Hospice Care

1. Hospice Care IND6259 Graduate Design 5- Healthcare Jackie Esteban I Victoria Heredia I Shayan Khalilahmadi I Leilani Orosa I Denise Paulino

2. Hospice Care • Hospice care is a facility that dedicates and focuses on people that are terminally ill. It is a place that helps the patient’s pain, symptoms, and concentrates their emotions and every need. Hospice care is also very much aware of the patient’s family member and they do their best to help them cope with what is happening and offer to provide support(Vitas Innovative Hospice Care,2011). Hospice nurses are trained caregivers that provide 24-hr rotational services to patients, family and friends. • Hospice care practitioners are trained to react to an individual’s last moments of life. Nurses provide literature for family members to read to help mentally prepare them for what it is next. With hospice care, or how the natural human body system works, is that everything is unpredictable. Reading literature on “how to prepare for death” is an important value experiencing this surreal moment. Providing care at an in-home environment creates a large support sensibility and is often recommended. • The role of hospice care is to provide comfort, whether it is emotionally healing for affected family and friends or constantly re-adapting to a patients decline in ability (Vitas Innovative Hospice Care,2011). This practice understands emotional pain, strength and the cycle of life. The most important goal that hospice care brings to make the patient, whom is terminally ill, is to make the environment pleasing, durable and comfortable for one's last week’s/days.

3. What kind of project are you proposing to do? • In this particular project we are proposing to design a comfortable environment for patients under VITA's/hospice care. Instead of designing a hospital space, we will be designing a home space with appropriate emergency equipment’s that a hospital requires. Our main concern is to dedicate the comfort to patient’s, but also to the family members. (Vitas Innovative Hospice Care,2011). • Who is the client? FIU Health Department and Vitas (Hospice project only) • Our clients for this project are the FIU Health Department and Vitas. Vita was founded in 1978 by a minster and a nurse. They have been leaders in the American hospice movement and have assisted on the care for terminally ill patients along with their families. • FIU Health Department is a service that is providing to the students which focuses on medical care promotes a healthy lifestyle. The service works with the community and the university to address the changes for the students. The health department helps the students lifestyle, provides them a mentor, education, and research on activities to help them become successful. (FIU Health Service, 2013) • What particular details about this project and this client type including their vision, mission, and values? • The mission for these clients is to give a wellness service to the students and a commitment to caring them. There values are to respect them and to ask them if they need anything. The client is the number one priority. Figure 1.

4. Why is this interesting to you? • Losing a person dear to you is a very long, painful process. When a patient is under the condition ‘terminally ill,’ it means that a person’s physical body is shutting down, but not mentally. This is what hospice care demonstrates. Hospice care not only provide services to those in need of care, but also make individuals aware that a patient’s body may be shutting down, but mentally and emotionally they are still there, and will always remain in spirit. Nurses recommend for affected family and friends to continue to make the effort to communicate those who are ill because it will keep their mind active. • What is different with hospice care is that because they are trained and prepared for someone’s end in their life cycle, it brings in another new perspective of death. Individuals are able to see the transformation of a human body as they come into earth as an infant, walk as an adult and eventually progress back to loss of mobility that an infant as. Terminally ill patients should not be confused as needy individuals. They are a group whose care is still as just important as a healthy person. • The experience through using hospice care is scary due to idea of service they provide, but at the same time it is comforting knowing that even though the current situation may not be easy to deal with, in meantime, loved ones are placed under great care.

5. Some of the equipment that will be required are as follows: • Oxygen tank • Hospital bed – different mattress (yes, hospital beds are multi functional in purpose, but not in comfort) • Alternating pressure mattress • Over-the-bed mechanical body-lift operator • Over-the-bed table • Walker • Wheelchair • Portable commode • Shower chair • Natural Lighting Figure 2. Hallway Figure 3. Patient Sleeping Area

6. In the patient’s room natural lighting will be provided in each facility and will have numerous interior lighting that will be adjustable for the comfort of the patients. A remote blind system will be installed onto windows to help adjust the patients comfort level. Colors used in the space will be warm soothing hues, as well as, the selected materials; for instance, shades of wood and having decorative accessories along the space. Flooring should be of smooth service to help clean surfaces, e.g. urine spills, at a quick pace. Restrooms will be accessible each of the patients rooms. Visiting family members and friends will have a separate restroom to help reduce any discomfort and feeling while experiencing hospice care of a loved one. • The families of the patients will have their own family space. In that room it will have a small kitchen with seating to eat his or her food, another area living space to read or to watch television. Having natural lighting will be provided in this space as well. Multiple restrooms will be provided in the facility. Figure 4. Figure 5.

