Design for Health, Architecture as a Healing Device. by Elizabeth Panzarino

Design for Health: Architecture as a Healing Device Rehabilitation for the future Elizabeth Panzarino Fal 2016 Professor Cohen

Preface

Architecture as a Healing Device: design for health

Submitted in Fulfillment of the Requirements for the Master of Architecture Degree

Author, Elizabeth Panzarino

Advisor, Andrew Cohen

Dean, Stephen White, AIA 0: Preface

Chapter 1: Introduction Problem Statement Thesis Statement Themes & Intentions Client & Users History of the Hospital Chapter 2: Precedents Groot Klimmendall Rehabilitation Center Bronx Development Center Spaulding Rehabilitation Hospital Chapter 3: Program Health Research and Design Stroke Rehabilitation The Patient Room

Community Spaces Parking Program Relationships Conceptual Program Chapter 4: Site Site identification Analysis History Physical Characteristic Regulatory Environment Chapter 5: Conceptual/Schematic Design Sheridan Expressway Site Constraints

Contents

Chapter 6: Final Design Design Conclusion Chapter 7: Solutions Structure Program Occupancy

Chapter 8: Appendix References Thesis Prep Presentations Thesis Review Boards

(Conceptual Design, Schematic Design/Mid-Review, Gate, Final Review)

Problem Statement

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â&#x20AC;&#x153;I was bringing my grandmother in and out of different rehabilitation places after she had brain surgery a few years back. It struck me as odd that all of the facilities that I was bringing her to for her outpatient care were generally depressing in the sense that they felt like a hospital, a place associated with where sick people go. As far as my grandma was concerned, she was not sick, and her stubborn nature made it a struggle to get her to the help that everyone knew she needed, probably herself included. I wondered how the recovering attitude would change if suddenly the place of where rehabilitation takes place no longer appeared as a hospital, but as a place where one can go to become a better self.â&#x20AC;?

to allow people to return to their lifestyles? Can architectural elements provide a sense of place, comfort and aid in healing to make injury and health issues easier to endure and get through?

With all the expensive machines, people fighting for recovery and doctors working hard to bring them back to health, wouldnâ&#x20AC;&#x2122;t it make sense for the medium in which all these activities take place to influence healing as well? Why is it that the building is only a backdrop to the actives occurring within?

Therefore, is it possible to create a space that can inspire faster recovery

1: Introduction

Architecture as a Healing Device: design for health

1: Introduction

Thesis Statement Project Statement

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Design and environmental psychology has proven that certain implementations have encouraged overall well-being, happiness and motivation. If various elements within design have such a powerful response to the people that experience a particular environment, architecture can evoke healing through carefully designed spaces.

There are two important elements to consider for a successful rehabilitation center. Environmental elements that produce healthy outcomes, mental wellbeing, and happiness for patients, visitors and doctors. Experimentation with the incorporation of nature, views, fresh air, materials, and layouts will be important to create a space that feels safe and comforting during a high stress time. Additionally, a place that welcomes and supports the community, provides not only a place of awareness, but a place that nurtures growth and connections. This center is no longer a place where sick people go to get less sick, but a place everyone goes to improve themselves.

stoke and brain injury recovery for when a patient leaves a hospital after surviving a stoke or other brain injury. At this point, patients have a journey ahead of them to return to the health they were once at prior to the incident that landed them in the hospital in the first place. The inpatient facility will be geared towards the comfort of patients, family and doctors, while offering services for community activities will help give the rehabilitation facility a sense of place and become a landmark for the recovering community. Community activities may include free workout classes to nurture the body, and a cafe lounge for people to study, socialize, and work.

With the broad scope of rehabilitation, I will focus on inpatient post-

1: Introduction

Architecture as a Healing Device: design for health

1: Introduction

Themes and Intentions Looking to the Future

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When designing a new rehabilitation facility, I will look at the following for organizing a facility that provides a place to heal with the following elements.

1. Sectional views and transparency of space 2. Views into nature and landscaping 3. Incorporate Design psychology 4. User experience 5. Community integration

1: Introduction

In order to optimize a new hospital in the 21st Century, the hospital must designed with evidence bases design, operational performance, and organization. An environment should be created that reduces stress on the patient, family and staff. This is important because when a human is stressed, their muscles tension increases and a hormone is released causing all forms of pain to get worse from the increased blood pressure, and decreased pain threshold. Stress hormones can cause cardiac arrhythmias, depression, and insomnia. This in turn affects the immune system. [Footnote] By providing a healing environment in a hospital setting, you provide a connection to nature, options and choices, positive distractions, access to social support, and a reduction in environment stress such as noise, glare, lack of privacy, and poor air quality.

