Independent Thesis: A Children's Hospice

BURDEN

ABPL 90169 2017 SM2 MASTER OF ARCHITECTURE DESIGN THESIS INDEPENDENT DESIGN THESIS A CHILDREN’S HOSPICE: BURDEN ALAN PERT CATHERINE MEI MIN WOO 562729

Completed only with the support of: K.M.G. D.Z.K. A.W.Z.W. J.L.S.W. Z.W.C.Y. Y.Y.W.

A.A. A.B. A.B. R.J.H. P.H. M.E.J. S.L. G.M. R.M. A.P. A.P. D.S. J.Z.

Dedicated to

L.S.R.C. W.C.F. G.H. E.W.Y.L. R.L. N.N. J.Y.T. J.Y.T. K.S.T. Y.E.T. L.Y.Y.

Harris Tan 27 February 1992 - 12 March 2017

THESIS

STATEMENT

STATEMENT THESIS

A.

Thesis statement

The field of research focuses on healthcare architecture, with specific interest in hospice typologies that are catered to children as the primary users, alongside staff and their support system (family and/or carers). This research investigates the current approach being taken by other designs within the same typology, and analysing the agency of architecture as tools that support and allow holistic approaches for sustaining life to be effectively conducted.

THESIS

STATEMENT

STATEMENT THESIS

This study outlines the typical narrative of a-dayin-the life of a children’s hospice is challenged through design fiction. Through the isolation of seven key moments within this narrative, these individual experiences will explore the treatment of the space in which significant events occur.

The investigation of spaces of Entry, Rest, Meals, Therapy, Bathing, & Passing, will focus on the user experience within these spaces, and propose alternative solutions to unpredictable socio-technological landscapes.

How can hospice architecture provide the infrastructure for respite that feels like a world of its own, without being haunted by the burden of routine found in the hospital and the home? What can architecture offer the living child, and what do the adults need as human beings trying to live and keep living?

CONTEXTUAL STUDIES

Contextual studies

The research begins & references the existing Very Special Kids Children’s Hospice in the suburbs of Malvern, Victoria.

Although the hospice is an emerging typology, there are various projects around the world that have attempted to establish the best approach towards fascilitating the best environment for its users. VSK is first contextualised on the world stage, and is then investigaed independently through interviews, workshops, & site analysis.

CONTEXTUAL STUDIES

B.

PROJECT:

Noah’s Ark Children’s Hospice, UK

ARCHITECT:

Squire & Partners, London, UK

CLIENT:

Noah’s Ark Children’s Hospice, UK

CONTEXTUAL STUDIES

PRECEDENT STUDY The use of the scale of the site allows for much of the space to be divided and dedicated approriately, in terms of individual room functionality and list of programs, this project covers most of the concerns that VSK has. Too much division between the spaces make the central spaces and shared office look very institutional. No dedicated staff wellfare spaces.

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UNIQUE UNITS

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ROOM INDEX b. Therapy room g. Games Room k. Family room M o. Bedroom XL

c. Sensory room h.Family room S l. Beedroom M p. Bedroom L

d. Teen den i. Connecting bedroom m. Bedroom M q. Bedroom L/XL

e. Soft Play

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ROOM INDEX a. Orangerie f. Play area

b. Interal courtyard g. Bedroom A

c. Common room h. Bedroom B

d. Creative area

e. Music room

PROJECT:

Future Design for a Children’s Hospice

ARCHITECT:

Poulsen, Hoff, & Lund

CLIENT:

CONTEXTUAL STUDIES

Aalborg University (Speculative project)

PRECEDENT STUDY There is not enough exploration that is extended to staff overall wellbeing, instead focusing on workflow. While that helps with efficiency, it does not address longevity & stability of the mental health of the staff. This has a direct impact on performance, and should be explored more to adapt the hospice atmosphere. This will differentiate ‘hospital’ engagement & ‘hospice’ engagement with patients & family.

PROJECT:

Robin House

ARCHITECT:

Gareth Hoskins Architects, Scotland

CLIENT:

Children’s Hospice Association Scotland

CONTEXTUAL STUDIES

PRECEDENT STUDY Focused on workflow. While that helps with efficiency, it does not address longevity & stability of the mental health of the staff. This has a direct impact on performance, and should be explored more to adapt the hospice atmosphere. This will differentiate ‘hospital’ engagement & ‘hospice’ engagement with patients & family. There is a curious preference for long corridors as well.