7. The staff members working in this area will have their personal space to work and to have a break room to enjoy his or her breakfast, lunch and dinner. In this space they will have ability to store their personal belongs as well as having a variety of sitting to do whatever he or she prefers to do. • The supervisors, managers and doctors will have their own private office with a space to write up important documents. This also gives the privacy for the doctors and families to go over his or her personal situation. It will have natural lighting along with adjustable interior lighting. The working surface will be large enough to have a private meeting or a group meeting. Figure 6. Patient Room Figure 8. Nurse Station Figure 9. Living Area Figure 7. Patient Room

8. INFORMATION GATHERING CODES – Facility Guidelines Institute (FGI) 1.2-6.1.6 Speech Privacy • Federal legislation requires that facilities guard patient information privacy. This includes speech privacy in all health care venues or wherever patient health information is discussed, either between staff, on the telephone, or during dictation. 1.2-6.2.1.5 Indoor Environmental Quality • Design for a healthy and productive indoor environment should be accomplished through measures such as the use of adequate ventilation, low VOC finishes and furnishings, reduced moisture entrapment, daylighting, and acoustical design measures. Such measures should not conflict with health care safety and infection control codes and standards. • High-volume photocopiers, portable sterilizing equipment, and aerosolized medications have been identified as important sources of indoor air pollution in health care settings. Dedicated exhaust ventilation may be necessary for specialty areas such as housekeeping, copy rooms, sterilization areas, etc., in which such chemical use occurs.

9. CODES – Facility Guidelines Institute (FGI) Continued… 2.1-2.4.2.4 Special Design Elements (2)(a)Window treatments shall be selected for ease of cleaning. Smooth-surfaced, easy-to-clean, wipeable, non-pleated window treatments shall be used. (b)Fabric drapes and curtains shall not be used for window treatments. Window shades should be a neutral color to maintain true coloration of patient skin. 2.1-2.4.3.2 Location (2)The room(s) shall be located to provide convenient access from the nursing station. 2.1-2.6.1.1 Administrative Center or Nurse Station This area shall provide (1) space for counters; (2) space for storage; (3) convenient access to hand-washing stations. 2.1-2.6.1.2 This area shall be permitted to be combined with or include centers for reception and communication. Figure 10.

10. CODES – Facility Guidelines Institute (FGI) Continued… 2.1-2.6.2 Documentation Area Charting facilities shall have sufficient work surface to ensure that staff and physicians can simultaneously chart and access information and communication systems. 2.1-2.6.4 Multipurpose Room At least one multipurpose room for each facility shall be provided for staff, patients, and patients’ families for patient conferences, reports, education, training sessions, and consultation. 2.1-2.6.7 Nourishment Area or Room Each nursing unit should have facilities for patient nourishment. The nourishment area or room shall have the following: (1) sink; (2) work counter; (3) refrigerator; (4) storage cabinets; (5) equipment for hot and cold nourishment between scheduled meals; and (6) space for trays and dishes used for nonscheduled meal service. 2.1-2.6.7.3 A hand-washing station shall be located in the nourishment room or adjacent to the nourishment area.

11. CODES – Facility Guidelines Institute (FGI) Continued… 2.1-2.6.11.3 Storage Space for Stretchers and Wheelchairs On each nursing unit, space for storage of stretchers and wheelchairs shall be provided out of corridors. 2.1-2.7.1 Staff Lounge Facilities Lounge facilities shall be sized per the functional program but shall not be less than 100 square feet. 2.1-2.7.3 Staff Storage Facilities Securable closets or cabinet compartments for the personal articles of nursing personnel shall be located in or near the nurse station. At a minimum, they shall be large enough for purses and billfolds. 4.3-2.3.3 Resident Outdoor Spaces Outdoor areas shall be available for residents.

12. CODES – Facility Guidelines Institute (FGI) Continued… 4.3 Specific Requirements for Hospice Facilities 4.3-2.2.2 Resident Room; 4.3-2.2.1 Capacity • Maximum room occupancy shall be one resident unless justified by the functional program and approve by the licensing authority. In no case shall bedrooms exceed two resident beds. 4.3-2.2.2 Space Requirements • Room size shall be based on the program of care, distinctive in-room furniture, and clothing storage requirements. • If consistent with the functional program, accommodation for dining shall be provided in the resident room. • Seating for visitors, with provisions for at least one sleeping accommodation in resident rooms, shall be provided. • Access shall be provided to both sides of the resident bed. A4.3-2.2.2.3 • Exterior windows should provide views to the natural environment and light when possible.