Architecture as a Healing Device: design for health incorporated into the space. These distractions gives patients and family a sense of peace, hope, reflection, and spiritual connection opportunities that may include relaxation, education and humor. Any opportunity to give patients control of their environment such as the option of privacy or socialization, the ability to control lighting levels, music, to express themselves, and learn about their illness and treatment options provides enhancing experiences of enrichment, laughter, relaxation and renewal. Any physical setting can be therapeutic if it eliminates the environmental stress. If a space can connect the patient to the outdoors whether though views, interior gardens, aquariums or water elements, the patients stress levels will decrease providing faster recovery, and general satisfaction. [Footnote]

A patientâ&#x20AC;&#x2122;s experiences can be designed in the sense that we can control a patients first impressions. Upon entering the parking lot, can a patient find the door, and can they see the waiting room before entering it? The goal when designing a health facility is to provide clues and evidence for all the senses so that they can tell a story that matches the intentions. Patients are at a disadvantage with the organization, and design of a facility the first time they set sights on a building. Therefore is important that there are clues around that they can understand to reduce their fears. If it is easy to interact with the staff and move about the design, the environment instantly feels more comfortable than it had at first glance. This in turn helps the patients and their families deal with illness, hospitalization, and losses. Upon entering a waiting room, the patient should have an option of seating arrangements that offer privacy or socialization, as well as active verse quiet seating areas. Additionally if possible, positive distractions such as interactive art, fireplaces, music, and video games should be 1: Introduction

Client and Users

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The Proposed Site is relatively central from where many patients are received and admitted into a hospital or clinic for stroke. Locations 1 through 6 are all within a 15 minute ride from the hospital to the new stroke rehabilitation center. Locations 7 and 8 are located in Manhattan and would be unlikely to use this facility. However, they are still within 20 minutes.

1. St. Johns Medical Center 2. Bronx Lebanon Hospital Center 3. SBH Health System 4. Lincoln Hospital-Cardio Clinic 5. Jacobi Medical Center 6.Montefiore Medical Center: Antoniello Daniel MD 7. Mount Sinai Stroke Center 8 Mount Sinai, St. Lukeâ&#x20AC;&#x2122;s Hospital 1: Introduction

Architecture as a Healing Device: design for health

1: Introduction

History of the Hospital Looking at the past

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Traditionally, there are four main components that are considered part of a healing environment: Nature, Daylight, Fresh Air, and Quiet. The presence of indoor plants have been linked in lifting peoples moods, and reducing the self-reported signs of physical discomfort. Even the ability of seeing nature on a screen or through a window has been shown to reduce pain and stress. With these proven facts, is it implied that architecture should adopt the scientific approaches of medicine?

The hospital has been around for centuries, with the first examples showing up in Greece. Healing was closely linked to religious rites and rituals leading to a hospital architecture design that referenced classical temples. Ospedale Maggiore built in Milan in 1456 was the first hospital to be designed with geometric principles of the Renaissance. The plan was symmetrical with a large central courtyard and on either side, the wings of the building created 4 smaller

courtyards. Allegemeines Krankenhaus built in Vienna in 1783 shows an example of the emergence of the corridor hospital. The corridors and its symmetrical layouts reflects the needs for separation between man and woman. Three revolutions can be identified in the evolution of the hospital. The first revolution is identified with the victory of science, philosophy, and technology. A series of smaller hospitals began to emerge in place of institutional hospitals. For example, the Paris’ hospital system exercised a system of healing qualities rather than medicine with the emergence of pavilion hospitals. The pavilion emphasized the natural environment and clean air ‘machines à guérir’. By 1900, the beneficial effect of nature kept the pavilion model popular. However, the medical science progression made the pavilions

1: Introduction

Architecture as a Healing Device: design for health healing feature lose importance. Once religion and superstitions were removed from the hospital, the hospital typology transformed into the first functional building typology in the history of architecture. Hospitals were always designed to represent public buildings that were primarily social rather than medical institutions. However, wealthy patients avoided hospitals as they represented almshouses for the poor. In the Second Revolution, medicine and science took over. This was a social turnaround as services became out of reach for the poor. The recognition of bacteria and ways to keep the air clean mean abandoning the pavilion for a more monumental building. A large building meant travel time and distances between functions were inefficient. Additionally, with the developments of technologies such as x-ray machines, it was more economical for many doctors to share equipment together rather than invest in their own equipment. Therefore it made the most sense that a hospital, a place with many doctors, would hold the shared equipment. This made the hospital the hub of technology and catered towards the wealthier classes. This era brought the compact block style hospital into fashion. Nature lost its place in hospital design and every element was became geared towards the needs of science and technology rather than user comfort and needs. Hospitals morphed into a product of technology and a scientific instrument. World War Two brought about the third revolution of hospitals which is considered the hospital for the masses. Hospitals became a place of social segregation and only accommodated the wealthy. However, the also represented a new age of scientific progress and social justice, and promised a successful battle against the old and new diseases. Wagenaar, Cor, â&#x20AC;&#x153;Five Revolutions: a short History of Hospital Architecture.â&#x20AC;? In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 26-41. Rotterdamn: NAi Publishers, 2006.

