Homelike design appeals to patients and families

Ask staff members for input

"It should look like Grandma's house."

This is how Jim Faulkner, AIA, NCARB, LEED AP, president of Dayton, OH-based Matrix Architects, an architectural firm that specializes in hospice, describes the ideally designed inpatient hospice facility.

"People want to feel comfortable with their surroundings, and the best way to make them feel comfortable is to make the building similar to a home," he says.

Designing a hospice inpatient facility requires attention to items that are different from other health care facilities, says Faulkner. "People use an inpatient hospice facility differently than a nursing home or hospital," he points out. "Family members will stay with their loved ones 24 hours a day when they are dying, and the facility has to be able to handle an influx of additional people."

Versatility for the facility begins in the parking lot, says Faulkner. You have to design the parking lot with a specific number of parking places according to local regulations and anticipated, normal, use of the facility, he says. However, what happens if several patients are at the end of life at the same time, and multiple families are at the facility? "We design driveways wider than normal to handle overflow parking when needed," Faulkner says.

Patient rooms must be larger than most health care rooms, says Faulkner. "More family members want to be involved in care at the end, so the rooms have to accommodate additional people providing care," he says. "If possible, we design a small sitting area with a pullout sofa and sometimes a small second room can be built adjacent to the patient room." These are expensive options, but some hospices opt for them to provide privacy to the patients and their families.

Another way to provide a private, quiet area for families to use is to build a number of "nooks and crannies" throughout the facility, suggests Faulkner. "Small sitting areas, counseling rooms, libraries, or bereavement rooms that resemble living rooms, all offer places for family members to gather," he says.

Even the kitchen in an inpatient hospice facility is different, points out Pat Stropko-O'Leary, executive director of Hospice of Medina (OH) County. "Hospital and nursing home kitchens serve meals at scheduled times of the day, but our kitchen has to make food available to family members throughout all hours," Stropko-O'Leary says. "We have to stock and staff it so that we can fix a sandwich or chicken soup or other comfort foods that family members want, any time of the day."

Stropko-O'Leary's staff had the advantage of operating an inpatient unit within an assisted living facility's building before designing their own building. "We asked staff members for input, and we got a lot of good ideas," she says. While the assisted living facilities had doorways opening onto outside patios from the rooms, staff members were concerned about security in a building with that many doors to the outside and a building that contains narcotics and other drugs. "Our inpatient hospice rooms face a beautiful, wooded park so we want them to enjoy the outdoors, but we opted for floor-to-ceiling windows rather than doors to the outside," Stropko-O'Leary says.

A children's counseling room and a library for families to use were two other ideas implemented from staff suggestions, she says. "Our inpatient staff also insisted on no carpeting in the unit," Stropko-O'Leary says. This suggestion went against the architect and hospice leadership's intention to make the building as warm and homelike as possible, but the nurses explained the difficulty keeping the carpet clean and unstained from blood, she says. "Our architects came up with another option. They found a durable, bacteriostatic carpet that would be easy to clean and disinfect," Stropko-O'Leary says. "The nurses were happy with the solution."

There was one employee suggestion that did not go far in the approval process because it didn't fit the mission of the project, Stropko-O'Leary admits. "One staff member wanted us to include a fitness area with showers and changing rooms so staff members could work out before going home or before starting work," she says.