13. CODES – Health Insurance Portability and Accountability Act (HIPAA) The Privacy Rule The privacy rule protects the health information of the individual patient and addresses the possible use and disclosure of a patient’s health information. The major goal is to secure the individual’s information, while allowing sufficient information to flow for the protection of the public’s health and well-being. Known as Protective Health Information (PHI), any information relating to the patient’s physical and mental health history, as well as what are called common identifiers such as social security; are protected under the privacy rule. The Security Rule The security rule uses confidentiality, through the use of administrative and physical precautions, to protect patient’s electronic health information. The Enforcement Rule Last but not least, the HIPAA enforcement rule ensures that a patient’s health information is protected, through carrying out procedures for investigations and hearings in which the act was violated. Understanding Health Information Privacy. Retrieved September 6, 2013, from: http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

14. CODES – Occupational Safety and Health Administration(OSHA) 1910.36(b) The number of exit routes must be adequate. 1910.36(b)(1) Two exit routes. At least two exit routes must be available in a workplace to permit prompt evacuation of employees and other building occupants during an emergency, except as allowed in paragraph (b)(3) of this section. The exit routes must be located as far away as practical from each other so that if one exit route is blocked by fire or smoke, employees can evacuate using the second exit route. 1910.36(g)(1) The ceiling of an exit route must be at least seven feet six inches (2.3 m) high. Any projection from the ceiling must not reach a point less than six feet eight inches (2.0 m) from the floor. OSHA Law & Regulations, Retrieved September 6, 2013, from:https://www.osha.gov/law-regs.html

15. CODES – ADA for Medical Care Facilities 6.1 General • Long term care facilities, nursing homes – At least 50 percent of patient bedrooms and toilets, and all public use and common use areas are required to be designed and constructed to be accessible. 6.2 Entrances • At least one accessible entrance that complies with 4.14 shall be protected from the weather by canopy or roof overhang. Such entrances shall incorporate a passenger loading zone that complies with 4.6.6. *4.14 Entrances • Minimum Number Accessible entrances shall be connected by an accessible route to public transportation stops, to accessible parking and passenger loading zones, and to public streets or sidewalks if available. • Service Entrances A service entrance shall not be the sole accessible entrance. Department of Justice. ADA Standards for Accessible Design. Retrieved September 6, 2013, from: http://www.ada.gov/adastd94.pdf

16. CODES – ADA for Medical Care Facilities Continued… 6.3 Patient Bedrooms • Each bedroom shall have a door that complies with 4.13. • Each bedroom shall have adequate space to provide a maneuvering space that complies with 4.2.3. • Each bedroom shall have adequate space to provide a minimum clear floor space of 36 inches along each side of the bed and to provide an accessible route complying with 4.3.3 to each side of each bed. Figure 11. Storage Shelves and Closets for APA

17. CODES – ADA for Medical Care Facilities Continued… 6.4 Patient Toilet Rooms • Where toilet/bath rooms are provided as a part of a patient bedroom, each patient bedroom that is required to be accessible shall have an accessible toilet/bath room that complies with 4.22 or 4.23 and shall be on an accessible route. Figure 13. Grab Bars at Bathtubs Figure 12. Clear Floor Space at Bathtub

18. UNIVERSAL DESIGN “Imagine an older man waiting in front of the door to a health care facility men’s room. He stands uncomfortably for a few moments before it becomes obvious that he can no longer hold in his need to use the bathroom. As his pant leg dampens, he walks away from the door in shame.” • In this anecdote, the older man was waiting for someone to come out of the restroom, because the door was too heavy for him to open • Universal Design ensures that facilities, products and services are usable to all occupants; this is especially important, in a hospice environment The seven principles of Universal Design are: • Equitable Use • Flexibility in Use • Simple and Intuitive Use • Perceptible Information • Tolerance for Error • Low Physical Effort – in this anecdote, this principle would have prevented it • Size/Space for Approach and Use

19. UNIVERSAL DESIGN • Small changes to care units such as the position of counters and protruding objects like magazine racks and equipment, as well as easy open door hardware can make all the difference, and create a safer environment for all users • Example: specifying multiple kinds of waiting room chairs, promote equity, since older occupants have more trouble getting up from a chair without the support of armrests, and larger occupants may have trouble fitting into chairs with armrests Figure 14. Patient Room