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CONTEXTUAL STUDIES

CIRCULATION

ROOM INDEX b. Study g. Smoking lounge l. Hydrotherapy q. Food storage

c. Play rooms h.Bereavement room m. Bedroom L

d. Seminar room i. Quiet & multi-threapy n. Bedroom M

e. Bedroom S j. Teen den o. Bedroom S

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ROOM INDEX a. Staff lounge e. Family unit S i. Quiet room

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b. Family unit L f. Teen & Multi-sensory room

c. Bedroom S g. Spa

d. Family unit M h. Bedroom M

PROJECT:

Bear Cottage

ARCHITECT:

McConnel Smith & Johnson, NSW

CLIENT:

CONTEXTUAL STUDIES

The Sydney Children’s Hospitals Network

PRECEDENT STUDY The more specific programs per room shows the increased consideration for staff efficiency but not for well-being. The concern for the upstairs units being so physically separated from the opportunity to engage with nature is concerning for all users. Storage continues to be an issue. Introduction of nooks for private spaces for all should be considered.

CONTEXTUAL STUDIES

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PRECEDENT STUDY - SUMMARY The common outcome is that the increased scales have provided an opportunity for more specific programming to occur to accomodate the increased number of overall users: > Varied scales & layots for residential units > Age specific rooms for recreation > Theraputic programs (Spa, hydrotherapy, orangery, etc) > Interaction with nature > Staff specific rest areas

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CONTEXTUAL STUDIES

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UNIQUE UNITS

UNIQUE UNITS

Compared to VSK the scale is much larger, hence the appropriation of these frameworks should be scales and layered meaningfully. The distinct lack of staff respite areas, and specific rooms are dedicated to bereavement is indicative of the lack of sensitivity to the percarious dynamic that exists within the walls of a hospice. While these projects present good opportunities to learn from, the sensitivity to users can be read as rather absent and is instead replaced by a clinical framework that cue a more institutionalized image.

Reduction of adverse direct stimuli Bed as sanctuary

CONTEXTUAL STUDIES

Reduction of reactionary stress Patient bed no longer the destination

Promote dynamic multi-sensory relationship Materiality

Promoting sense of regaining autonomy Transition spaces

Promote connection with natural world Nature + spiritual space

Prayer & Meditation Pavillion / Studio Tam Associati

Promotion of dignity & self-significance Coping with duress (isolation/ communt)

CONTEXTUAL STUDIES

Avoidanc of exposure to distress/ grief Better single/family rooms

Opportunity for choice

DIGNITY The exploration of the idea of spaces being designed to service dignity through architecture for its users stem from Ian Clarke’s article that attempts to unpack the potential archiectural features of spaces that consider dignity in design.

Through an image association exercise, Clarke’skey aspects of designing for dignity are broken down and plugged into an image association exercise of existing spaces that provide such atmospheres. This collection of images and associated ideas will be appropriated into spatial design proposals to challenge the narrative of the hospice typology.

CONTEXTUAL STUDIES

CONTEXTUAL STUDIES

Very Special Kids Children’s Hospice 321 Glenferrie Rd, Malvern VIC 3144, Australia Established: 1985 Beds: 8 bed Family Accomodation: Yes (Short-term) Duration of patient stay: 21-Days / year Heritage listing: Partial - Architecture

- Landscaping

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MEALS

CONTEXTUAL STUDIES

REST

CONTEXTUAL STUDIES

BATH

THERAPY

The construction of a a narrative was crucial in decoding the day in the life of the users of the building.

To contrast the burden found in the attempts to recreate the routine between a home and a hospital has resulted in the conflict found in most of the precedents and in VSK. A challenge for these isolated is proposed in parallel to these investigations.

PASSING

CONTEXTUAL STUDIES

“So where is the hospice?”

“Oh”

Off to the side of the nostalgic mantle is where you’ll go First step, is being greeted with the dining hall bustling & full Second step, quick and decisive, any conversation ends as quickly as it starts

“It’s rude to stare”

Third step, in the thick of it all.

“It’s rude to stare” “It’s rude to stare” “It’s rude to stare”

CONTEXTUAL STUDIES

Welcome

Your journey starts here.