1: Introduction

Precedents Spaulding Rehabilitation Center

Spaulding Rehabilitation Center Case Study Perkins and Will, Boston, MA I 2013 I 378,367 SF

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â&#x20AC;&#x153;For far too long, rehabilitative care was an afterthought to many, relegated to the basements of hospitals and out of sight. This hospital makes a bold statement that a new era of rehabilitative medicine is hereby bringing together scientific innovation and patient-centered design that puts this institution on par with the major centers of healing in the world,â&#x20AC;? -David Storto, President

The buildings scale has been reduced by dividing the structure into two connected sections; the 8 floor patient tower and the three floor therapeutic tower with two gymnasiums, and a pool. The patient tower includes automates shades, patient lifts, private bathrooms, and such as family member sleeping accommodations. An activities of daily living suite, transitional patient apartments, and satellite gyms can also be found on two inpatient floors.

Spaulding and Sustainability All HVAC equipment was located to the roof in case of flooding, and The main entry is at street level making the facility accessible for gymnasiums, multi-purpose rooms, and educational rooms have everyone. The facility dedicates 75 percent of its first floor to the automatic operable windows for natural ventilation. Operational community making it a place for community gathering as well as integrating the building with the Boston Harbor Walk. A trail running along windows are also utilized for the case that the mechanical systems are interrupted. The roofs are vegetated to helps with storm water the waterfront encourages healing by providing therapeutic equipment. runoff and reduce cooling loads and the heat-island effect. These This allows physical therapy to take place on a variety of different landscaped surfaces. efforts have allowed the facility to achieve LEED Gold Certification. 2: Precedent Analysis

Architecture as a Healing Device: design for health

Exterior shots of the Spaulding Rehabilitation Center. The center overlooks the Charles River with various patios for patients and public use. The center is well designed in the sense that it does not have a â&#x20AC;&#x153;backâ&#x20AC;? all sides of the facility are equally designed. Glass curtain-walls are integrated into the design creating transparency and an abundance of natural light throughout the interior which results in a space that is open and inviting.

2: Precedent Analysis

First Floor

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First Floor

2: Precedent Analysis

Architecture as a Healing Device: design for health

Mechanical Equipment Patient Tower Community Therapeutic Tower

Spaulding Rehab Center placed on Proposed Site 2: Precedent Analysis

Groot Klimmendaal Rehabilitation Case Study

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Koen Van Velson, Netherlands I 2011 I 150,694 SF

“The care concept is based on the idea that a positive and stimulating environment increases the well-being of patients and has a beneficial effect on their revalidation process. The design ambition was not to create a center with the appearance of a health building but a building as a part of its surroundings and the community.” Full height glazing along the central space allows for continuity between indoor and outdoor spaces creating a strong visual connection to the surrounding nature. This facility also incorporates

the local community to use the building making the building identify as the “center of the community.” The spaces were designed with the intention of creating a stimulating environment that would differ from the traditional appearance of a health care facility. Large and small voids as well as light wells create spatial connections between different floor levels as well as to bring natural lighting into some of the interior spaces. The lower level contains office space with the support for the administrations offices; storage, file rooms, etc. The Ground level has many community functions as well as the shared uses between community and rehabilitation such as the pool and gymnasium. Community program includes a restaurant, and a theater. Many of these elements are double height spaces which allows it to puncture through the second floor creating sectional qualities. A main staircase of wood runs up this atrium like space connecting

2: Precedent Analysis

Architecture as a Healing Device: design for health the programs together. The third floor contains many of the rehabilitation functions and needs and contains many outdoor patio spaces for fresh air, and provides the patient with additional spaces and surface for getting back to healthy living. The fourth floor holds the patient rooms and living spaces. In the core, you can see into the patio spaces below on the rehabilitation dedicated floor as well as support spaces for patients and staff.

Fourth Level

Third Level

Offices/Administration Support/Mechanical/Storage

Second Level

Circulation Outdoor Space Rehabilitation Services Ground Level

Reception / Entry Double height Space Below Patient Rooms Patient Living Areas

Lower Level 2: Precedent Analysis

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Examples of sectional qualities within the rehabilitation center. Double height spaces, voids, depth, and views into nature.

2: Precedent Analysis

Architecture as a Healing Device: design for health

Light-wells / Outdoor Spaces.

Program Requiring abundant light, and views to the outside are positioned around exterior spaces and light wells.

Light wells in Section puncturing building and bringing light into Lower levels

Light wells have green plants and trees to merge the line between interior and exterior, bringing the nature and its healing qualities in.

Open spaces and atrium bring in lots of light and provides Transparency. 2: Precedent Analysis

Mike Ellis, Inside/Out1 Toronto, Canada “As a child I spent a lot of time in and out of hospitals. Once a month my parents and I would drive to Sick Kids Hospital in Toronto for appointments. I know the feeling of vulnerability that often situates itself in the sterile settings of a hospital waiting room. At an early age I learned the benefits of escapism, withdrawing into one’s own mind for entertainment and enjoyment. I would often find myself imagining wonderful open landscapes with the sounds of water on a beach and mountains in the distance. From an early age I found solace in nature, thus natural elements are what inspired my final poster design. The sights, sounds, and warmth found in my ideal natural setting. I believe that a good place of care is one that blurs the boundaries between function and comfort. A space that helps you forget why exactly you are there and acts as a vessel aiding in the healing process.”

