on a day-to-day basis and should not be focused on death. They must also help the patient feel secure without giving false hopes. Hope is never taken away, it is only channeled differently. Quality of Life is important and should be taken into consideration in the design of the facilities.

After being diagnosed with a terminal illness, these patients are still living, it should be thought of as a limited life rather than an impending death. As such, maintaining dignity as a human being and conserving a quality of life is valuable. The focus here should be on sharing and appreciating life, health, children and love. Patients are often separated from this. Talking about simple things always helps, they cannot allow themselves to think of long-term goals for themselves anymore.

Other notions extracted from the workshop video
Entertainment, especially in the form of music, can help pass the time and allow for the patients to enjoy the moment. Music has depth and can be used as a safety net for difficult feelings. It is a good method of interactive therapy.
Designated lounge for listening or having live musicians play.

Celebrating holidays is also important in order to acknowledge that they are still LIVING. Dining with visiting family members rather than always eating in bed can bring joy in their daily lives. Large Dining Room that can also be used for holiday meals for larger groups.

Preparatory grief work should also be done in order to help the family. Psychologists can play major roles in coping with the grief. Counseling Psychologists office

Time is a huge distraction. Night times can be very lonely and patients have more anxiety. It is important to know how to plan for this and find ways to help orient the patient better. In time and in space. At the hospital they try to put clocks in all the rooms. Created uncomplicated forms, lots of views to the exterior, obvious relationships between different spaces within.

The Palliative
Care at the
Royal Victoria
Hospital
31/03/2000
There are 16 beds at the RVH and 10 more at the MGH. The growing need for more rooms must also be accounted for.
At the moment, many rooms are also doubled, however, there is a strong need for privacy. The patients in double rooms that are approaching the very end of their life are often moved into single rooms at this point.
There is also a hide abed in each room for family members that wish to stay over night. Sufficient space must be given to accommodate this. At the moment all the rooms ar very cramped.
30 bedrooms.

Single rooms are important. However they could be designed large enough to move two beds into the same room when a patient wishes the company of another patient.
Also need sufficient room for hide abeds.
Rooms are presently approx. 8' x 10'.

Staff at the RVH (for 16 patients)

1 Director of Research + Assistant
1 Psychologist
1 Music Therapist
1 Occupational Therapist
1 Bereavement Coordinator
1 Full-time Doctor + 1 Part-time
4 Nurses
3 Volunteers
(For 32 Beds)
# of offices
2 + 2
2
2
2
2
2 + 2
8
6
1 general staff lounge

Room for special bath unit. This is a massaging bath used by patients, especially when they are taking pain killers. It helps relax them. Special room
approx. 15' x 15'

There is a small library of CDs and Tapes along the corridor walls for patients. Each patient has a cassette player by their bed. Library

"Staff Rounds" Conference Room Conference room

Nursing/Medication Room. This room is at the back of another room. Access is limited. Medication room

Large solarium with piano. This room at the RVH is also used for monthly memorial services. It is presently approx. 20' x 30' and is not nearly large enough to accommodate every one. Large solarium and separate memorial service room. Can also be used as a chapel or other prayer room.

Family room, also used as a meditation room. Family room, meditation room can be combined with the memorial service room.

Kitchen with fridge. There is also a small alcove in one corner for patients that want to sit with their family in privacy. This room is definitely undersized. Large kitchen next to the dining room.

Some patients need radiation therapy and chemo therapy. This services are offered in another area of the hospital. These services should be offered at the hospital and not at the hospice.

Program Development
The following program was developed after attending a workshop about Palliative Care and then visiting the Palliative Care Unit at the Royal Victoria Hospital. The program has also been fine tuned over several weeks of design and adapting the program to the site in question. Furthermore, the review of several examples of precedence on existing hospices has given me other clues as to what should be included in the building program. The importance here is to look at the combination of rooms designated for larger group gatherings versus rooms that are subdivided in order to accommodate several families all while giving them enough privacy. This is meant to acknowledge the fact that patients and families need a certain level of privacy when they are in the hospice, as the issues at hand are very personal. However, it is imperative to also have spaces for large group gatherings in order to initiate a sense of community within the hospice.
For concept sketches of the program distribution below please visit the Concept Drawings / Analytique & Model Photos page.
The program includes the following:

Lobby/Reception/Entrance Hall 30 square meters (s.m.)