CONTEXTUAL STUDIES

It is dependent on a moment “We need to top up the

between station to station, hand sanitizers” and from one event to the next

Dirt is a matter out of place

Make sure you clean yourself at every turn at every entry, between every room, between every person, take care with every touch.

Be clean.

“Please use the hand sanitizers”

CONTEXTUAL STUDIES

1...2...3...4...5...6...7...8...9 ...10 The mist clears The forest of curtain strips are parted & it is as though the outside world had just washed away.

MEALS

CONTEXTUAL STUDIES

THERAPY REST

CONTEXTUAL STUDIES

BATH

These are the proposals as follows: Rest Meals Therapy Bath Passing

PASSING

CONTEXTUAL STUDIES

By the time the sunlight dances across the glass, it is already noon.

Thankfully, they had come before the sun and whisked them away for breakfast.

The sounds of neighbors shuffling around the shared “It’s alright, you’re alright, toilet always caused a stir.

try to rest. It is only the piping.”

Even with the curtains drawn, the warmth of summer creeps in through the edges.

In summer, the towels come out to wipe the sweat off foreheads, while the ceiling cooly watches “Just Imagine sheep in the on. ceiling, jumping over fences 1... 2... 3...”

CONTEXTUAL STUDIES

Good morning Good afternoon Good night

Every frame is a different sight

CONTEXTUAL STUDIES

It is a mosaic of food, stationary, cutlery, and song.

“One more mouthful, one last one-”

Every meal is different, be it ruled by bottles, plates, or tubes.

The giggles and screams echo along the chamber like whispering walls.

It’s as though I’m hearing

The rumbles andeverything smells twice. I can’t hear spread freely from the myself think. open kitchen. Could you open the windows please?

Nothing too pungent to “Back to the telly after you be cooked, lest the carpets take your food, alright?” hold the smell.

The telly stays on, it seems.

Close the windows please, it’s too windy now.

CONTEXTUAL STUDIES

Food can be beautiful, and food can be fun for tubes and bowls both.

Why stare at a telly when there are giant honeysuckles & toadstools?

CONTEXTUAL STUDIES

So tucked away and out of sight, how do we keep them safe?

“Hold on, I can’t watch them all at once”

The kids that can run, run, while the rest sit idly staring into static of the telly (if it was on) “What songs do you like?

Today we’ll be playing ...”

In and out, there is a ceremony of music and smells of paint that carries throughout the day But as quickly as they come, they go, & the idling starts again “Some like the activity, some do not“

CONTEXTUAL STUDIES

A permeable memberane between inside and out Why not both?

Why not both when you have friends both high above and down below?

CONTEXTUAL STUDIES

Up and down Up and down Up and down “Can you be more gentle please?”

From the bed to the bath it is Up and down Up and down “It’s okay, we’re going for a bath, it will be fun!”

Four times Six times How strong they are “Hold still please, try to prop them up.“

CONTEXTUAL STUDIES

Lower them gently into the pool before joining them yourself

It’s the chance to play in the rain (for once)

CONTEXTUAL STUDIES

Who is dreading the stay?

“It’s alright, one more day and you will be out of here”

The adult, or the child?

“I want to visit my sister/ brother“

CONTEXTUAL STUDIES

Just another threshold, just another adventure.

Look around you, you are never alone.

RESEARCH OUTCOME

C.

Research Outcomes

A comparison and generation of spatial responses to the treatment of the exisiting projects by its inhabitants is outlined in this narrative, juxtaposing the interviews & observations conducted at the VSK hospice with the analysis of Koolhaas Houselife.

RESEARCH OUTCOME

The investigation of precedents beyond that of the standard hospice, brings the existing Very Special Kids Children’s Hospice & the film Koolhaas Houselife by Louise Lemoine.

00:00

Koolhaas Houselife Very Special Kids

LOUISE LEMOINE ILA BÊKA SUE KEARNEY SYVET MICHELLE

RESEARCH OUTCOME

00.

A case for beyond in between

A comparison and generation of spatial responses to the treatment of the exisiting projects by its inhabitants is outlined in this narrative, juxtaposing the interviews & observations conducted at the VSK hospice with the analysis of Koolhaas Houselife.