Program

â&#x20AC;&#x153;Its amazing that what was so natural before my stroke, now takes a lot of thought and concentration. Left Leg Right Arm, Right Leg Left Armâ&#x20AC;?2 -Britta (A Patient at Helen Hayes Hospital)

“The Hospital is still the place where patients and their families, caregivers, and administrators come together for the common purpose of restoring a patient to good health. The issues each of these parties face all come into sharp focus in the patient room. It is there that the delivery of care is undergoing more change than at any other point in history.” -Herman Miller Healthcare3

Health Research and Design The Patient Room

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Making Room For Guests The presence of family members in the patient room as proven to increase patient safety. Studies have also shown that presence of family members has been linked to less patient anxiety, less chance of medical errors, and improved physical and mental health. However, when patients all have people visiting, it can get very crowded. It is beneficial when an area has been designates within patient reach where family can work.4

Family members can also give input that the patient or caregiver may not give, hear what needs to be done and respond, and recognize when the patient is not acting normally based upon their history with the patient.5

“If the Patient is happy and the family is happy, satisfaction will be higher.” - Nurse Manager Chapter 3: Program

Architecture as a Healing Device: design for health Room Design/Organization Many questions arise when deciding on what the layout of the patient room should be; should the room be mirrored or same handed? It is currently assumed that having same handed rooms allows for less mistakes and errors since the caregiver always knows where everything is. 6 However, there is the question of if it is worth the added expense of having each patient room on its own plumbing chaise which may add anywhere between $3,000 to $5,000 per same handed room.7 In the case of a rehabilitation facility where everyone has been discharged from the hospital for recovery, with a very small possibility of occurrences that would be life or death, there is no need for the added expense of same handed rooms. For a rehabilitation facility, mirrored rooms would be more than effective. Reasons Patients Fall8 1. Low viability into patient room from corridor or nurses station. 2. Difficult access to toilet rooms. Often they are across from the bed making an unassisted path from the bed to the bathroom. Many times, recovering patients think that they are fine to walk to the bathroom unassisted or are too stubborn to ask for help. 3. Small bathrooms and small access doors. Often time the bathrooms are not large enough for the patient and the caregiver assisting the patient. Additionally they often donâ&#x20AC;&#x2122;t have grab bars. 4. Poorly lit rooms at night. Often the patient rooms are only lit during the day, and only one supplemental light a night. This leaves the path the bathrooms poorly lit. 5. Slippery Materials. Many finishes can cause the patient to lose their balance. 6. Lack of patient control. Patients try to get out of bed to adjust lighting levels, close window shades, or grab personal belongings from across the room.

Same-Handed Patient Room

Mirrored Patient Room Chapter 3: Program

Toilet Room Location in Patient Bedrooms Toilet rooms should be placed near the head of the bed to allow for easy access for patients who can get to the bathroom without assistance. Grab bars should line the way from patient bed to bathroom with fixed night lights illuminating the way. Additionally, wider doors should be used for bathroom door openings to allow caregivers to enter at patients side. Open showers in patient rooms should be able to accommodate a shower chair or have space for caregivers to help patients.9

Advantages: Easy patient visibility, privacy, and views to the outside. The decision: For a rehabilitation facility, with the design implications revolving around views to nature, the best way to maximize patient views and natural daylighting is to implement either the inboard toilet room or the nested toilet room. However, with the limited width on the site, it makes the most sense to utilize the inboard toilet room layout. This should not effect visibility into the room with careful designing.

Inboard Toilet Room: Location at Corridor Wall Disadvantages: May limit caregivers view into Patient Room if not carefully designed. A work around to this is to shift the bathroom to the foot side of the patient bed rather than the head. However, this has led to any increase in falls as the travel distance increases. Benefits: maximizes window space along perimeter of exterior building. It also provides the most privacy and acoustical separation from any corridor noise. Several studies have shown that inboard toilet placement has been shown reduce more stress, pain, depression and length of stay compared to other toilet room locations.10

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Outboard Toilet Room: Location at Exterior Wall Disadvantages: restricts views to the outdoors, and patient privacy. Designers must use spandrels or frosted glass for privacy in the bathrooms. Benefits: Clear visual contact from corridor and nurses station into patient room.

Nested Toilet Room: Two Bathrooms are located between two Patient Rooms Resulting in one Inboard bathroom and one Outboard bathroom. Disadvantages: Makes the building longer which may cause site restrictions and increases the travel distance a nurse will travel between rooms. Chapter 3: Program

Inboard Toilet Room

Outboard Toilet Room

Nested Toilet Room

Architecture as a Healing Device: design for health

Nature Based Design

The Journal of Environmental Health Research points to twelve specific implementations that create “healthful places.” A few of these ideas that can be implemented into a rehabilitation space include: 1. Cultivate grounds for viewing 2. Maintain healing gardens 3. Incorporate wooded parks and green spaces in communities 4. Welcome animals indoors 5. Provide indoor potted plants within view 6. Illuminate rooms with bright natural light 7. Provide a clear view of nature 8. Let outside air and sounds in 9. Display nature photography and realistic nature art 10. Listen to recorded sounds of nature11