Approx. 30 bedrooms 30 s.m. each (total of 900 s.m.)

Offices:
2 psychologists (20 s.m. each)
1 music therapist (20) + assistant (15)
2 occupational therapists (20)
1 massotherapist
1 berievement coordinator + assistant
2 full time + 2 part time doctors
1 head nurse
8 nurses (staff room)
1 volunteer co-ordinator
6 volunteer staff room
Orderlies's and General staff room/office Total
40s.m.
35s.m.
40s.m.
20s.m.
30s.m.
80s.m.
20s.m.
30s.m.
15s.m.
30s.m.
30s.m.

Patients' Files Storage Room (incl. nurse's station) + medication room (under lock) 30s.m.

Conference Room 50s.m.

2 group counseiling rooms (25 s.m. each)
which can also be doubled up as family meeting rooms (where families meet in private with professionals to discuss care and options)
- Rooms must offer privacy and therefore must also be sound proof. 50s.m.

Resource Room (where staff and families or even the public can obtain educational information in different forms - i.e. books, videos, CD Roms, etc.) 60s.m.

Large Kitchen (meals for patients or staff) 40s.m.

Small Kitchen (for families or staff to use on their own) 15s.m.

Large Dining Room (designed in a way to create private areas to give a sense of a home dining room rather than a cafeteria room) 60s.m.

Music Lounge 60s.m.

Sitting room/solarium 60s.m.

Library/reading room (for leisure purposes) 60s.m.

Therapeutic Bath Room 20s.m.

Non-denominational prayer room (meditation room) 60s.m.

Supply storage room/loading dock 30s.m.

Ambulance Entrance and garage 40s.m.

Laundry Room and Linen Storage Room 40s.m.

Outdoor Spaces N/A

Mechanical Room ?

Washroom Facilities (ensure sufficient facilities) ?

TOTAL Approx. 2100s.m.
(21,000sq.ft.)