RESEARCH OUTCOME

The investigation of precedents beyond that of the standard hospice, brings the existing Very Special Kids Children’s Hospice & the film Koolhaas Houselife by Louise Lemoine.

00:57

01.

Elevator RESEARCH OUTCOME

We would like to be closer to the hospice...

Maybe even on a second floor.

Yes, a second floor! More space for dedicated counselling spaces, no more doubling up desks and office spaces.

RESEARCH OUTCOME

05:19

02.

Curtain RESEARCH OUTCOME

Curtains are more like a semblance of diving up space. Cloth can harbour germs, and if they’re too thin you can still hear and see what’s going on so it’s almost redundant in terms of offering any sense of privacy.

The curtains are always drawn in the summer.

It gets too hot in the bedrooms, and there is not much to regulate the environment indoors.

The common room uses them well. Too glaring.

RESEARCH OUTCOME

05:30

03.

Curtain path RESEARCH OUTCOME

Everyone walks in and all at once you’re greeted by everything at the same time. You see all the kids, all the staff, and everything that is going on.

There is no where to catch your breath. At any moment <printer starts up, whirring in corner> someone would walk by and <door flings open> Oh sorry, just here to collect my prints! Thanks!

Sorry again <door shuts, moment is lost>

RESEARCH OUTCOME

06:34

04.

Roundabout RESEARCH OUTCOME

If we’re not eating with the kids, we really only have the meeting room to have a moment to oursleves.

We don’t take breaks, we have a tight knit unit and we know how to support each other.

RESEARCH OUTCOME

07:03

05.

Endless shelving RESEARCH OUTCOME

What was once the art room is now the store room for donations like toys, For art therapy, the props we make would make a lovely display as well. Yes, shelving deep enough for our supplies and the larger props.

The books and dvds are not used much but they get put here anyway.

It is quite an event to access the store.

RESEARCH OUTCOME

10:00

06.

Inconvenient stairs RESEARCH OUTCOME

No stair issues, however the doors are too small to comfortably roll out all the beds, cots, and chairs (we still manage).

Perhaps an underground car park? ......

RESEARCH OUTCOME

11:03

07.

Invonveninet stairs RESEARCH OUTCOME

We would like to be upstairs, closer to the staff and kids so we can work together in the same space.

That would require a lift as well wouldnâ&#x20AC;&#x2122;t it?

Yes, for it to be accessible to all staff, family, ...

RESEARCH OUTCOME

12:15

08.

Inconvenient stairs RESEARCH OUTCOME

The sensory room had tubing for lights and bubbles beforeBut some of the more boisterous kids pulled them and the tubing can no longer be in the room safely.

They become a bit of a hazard but they love things that they can interact withSafely.

RESEARCH OUTCOME

12:33

09.

Inconvenient stairs RESEARCH OUTCOME

It would be great to have the sand pit or ball tub accessible for all the kids...

Even in their beds or chairs!

We do have trays we attach to their beds or chairs that support their canvas for art therapy.

Some kids do like being on the floor though.

They do love the ceiling of the holiday tents.

RESEARCH OUTCOME

13:29

10.

Peephole RESEARCH OUTCOME

The users are quite distinct from engaging with the building, no interraction with the facade at all.

There are feature windows, they are circular windows in a masonry frame yet they do not stand out at all in the architecture.

Maybe a proper reception area for visitors...

Nah, we donâ&#x20AC;&#x2122;t need it.

RESEARCH OUTCOME

15:59

11.

Soft touch RESEARCH OUTCOME

Gentle detail for easy movement of fixtures would be interesting.

Plugging in, plugging out should not be so hard when its about oxygen or food.

Kind of like moving out of a room, not needing any help.

RESEARCH OUTCOME

16:18

12.

RESEARCH OUTCOME

Switch

To change apetures of openings like doors, a simple switch is good.

What are you looking at? Perhaps the eyes can be a switch in the future?

Or like the theremin, a gesture to guide them.

RESEARCH OUTCOME

17:20

13.

Trip hazard RESEARCH OUTCOME

The drying racks and donations have to go into the corridor sometimes.

The laundry area is not big enough and outside can be risky in terms of exposure.

Some of the drip stands are there as well.

But there is always the pool table for transient storage throughout the day! It works pretty well actually.