“Incorporating nature into the built environment is not just a luxury, but a sound economic investment in the health and productivity, based in well researched neurological and physiological evidence.”14 -Terrapin Bright Green

Additionally, their have been indications that attention, learning, and cognitive functions may be improved by nature-based design. For stroke patients, this can be a critical addition as many patients struggle in these areas. Psychologists Rachel and Steven Kaplen have shown that contact with nature can improve cognitive functioning and attentional recovery which is defined as “the ability to reactivate mental effort after a period of intense work.”12 It has been recognized that humans are naturally hardwired to have “Biophilla.” Another words, humans have a biological need for connection with nature on a physical, mental, and social level.13 Therefore, it only make sense that green atrium and nature will need to be incorporated into the design. While patient rooms will have views to the river, all therapy spaces need to have access to a view into an interior entry or outdoor courtyard. Exterior spaces will need to be maximized for patient and caregiver space, while interior spaces will be utilized as support. Chapter 3: Program

Memory Improvement16

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Stroke Rehabilitation

After suffering from a stroke, there are many steps that need to be taken to return to a functioning life. After a brain injury from a trauma such as a stroke, the brain can heal for up to 8 years. This means that patient recovery continues after leaving inpatient care, through outpatient and after outpatient care. After a stroke, many patients suffer from Post Stroke Fatigue and inactivity. This will require a patient to adjust their sleep and activity patterns. This often requires spreading activities out rather than bunching them together.17 Stroke patients lose their neuro-connections, so simple tasks that were easy without much thought, now require a lot of thought.18 After a stroke, most patients need to work on balance re-education. This includes improved trunk control, single leg stance activities, and dynamic walking activities. Patients will do a variety of exercises such as step ups onto different surface, standing on one leg and tapping different objects, kicking a ball, and moving objects. This

type of rehabilitation only requires an open traffic free space in which therapists can work with the patient. It may be an open hallway, and break out area, a dedicated therapy room or the patients room.19 Another Area that requires attention is â&#x20AC;&#x153;Activities of Daily Livingâ&#x20AC;? or ADL. This may include tasks such as dressing, bathing, and eating. It is the occupational therapists job to work with simple strategies to compensate for a patients loss of abilites.20 Regaining memory skills is another area that requires rehabilitation. Utilizing different colors and numbers on cards, and arranging them differently each time is one strategy used to in rebuilding memory.21 After stoke, it has been determined that about two thirds of stroke survivors will experience a problem with their vision depending on where in the brain the stroke occurred. Patients may have vision

Chapter 3: Program

loss or vision perception problems. This may include feeling like the room around them is spinning, seeing everything upside down, or jumbled. Therefore, therapists use a variety of exercises to strengthen impaired vision, improve blind spots, focus, expand the visual field, and reduce double vision or visual select. 22 One method of helping patients with visual deficits is DYNAVISION. This machine not only helps with visual deficits, but with problems with balance and gross and fine motor coordination. This method requires a patient to stand directly in front of the unit about a foot away. Without moving their neck, the patient is expected to locate illuminated lights and press the button of the light location. This helps the patient with their peripheral awareness, reaction time, functional mobility, and improves neurocogitive abilities.23 The zero gravity of water plus the warm water, (92 degrees) allow patients to relax muscles and move safer and easier than they would be able to on land. While in the water, patients can receive hands on techniques to release tight muscles, and practice Water Tai Chi which is know as Tai Chi in order to improve balance, and joint range of motion and relaxation. These pools typically donâ&#x20AC;&#x2122;t get deeper than 5 feet and may start off at 4 feet deep to accommodate for different activities. The pools would be equip with grab bars, movable pool tables, stairs, and a lift. 24

Architecture as a Healing Device: design for health strong hand and the reflection mirroring what his weak hand would look like. This creates the illusion that the hand affected by the stroke is moving. This technique can be used for the hand, foot or leg. This action activates mirror neurons in the premotor cortex of the brain, creating new neural pathways for functional movement. This therapy has proven to help re-wire the brain to preform motor functions. This therapy proves that the brain has the ability to reorganize itself to move functions to an undamaged area of the brain.26 Locomotive training is a therapy that gives body weight support on a treadmill to increase lower extremity weight bearing, and normalize a patients walking pattern using help from therapists. Using this method, therapists can help move the patients legs through the correct walking form, introduce activities such as obstacle navigation.27

Functional Electrical Stimulation (FES) is a rehabilitation method used to stimulate the nerves that connect the spinal cord to muscles. By stimulating these nerves, the nerves evoke a patterned movement of the legs allowing FES to enable the patients muscles to perform even thought the patient may have lost all or some of their voluntary control of the muscles.25 Mirror Box Therapy helps patients retain their brain function, regain function, and improve their quality of life. When the patient inserts his weak hand into a mirror box, it allows him to only see his Chapter 3: Program

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Balance Re-Education 28

Activities of Daily Living (ADL)30

Balance Re-Education29

DYNAVISION31

Chapter 3: Program

Architecture as a Healing Device: design for health

Aquatic Therapy32

Functional Electrical Stimulation33 Chapter 3: Program

Mirror Box Therapy34

Locomotor Training35 37

Program by Room15 General Facility Program

Vehicular Drop-Off and Pedestrian Entrance Service Entrance An off-street unloading area separated from the public streets for receiving and distributing services such as food, product shipments and linen services. May be shared with several services. Must be able to accommodate delivery trucks and other equipment. Should be separated from occupied building areas to eliminate noise and odors from building occupants. Associated Program: A place for unpacking, sorting, and staging of incoming materials and supplies.