20. UNIVERSAL CONCEPT for Patient Rooms by RTKL Figure 15. Floor plan of patient rooms Figure 16. Floor plan of facility

21. Psychological Needs and Theories: • Issues and Problems • Some of the issues and problems that hospice and palliative care face are: • Clear communication between healthcare providers and the patients and their family members • Ethical practices during end of life care • Stress • The interior environment feeling too sterile and institutional • Stigma of what a “Hospice” is • About 70% of hospice patients are receiving treatments at home- for these patients distance from the facility could be an issue (delivery of medication and services could take 2-3 hours) • Specific Requirements for Hospice Patient Population • The needs hospice and palliative care patients are: • Flexible space • A family room for family gatherings • Quiet space outside of their room • Support (spiritual, counseling, etc.) • Room for family to spend the night • Different options for lighting ( natural lighting, sconces, task lighting) • Storage space

22. Psychological Needs and Theories: Principles and Theories • Some of the principles and theories used in hospice and palliative care are: • Color theory: • Color theory application in hospice and palliative care would benefit patients. Our body responses to color are subtle. Color can have an impact on our brainwaves, emotions, and biological systems (Reed, 2010). Researcher have proven that color and natural materials can have a physiological response on patients (Novak,2012). Using white has become the norm for hospital interiors. The color white has a negative impact on patients because they associate this color with sterile and cold spaces (Novak,2012). • Control theory: • The control theory is the belief of control over one’s life. This theory of control states that a sense of control can be the an important defense for those individuals who are distressed (Redding,2000). The control theory is able to provide problem-solving solutions to develop the patients overall wellness (Redding,2000). Figure 17. Novak, C. A. (2000, September). Functional Color and Design in Healthcare Environments: Color and nature provide healing benefits in hospital settings. Retrieved September 5, 2013, from Architectural Records Continuing Education: http://continuingeducation.construction.com/article.php?L=222&C=928&P=1 Redding, S. (2000). Control theory in dying: What do we know? American Journal of Hospice & Palliative Care, 204-208. Reed, R. (2010). Color Design: Transforming interior space. New York: Fairchild Books. Figure 1: http://www.gettyimages.com/detail/photo/mature-doctor-pointing-portrait-high-res-stock-photography/82144387

23. Precedent Studies: Palliative Care Center in Gottingen, Germany • Build in 2007, designed by Michael Timm of Architekten. • Small Inpatient hospice that accommodates 10 patients, 8 single and 1 double bed room • Nurses, psychologist, and architects came together on a design that supports the care model of reducing the patients suffering and help families and relatives in the last moments their life. • Located in the upper level of the hospital, a trellis façade embellishes the entrance, keeping with their concept of nature being a “protective cover” for the ward • “Room of Sound” seen in figure 1, is a space that is of great significance to the patient family and staff. Separated by walls with speakers hidden behind the fabric, create more privacy by playing soothing nature sounds. • “Inside and out, materials and colors generate a sense of subtle warmth and create an ambiance offering a variety of activities and moods: outward views and inner reflection, stimulation and relaxation, calmness and movement, communication and silence, activity and withdrawal. ” Figure 18. Room of Sound Figure 19. Entrance Siepl-Coates, S. (2009, September 30). The palliative care center in gottingen, Germany. Healthcare Design Magazine. Retrieved Septemer 7, 2013, from: http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany

24. Precedent Studies: Palliative Care Center in Gottingen, Germany • Keeping with the importance of nature, patients have access to how much or how little they take in, ventilated windows and exteriors shades can be controlled by patient. • These outdoor-scapes are even pleasant at night being illuminated, significantly blocking to view to a dark emptiness. • Also, each room has their own private courtyard garden seen in figure 21& 23. Figure 20. Bathing Room • Taking from wellness spas they have created a Bathing Room, which has special details to help patients in the relaxing process. Features like: • Water jets, along with light illuminating the tub • Rain shower from over head • Along with small spec of lights in the ceiling giving the feel of being outdoors. Figure 21. Private Gardens Figure 22. Private Gardens Figure 23. Patient Room Figure 24. Outdoor Green Space Siepl-Coates, S. (2009, September 30). The palliative care center in gottingen, Germany. Healthcare Design Magazine. Retrieved Septemer 7, 2013, from: http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany

25. Precedent Studies: St . Wilfrid’s Hospice Eastbourne, East Sussex UK • More modern look at hospice design to be built in Eastbourne East Sussex in the UK by November 2013. With 20 private patents rooms. Surrounded with “beautifully landscaped gardens, day care facilities, therapy rooms and space for further expansion if required”. • More attention to the families with more facilities for them to inhabit, like private and lounge areas. A chapel for reflection and a coffee shop, this being for the public space, not interfering with the hospice main purpose.  • Other accommodation will include; well-being clinic, treatment and therapy rooms, physiotherapy gym And spaces for a group can reflect and converse if desired.  • “On the upper floor, we will have dedicated educational facilities for training other professionals in the care of the dying as well as office accommodation for our staff.” Figure 27. Under Construction Figure 25. Patient Room Figure 28. Under Construction Figure 26. Entry Figure 29. Under Construction Our Vision. St Wilfrid’s Hospice. Retrieved September 7, 2013, from : http://www.stwhospice.org/our-vision

26. Precedent Studies: St.. Wilfrid’sHospice Eastbourne, East Sussex UK http://www.youtube.com/watch?v=IRaUCnhnWJE

27. Image References • Figure 1. http://www.tnhospice.org/ • Figure 2. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 3. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 4. http://www.tnhospice.org/ • Figure 5. http://brighthorizonhospice.com/medical-equipment/ • Figure 6. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 7. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 8. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 9. http://gallunsnow.com/interior-environments/healing/denver-hospice-inpatient-care-center.html • Figure 10. • Figure 11. http://www.ada.gov/adastd94.pdf • Figure 12. http://www.ada.gov/adastd94.pdf • Figure 13. http://www.ada.gov/adastd94.pdf • Figure 14. http://www.mercyiowacity.org/upload/images/Medical%20Services/Cancer%20Care/Hospice-DC%20004.jpg • Figure 15. http://www.healthcaredesignmagazine.com/article/beyond-universal-patient-room?page=3 • Figure 16. http://www.healthcaredesignmagazine.com/article/beyond-universal-patient-room?page=3 • Figure 17. http://www.gettyimages.com/detail/photo/mature-doctor-pointing-portrait-high-res-stock-photography/82144387 • Figure 18. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 19. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 20. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 21. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 22. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 23. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 24. http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • Figure 25. http://www.stwhospice.org/news/our-new-hospice/New%20hospice%20gallery.asp • Figure 26. http://www.stwhospice.org/news/our-new-hospice/New%20hospice%20gallery.asp • Figure 27. http://www.stwhospice.org/news/our-new-hospice/New%20hospice%20gallery.asp • Figure 28. http://www.stwhospice.org/news/our-new-hospice/New%20hospice%20gallery.asp • Figure 29. http://www.stwhospice.org/news/our-new-hospice/New%20hospice%20gallery.asp

28. References • Department of Justice. ADA Standards for Accessible Design. Retrieved September 6, 2013, from: http://www.ada.gov/adastd94.pdf • Facility guideline institute. (n.d.). Retrieved from http://www.fgiguidelines.org/ • Novak, C. A. (2000, September). Functional Color and Design in Healthcare Environments: Color and nature provide healing benefits in hospital settings. Retrieved September 5, 2013, from Architectural Records Continuing Education: http://continuingeducation.construction.com/article.php?L=222&C=928&P=1 • OSHA Law & Regulations, Retrieved September 6, 2013, from:https://www.osha.gov/law-regs.html • Our Vision. St Wilfrid’s Hospice. Retrieved September 7, 2013, from : http://www.stwhospice.org/our-vision • Rawlings, S. (2005, April 30). Beyond the universal patient room. Healthcare Design Magazine, Retrieved from http://www.healthcaredesignmagazine.com/article/beyond- universal-patient-room • Redding, S. (2000). Control theory in dying: What do we know? American Journal of Hospice & Palliative Care, 204-208. • Reed, R. (2010). Color Design: Transforming interior space. New York: Fairchild Books. • Siepl-Coates, S. (2009). The palliative care center in Gottingen, Germany. Healthcare Design Magazine. Retrieved September 7, 2013, from: http://www.healthcaredesignmagazine.com/article/palliative-care-center-gottingen-germany • U.S. Department of Health & Human Services, Office for Civil Rights. (n.d.). Health information privacy . Retrieved from website: http://www.hhs.gov/ocr/privacy/index.html • Understanding Health Information Privacy. Retrieved September 6, 2013, from: http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html • (2009). Universal design for healthcare facilities. Environment of Care News, 12(1), 8-11. Retrieved from http://thebarrierfreehealthcareinitiative.org/wp- content/uploads/2009/06/universal-design-for-health-care-facilities-1.pdf • http://www.youtube.com/watch?v=IRaUCnhnWJE