RESEARCH OUTCOME

18:52

14.

Falling Hazard RESEARCH OUTCOME

Thankfully everything is on a single floor.

Some kids lose their balance at random some times so they need to have someone with them to make sure they have somewhere to sit if that happens.

What about the staff? Where do they sit?

RESEARCH OUTCOME

21:14

15.

Performing RESEARCH OUTCOME

They giggle sometimes, watching chores being done and others just playing.

After a while the shy ones in their bed or chairs, going from disinterested to clapping their hands.

Suddenly, it is not so quiet anymore: another dancer has joined the canvas.

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21:46

16.

RESEARCH OUTCOME

Looking up

When the ceiling is the view most of the time, the holiday tent always has the best view.

This year: under the sea.

Shadows, little pockets of light, and drapes of color.

While the filter of the actual aquarium next to the pool table humms unnoticed.

RESEARCH OUTCOME

24:00

17.

Moving yet fiddly RESEARCH OUTCOME

Again, more storage would be great.

And designated storage: dedicated medicine room and sterile spaces for kids that need it.

Definitely more space though, equiment is huge.

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24:10

18.

Moving RESEARCH OUTCOME

Kids that move freely aorund the hospice like touching their surroundings.

Be careful though, some things should not be so easily reached.

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25:05

19.

Too many small spaces RESEARCH OUTCOME

When there is contamination the place shuts down for a couple of days.

When the carpet retains paint, grease, and smell is it really okay?

We have come a long way from what they use in hospitals like linoleum. Apparently they look a lot better now.

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27:30

20.

Texture x collections RESEARCH OUTCOME

The walls are a collage of work by artists and also the resident budding artists.

Framed and unframed.

Canvas works get worked on before getting sliced up and divided amongst the participants, turning them into something special.

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28:38

21.

Quick stop RESEARCH OUTCOME

The fancy chairs are hard to get about.

Especially if you donâ&#x20AC;&#x2122;t know how to use it!

Just be sure not to bump into anyone or any thing!

RESEARCH OUTCOME

30:21

22.

Leaky business RESEARCH OUTCOME

The presence of rain is not felt much inside the hospice.

Maybe a functional distraction will help with the kids behavioral management?

Instead of leaking into the house uninvited.

RESEARCH OUTCOME

rainwater redirection

30:49

23.

Wear & tear RESEARCH OUTCOME

No one really uses the playground much, the weather is too unpredictable.

They do like looking at the fish or the telly.

Canâ&#x20AC;&#x2122;t touch the fish though...

Or can they?

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42:09

24.

Moving walls RESEARCH OUTCOME

Again, maybe eyes could be the switch in the future.

Or maybe the touch.

Between breathing in and breathing out.

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43:33

25.

RESEARCH OUTCOME

Concealed

The oxygen piping would be great in every room.

Where would they go?

In the walls or thr ground, whiever is the most easily accessible.

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26.

Cumbersome RESEARCH OUTCOME

Odd places are not practical to have and the lack of extensive tracking rails make getting out of bed or bath time very extensive.

They raised the pool. Only families use the pool now.

It is just like any other pool, tablet of chlorine, only with a harness and track suspended from the ceiling across the pool.

RESEARCH OUTCOME

50:40

27.

Simple access RESEARCH OUTCOME

Kids like interracting with their environment.

Even the older kids stop wanting to engage as muchSome things should not be acessible though.

Yeah the staff station is often a victime of that accessibility.

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54:52

28.

Dynamic doors RESEARCH OUTCOME

While the doors are too big, there is nothing to say they canâ&#x20AC;&#x2122;t be sliding or revolving doors.

Open Close Open... Close Close.

RESEARCH OUTCOME

41:40

29.

Performance RESEARCH OUTCOME

A breathing facade or walls could be a treat for the kids.

The use of the instruments akin to the theramin can benefit from a flexible yet dynamic space could yield.

The walls itself, could perform in sound and in form.

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58:46

30.

Glow RESEARCH OUTCOME

Each room, though distinct and indepedents, could benefit from a subtle tip.

Like the lights in the ceiling.

RESEARCH OUTCOME

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RESEARCH OUTCOME

PROPOSED OUTCOME

D.

Proposed Outcome

The colleciton of 30 architectural theories are now tested.