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Telecommunications Service Entry Room (TSER) The point in which outside carrier data and voice circuits enter the facility and where outdoor cabling interfaces with the buildingâ&#x20AC;&#x2122;s internal cabling infrastructure. Access to room should be restricted and controlled. Room shall have minimum interior dimensions of 12 feet by 14 feet.

Technology Equipment Center (TEC) Dedicated for use of data storage, processing, and networking. May not be located on top floor of a facility, basement, or location where susceptible to flooding or rain damage. Technology Distribution Room (TDR) Must be one room on each floor of the facility. Should be located in an accessible, non-sterile area on each floor. Access should be directly off a corridor and not through another space. Minimum interior dimensions of 14 feet by 12 feet.

Waste Collection and Storage Facilities Typically decide the size in project planning phases and projected volume of waste. Linen Services An area for storing and processing clean and soiled linen used for patient care support. The physical laundry service will be provided off-site. With off an off-site service, their will need to be a soiled linen holding room where dirty linens await pick-up. Discharge from soiled linen chutes need to be received in a separate room adjacent to the soiled holding room. A clean linen storage room for incoming cleaned laundry needs to be provided in addition to a clean linen storage closet in the patient unit. Cart storage area needs to be provided to allow space to park clean a soiled linen carts out of traffic. The clean carts must be separated from the soiled carts. Clean and Soiled Rooms Must be physically separated from each other. The Clean Assembly workroom is a workspace that has equipment for terminal sterilization or a high level of medical equipment and supplies. The soiled workroom is a place for washer or sterilizer decontaminates, and a place for waste and soiled linen receptive. General Storage Areas Should equal no less than 20 square feet per impatient bed. An additional storage area for outpatients should be no less than 5 percent of the total floor area of the outpatient facilities.

Chapter 3: Program

Equipment and Supply Storage Holds Clean and sterile medical supples. For materials coming in, a separate adjacent room should be provided to receive and unpacking sterile supplies received from outside the facility. A storage room for patient care and distribution carts to be located adjacent to the clean room and close to the main distribution point to keep traffic to a minimum and ease work flow. Elevators At least two hospital type elevators need to be installed in any facility with 1-59 beds located on any floor other than the main level. Elevator cabs must be 5 feet 8 inches wide by 9 feet deep. The doors of the cab must have a minimum clear width of 54 inches and a minimum height of 84 inches. Food and Nutritional Services Should be shared between the patient food service and the retail food service. The only time you would separate the services is if the health facility has more than 250 beds. Design should try to incorporate a way that food service storage, production, sanitation, tray assembly and the main retail area contiguous of each other. Associated program would include: Space for: cart storage, meal distribution, receiving soiled carts, and sanitizing carts, an office for food service management, food prep areas, hand washing station, storage for food goods, a receiving area for incoming shipments, an environmental services room, and trash storage. Retail Food Service Area A dinning area for the public as well as a private dinning area for patients. Minimum aisle spacing and chair spacing is 3 feet. Support Areas for Staff

Architecture as a Healing Device: design for health This area should include toilet rooms, lockers, and a lounge specifically for staff members. Ideally, they would be located close to where they are working. This space may be one main area, or several scattered smaller areas. Reception Shall provide access to information, a public waiting are, public toilets, access to make phone calls, and provisions for drinking water. A toilet room is required only for waiting areas serving more than 15 people. Administrative Area Will include an interview room to meet with families of prospective patients, offices and open work space for business transactions, equipment and supply storage as required by the program. Medical Records Area To be located in an area that is restricted to staff movement or located so that it is remote from treatment and public areas.

The Unit Rehabilitation Therapy Units May include many therapy modalities: ultrasonics, hydrotherapy, thermo-therapy, diathermy, speech and hearing therapy, occupational therapy, activities of daily living, education therapy, and recreation therapy (assisted in the development and maintenance of community living skills through leisure-time activities, which may occur in a gymnasium, nursing unit, or outdoors). Many of these services may be provided at the patients bed or in a corridor space near the patients room. Medical Evaluation Unit Every Rehabilitation facility must contain this unit. Will include

Chapter 3: Program

an examination room of 140 square feet with a minimal room dimension of 10 feet. The examination room shall contain a hand washing station, work counter, storage facilities, and accommodations for written or electronic documentation. An evaluation room(s): if facility is small enough, the use of an examination room in place of an evaluation room is permitted. Room should include a desk and work area for the evaluators, writing and work space for patients, and storage for supplies. Lastly support offices provided for personnel. Physical Therapy Spaces Group work area should be sized for one therapy group at a time. Private therapy rooms should be considered. Most treatment areas will need to be larger than 60 square feet. Individual Treatment Areas Space based on equipment going into rooms. Each individual patient care station shall have a minimum clear floor area of 60 square feet. Spaces with permanent partitions shall have a minimum clear floor area of 80 square feet. A minimum clearance of 2 foot 8 inches on at least 3 sides of the treatment furniture.

