Care Dimensions Hospice House

The project is a new 18-bed inpatient hospice, built to expand the reach of the client's services beyond their existing 20-bed inpatient facility and at-home and hospital-based services. The scope included the site work and building construction of the 18-bed hospice on a site previously occupied by a single-family residence. The two-story building includes 18 private rooms with baths, each room containing provisions for loved ones to spend the night. Additionally, the building includes a range of public, semi-public and private spaces for use by patients and their families including living rooms, kitchen and dining, child activity areas and a reflection room. The remainder of the facility is devoted to staff spaces.

"The connection to nature is really beautiful and has a spiritual quality. The designers really thought through who would use the space." - Jury comment

Project goals

• Provide a very high quality in-patient hospice house with modern amenities and functional efficiencies on a beautiful but difficult site within a "rural" community with a strong historical context. The project provides all of the required programmatic elements in a relatively compact footprint driven by the steep grade. The exterior reflects a rich residential appearance that draws on local precedent while fitting naturally in its setting.
• Design a hospice that provides an enriching backdrop for the wide range of emotional experiences that the patients and their loved ones experience over the course of their stay, while simultaneously allowing care to be provided by staff. People come to hospice in the last days of their lives. The project intentionally creates a series of increasingly private spaces to allow patients and their loved ones to find the level of interaction that their current emotional state requires. The obvious distinction is between places like the lobby and the patient rooms, the polar opposite of public/private spaces. But between those areas exists a layered series of experiences that provide opportunities for individual or small groups to be more or less removed from others as they desire, and more or less removed from the loved one they are there to be with if the need arises.

Unique features

The project includes spaces within the resident room for family and friends to spend the night in close proximity to their loved ones and also to remain engaged with the outside world. These spaces transition from public to private. Staff spaces and institutional systems are also hidden from immediate view to preserve the home-like character while remaining proximate and available so the best possible care can be provided. This includes smaller items like piped gases which are hidden in millwork/casework, as well as mundane staff areas like soiled utility and charting which are clustered off a secondary corridor so as to be less apparent and intrusive to visitors. The site was largely ledge and the blasted material was used to create a series of extensive retaining walls on the site.

Design challenges

The most important challenge in facilities like this is prioritizing home-like characteristics while maintaining the highest quality of the clinical elements. An inpatient hospice provides a high level of healthcare services but is focused on doing it in a setting that is as comfortable and inviting as possible. Achieving the balance between those two things is the primary challenge. Examples of how this was addressed:

• Medical gases and other clinical items in the patient rooms are hidden within casework.
• Primary clinical spaces like soiled utility and charting are accessed off secondary circulation systems and out of the line of sight of visitors.
• Back of house and administrative spaces are completely separated from the care areas.
• Finishes are contemporary and durable but very warm and inviting.
• Views into the park-like setting are everywhere, with parking and roads removed from the primary view shed.

The second biggest challenge was the site itself–steep and essentially all ledge. Examples of how this was addressed:

• The building took on a linear form to reduce the need for extensive earthwork.
• The building was built as a two-story structure, providing patient areas on both floors.
• The ledge was re-purposed for retaining walls throughout the site, especially along the entry drive.