Within this conceptual building fabric, a-dayin-the-life of a childrenâ&#x20AC;&#x2122;s hospice is isolated and a narrative serves as the link between different key events throughout the day.

PROPOSED OUTCOME

The drama and event is found in the details of the space, from the scale of a stage, to the gentle detail of a panel.

PROPOSED OUTCOME

D.1

Entry

Welcome

Your journey

PROPOSED OUTCOME

starts here.

PROPOSED OUTCOME

D.2

Rest

Good morning Good afternoon Good night

PROPOSED OUTCOME

Every frame is a different sight

PROPOSED OUTCOME

D.3

Bath

Lower them gently into the pool before joining them yourself

PROPOSED OUTCOME

Itâ&#x20AC;&#x2122;s the chance to play in the rain (for once)

PROPOSED OUTCOME

D.4

Meals

Food can be beautiful, and food can be fun

PROPOSED OUTCOME

for tubes and bowls both.

PROPOSED OUTCOME

D.5

Therapy & Passing

A permeable memberane between inside and out Why not both?

PROPOSED OUTCOME

Why not both when you have friends both high above and down below?

Fin.

Closing Statements

This research hopes to analyse the potential of architecture as an active agent involved in the processes of growing, healing, and bereavement in a childrenâ&#x20AC;&#x2122;s hospice.

A methodology was established through an interrogation of precedents, a series of interviews, workshops, and developing a catalogue of architectural theories from plan to detail.

I would have liked to take these investigations further, and hope to revisit this body of work in the future.

REFERENCES Bêka, I. & Lemoine, L., 2017. Koolhaas Houselife. [Online Video]. 18 October 2008.

Available from: https://vimeo.com/ondemand/koolhaashouselife/188058775. [Accessed: 4 September 2017].

Clarke, I., 2009. Design and dignity in hospitals. Studies: An Irish Quarterly Review, 98(392), pp.419-428.

Fund, R., 2006. Programme for the Good Hospice in Denmark.

Jencks, M.K., 1995. a view from the front line. Maggies Caring Cancer Centre.

Kearney, S., 2017. Interview at Very Special Kids site visit, 1 August 2017.

McCluggage, H.L. and Elborn, J.S., 2006. Symptoms suffered by life-limited children that cause anxiety to UK children’s hospice staff. International journal of palliative nursing, 12(6).

Poulsen, M., Knudstrup, M-A., Hoff, P. & Lund, M., 2017, Future design of a Children’s Hospice. in N Mathiasen & AK Frandsen (eds), ARCH17 3rd International Conference on Architecture, Research, Care, Health. 1 edition edn, Polyteknisk Forlag, pp. 72 .

Rophie, K. 2016. Violet Hour: Great Writers at the End. [S.l.]: Virago Press Ltd, pp.2576.

Verderber, S. and Refuerzo, B.J., 2003. Innovations in hospice architecture. Taylor & Francis.

Interviews: Very Special Kids Tour & Interview. (2017).

DATE: 1st August 2017 CANDIDATE: Very Special Kids CEO Very Special Kids Tour & Interview. (2017).

DATE: 11th September 2017 CANDIDATE: Very Special Kids head of nursing staff Workshops: Very Special Kids Tour & Interview. (2017).

DATE: 1st August 2017 CLIENT: Very Special Kids key nursing staff Precedent Studies: Very Special Kids, Malvern, Australia ARCHITECT: Roth Lowman (Family Accommodation) CLIENT: Very Special Kids Maison à Bordeaux, Frace ARCHITECT: OMA CLIENT: Jean Francois Lemoine & Family Bear Cottage , NSW, Australia ARCHITECT: McConnel Smith & Johnson, NSW Australia CLIENT: The Sydney Children’s Hospitals Network Future Design of a Children’s Hospice ARCHITECT: Poulsen, Hoff, & Lund CLIENT: Aalborg University (Speculative project) Noah’s Ark Children’s Hospice, Barnet, UK ARCHITECT: Squire & Partners, London, UK CLIENT: Noah’s Ark Children’s Hospice, UK Robin House Children’s Hospice, Balloch, Scotland ARCHITECT: Gareth Hoskins Architects, Glasgow, Scotland CLIENT: Children’s Hospice Association Scotland (CHAS), Scotland