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Occupational Therapy Areas At least one classroom shall be 30 square feet per person plus space for the instructor and instructional resources. The classroom must be a minimum of 150 square feet. A teaching area shall be provided for teaching activities of daily living.

Speech and Hearing Service Space for evaluation and treatment. Design shall minimize external sound from high-traffic, public, and other noisy areas. Opt. Psychological Services Unit Often provided for testing, evaluation and counseling.

Opt. Vocational Service Unit Office and work space shall be provided for vocational training, counseling, and placement. Daily Living Unit A unit similar to a residential unit for teaching activities of daily life so that patients can practice what it would be like when they return home. Unit shall contain a bedroom, a bathroom, (does not get included in bathing requirements count for building), a kitchen, space for training stairs. Personal Services (Barber/Beauty) Area A separate room with fixtures and utilities for patient grooming. Activities of daily life unit my serve this purpose. Patient Living Areas Dining, Recreation, and Day Space may be adjoining spaces or separate. A glazed area should allow light into space. For inpatient a minimum of 55 square feet per person shall be provided. If dinning is not part of the program for Outpatient care, 35 square feet must be provided per person for recreation and day spaces. A handwashing station must be provided in each dinning area. Airborne Infection Isolation Room The need and number of isolation rooms must be determined by a an infection control risk assessment. Toilet Rooms for Public Use Provided separate from public use toilets and located to permit access from patient care areas without passing though publicly accessible areas. Nurses Stations Decentralized Nurses stations allow nurses to be closer to their patients to help assist them faster.

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Architecture as a Healing Device: design for health closet or locker with minimum dimensions of 1 foot 8 inches by 1 foot 8 inches for storage of personal items. An adjustable rod and shelf will be provided.

Secured Storage Provided for potentially harmful supplies and equipment. Physical Therapy Support Areas Soiled material storage, separate storage for soiled linens, towels, and supplies. Equipment and Supply Storage: clean linen and towel storage for equipment and supplies. Equipment and Supply Storage A clean linen storage, equipment storage room for equipment such as IV stands, inhalators, air mattresses and walkers, storage for wheelchairs, and administrative supplies. Wheelchair storage shall also be provided around different therapy units as well as in the inpatient unit. Bathing Facility 1 Bathtubs or shower facility must be provided for every 8 beds if not provided in patient room. Each tub or shower must be an individual room or have a privacy enclosure that provides space for bathing, drying, and dressing with a wheelchair and an assistant. Showers must be at least 4 feet square, curb free, and designed for use of wheelchair patients. A toilet room that can be accessed without entering the main corridor must be located in each bathing area. Doorways should be designed to accommodate the entry of portable/mobile mechanical lifts and shower gurney devices.

Patient Support Services Medication Safety Zones Place where medication is prepared/dispensed, stored and administered. The number and location of medication safety zones is determined by the medication safety risk assessment. Nourishment Area / Room When provided, shall have a hand-washing station located in or directly accessible to nourishment area, a food-preparation sink, work counter, storage and fixtures and appliances for the beverages and or nourishment provided in the facility.

Patient Room 1 person per room with a minimum floor area of 140 square feet. The arrangement of the room should leave a clearance of 3 feet between the sides and foot of the be and any wall or fixed object. Attached toilet rooms must be ADA. A hand washing station must be located in each room. Patient Storage in each patient room is to include a wardrobe, Chapter 3: Program

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Diagrams of Building Elements

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Jing Wei, Waiting Room New York City, United States

â&#x20AC;&#x153;For this piece, I wanted to create small, private moments within a public landscape. I liked the thought of multiple stories existing in a single open space, so I started with an empty room, and slowly built furniture and characters to occupy it. Even though this is a healthcare environment, the space itself is inspired by a combination of a gallery and a video game, complete with impractical staircases and a ladder that leads to nowhere.â&#x20AC;? Chapter 3: Program

Architecture as a Healing Device: design for health Community/Visitors Vestibule Lobby Reception Meeting/Conference Rooms Cafe Public Bathrooms

Clinical Support Nurses Station Charting Conference Room Clean room Storage Equipment

Exterior Community Components Waterfront walk Outdoor courtyard spaces Offices Financial/Insurance Administration

Back of House Kitchen Service Entry Storage Waste Lab Environmental Services Mechanical Laundry Staff Lounge

Therapy Spaces Pool Studios - yoga, stretching etc Gym Occupational therapy Library Specialized Inpatient Units Patient beds with associated bathrooms Dinning Quiet room Exam rooms Bathrooms Interior green spaces/atriums Counseling Patient support Visitor room

A comfortable place where you can pause and consider the best way to move forward, get inspired, recharge, or a place to digest complex information with the necessary degree of quiet and focus.