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Thoughts from the Palliative Care Workshop 29/03/2000	Important aspects regarding palliative care: One of the most basic needs regarding palliative care is getting rid or at the least controlling the pain of the patient. However, the patient's needs do not end there. It is also essential to emphasize on enjoying the moment, the here and now. Being with their family, as well as being strong for them is important to the patient.	Architectural Interpretation Family Rooms
	Furthermore, the role of the caregivers is also to support the patient and their loved ones. This support should be dealt with on a day-to-day basis and should not be focused on death. They must also help the patient feel secure without giving false hopes. Hope is never taken away, it is only channeled differently.	Quality of Life is important and should be taken into consideration in the design of the facilities.
	After being diagnosed with a terminal illness, these patients are still living, it should be thought of as a limited life rather than an impending death. As such, maintaining dignity as a human being and conserving a quality of life is valuable. The focus here should be on sharing and appreciating life, health, children and love. Patients are often separated from this. Talking about simple things always helps, they cannot allow themselves to think of long-term goals for themselves anymore.
	Other notions extracted from the workshop video Entertainment, especially in the form of music, can help pass the time and allow for the patients to enjoy the moment. Music has depth and can be used as a safety net for difficult feelings. It is a good method of interactive therapy.	Designated lounge for listening or having live musicians play.
	Celebrating holidays is also important in order to acknowledge that they are still LIVING. Dining with visiting family members rather than always eating in bed can bring joy in their daily lives.	Large Dining Room that can also be used for holiday meals for larger groups.
	Preparatory grief work should also be done in order to help the family. Psychologists can play major roles in coping with the grief.	Counseling Psychologists office
	Time is a huge distraction. Night times can be very lonely and patients have more anxiety. It is important to know how to plan for this and find ways to help orient the patient better. In time and in space. At the hospital they try to put clocks in all the rooms.	Created uncomplicated forms, lots of views to the exterior, obvious relationships between different spaces within.
The Palliative Care at the Royal Victoria Hospital 31/03/2000	There are 16 beds at the RVH and 10 more at the MGH. The growing need for more rooms must also be accounted for. At the moment, many rooms are also doubled, however, there is a strong need for privacy. The patients in double rooms that are approaching the very end of their life are often moved into single rooms at this point. There is also a hide abed in each room for family members that wish to stay over night. Sufficient space must be given to accommodate this. At the moment all the rooms ar very cramped.	30 bedrooms. Single rooms are important. However they could be designed large enough to move two beds into the same room when a patient wishes the company of another patient. Also need sufficient room for hide abeds. Rooms are presently approx. 8' x 10'.
	Staff at the RVH (for 16 patients) 1 Director of Research + Assistant 1 Psychologist 1 Music Therapist 1 Occupational Therapist 1 Bereavement Coordinator 1 Full-time Doctor + 1 Part-time 4 Nurses 3 Volunteers	(For 32 Beds) # of offices 2 + 2 2 2 2 2 2 + 2 8 6 1 general staff lounge
	Room for special bath unit. This is a massaging bath used by patients, especially when they are taking pain killers. It helps relax them.	Special room approx. 15' x 15'
	There is a small library of CDs and Tapes along the corridor walls for patients. Each patient has a cassette player by their bed.	Library
	"Staff Rounds" Conference Room	Conference room
	Nursing/Medication Room. This room is at the back of another room. Access is limited.	Medication room
	Large solarium with piano. This room at the RVH is also used for monthly memorial services. It is presently approx. 20' x 30' and is not nearly large enough to accommodate every one.	Large solarium and separate memorial service room. Can also be used as a chapel or other prayer room.
	Family room, also used as a meditation room.	Family room, meditation room can be combined with the memorial service room.
	Kitchen with fridge. There is also a small alcove in one corner for patients that want to sit with their family in privacy. This room is definitely undersized.	Large kitchen next to the dining room.
	Some patients need radiation therapy and chemo therapy. This services are offered in another area of the hospital.	These services should be offered at the hospital and not at the hospice.

Lobby/Reception/Entrance Hall	30 square meters (s.m.)
Approx. 30 bedrooms	30 s.m. each (total of 900 s.m.)
Offices: 2 psychologists (20 s.m. each) 1 music therapist (20) + assistant (15) 2 occupational therapists (20) 1 massotherapist 1 berievement coordinator + assistant 2 full time + 2 part time doctors 1 head nurse 8 nurses (staff room) 1 volunteer co-ordinator 6 volunteer staff room Orderlies's and General staff room/office	Total 40s.m. 35s.m. 40s.m. 20s.m. 30s.m. 80s.m. 20s.m. 30s.m. 15s.m. 30s.m. 30s.m.
Patients' Files Storage Room (incl. nurse's station) + medication room (under lock)	30s.m.
Conference Room	50s.m.
2 group counseiling rooms (25 s.m. each) which can also be doubled up as family meeting rooms (where families meet in private with professionals to discuss care and options) - Rooms must offer privacy and therefore must also be sound proof.	50s.m.
Resource Room (where staff and families or even the public can obtain educational information in different forms - i.e. books, videos, CD Roms, etc.)	60s.m.
Large Kitchen (meals for patients or staff)	40s.m.
Small Kitchen (for families or staff to use on their own)	15s.m.
Large Dining Room (designed in a way to create private areas to give a sense of a home dining room rather than a cafeteria room)	60s.m.
Music Lounge	60s.m.
Sitting room/solarium	60s.m.
Library/reading room (for leisure purposes)	60s.m.
Therapeutic Bath Room	20s.m.
Non-denominational prayer room (meditation room)	60s.m.
Supply storage room/loading dock	30s.m.
Ambulance Entrance and garage	40s.m.
Laundry Room and Linen Storage Room	40s.m.
Outdoor Spaces	N/A
Mechanical Room	?
Washroom Facilities (ensure sufficient facilities)	?
TOTAL	Approx. 2100s.m. (21,000sq.ft.)