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Community Spaces

With the area around the Sheridan Expressway undergoing extensive renovations to revitalize the area, as well as massive amounts of redevelopments, and new housing, the area needs public support spaces to foster the people in the area.

the two groups together makes one place where people go to better themselves. A rehabilitation center will no longer be the place you only go to when you are ill, but a place that anyone can go to when they would like to better themselves.

Spaces that may be utilized include a work cafe, breakout rooms for small meetings and study, multi-function rooms for community engagement and growth, contemplative spaces for quiet thought, and spaces for flexible working.

The community spaces may be a combination of indoor and outdoor spaces that will promote access to the water front regardless of if they decide to actually enter or use the facility.

The cafe will serve as a place for the public as well as a place for visiting family and friends to grab food. Access to well prepared food is an essential component for family satisfaction. By adding these kinds of community components, this building will become not only a place for the sick to get better, but a place for the healthy to improve themselves as well. This new idea of merging

By incorporating community components, a precedent will be set for all future buildings on the stretch of land between the Bronx River and the Sheridan Expressway for establishing public access and use for its facilities. The Bronx River Alliance building between the proposed site and Starlight Park, is the first building in this area to have public functions.

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A working cafe area that people of the community as well as visitors of the rehab facility can use to grab a quick bite to eat or drink. This place would also be utilized for impromptu interaction, catching up with peers, or clients, as well a place to study and do work.

Breakout rooms that can be used by anyone for purposeful interactions between 2-3 peers. Can also be used as a place for small group study and conference meetings for freelancers, or collaborative place to work outside the office. Possibility for use of technology, writable walls, etc. Perfect for use of family members who have to take off work, but still need to get work done. Essentially a quiet space to get work done.

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A comfortable outdoor place where you can pause and consider the best way to move forward, get inspired, recharge, or a place to digest complex information with the necessary degree of quiet and focus. A public place where people can gather, exercise. Classes such as outdoor yoga and stretching may be offered to engage the community.

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Chapter 3. Sources

1. Ellis, Mike. "Inside/Out." Digital image. What Kind of Place Are You. Accessed August 23, 2016.

of Healing,” Research, Herman Miller, 2010, accessed August 23, 2016.

2. Helen Hayes Hospital. “Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking.” Filmed [February 2015]. YouTube Video, 07:05. Posted [February 2015]. https:// www.youtube.com/watch?v=u5jpGOrEJkE&feature=youtu.be

6. Maze, Camie. "Inboard, Outboard, or Nested?" Health Care Design. March 1, 2009. Accessed August 24, 2016. http://www. healthcaredesignmagazine.com/article/inboard-outboard-or-nested.

3. HermanMiller Healthcare, “Patient Rooms: A changing Scene of Healing,” Research, Herman Miller, 2010, accessed August 23, 2016.

7. HermanMiller Healthcare, “Patient Rooms: A changing Scene of Healing,” Research, Herman Miller, 2010, accessed August 23, 2016.

4. HermanMiller Healthcare, “Patient Rooms: A changing Scene of Healing,” Research, Herman Miller, 2010, accessed August 23, 2016.

8. Gow, Catherine. "Designing for Safety." Health Care Design. November 11, 2011. Accessed August 23, 2016. http://www. healthcaredesignmagazine.com/article/designing-safety-0.

5. HermanMiller Healthcare, “Patient Rooms: A changing Scene

9. Maze, Camie. "Inboard, Outboard, or Nested?" Health Care

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Design. March 1, 2009. Accessed August 24, 2016. http://www. healthcaredesignmagazine.com/article/inboard-outboard-or-nested. 10. Maze, Camie. "Inboard, Outboard, or Nested?" Health Care Design. March 1, 2009. Accessed August 24, 2016. http://www. healthcaredesignmagazine.com/article/inboard-outboard-or-nested. 11. Largo-Wight, Erin. "Cultivating Healthy Places and Communities: Evidenced-based Nature Contact Recommendations." Int. J. of Env. Hlth. Res. International Journal of Environmental Health Research CIJE 21, no. 1 (January 17, 2011): 41-61. Accessed August 24, 2016. doi:10.1080/09603123.2010.499452.

Architecture as a Healing Device: design for health Stroke Rehabilitation 16. Helen Hayes Hospital. “Regaining Memory After Stroke.” Filmed [June 2016]. YouTube Video, 03:04. Posted [June 2016]. https:// www.youtube.com/watch?v=BW1EPIaNeZM&feature=youtu.be 17. Helen Hayes Hospital. “Rehab Following a Stroke: A Personal Story of Recovery.” Filmed [June 2016]. YouTube Video, 20:44. Posted [June 2016]. https://www.youtube.com/watch?v=WxDOkTUUP4Q&feature=youtu.be 18. Helen Hayes Hospital. “Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking.” Filmed [February 2015]. YouTube Video, 07:05. Posted [February 2015]. https:// www.youtube.com/watch?v=u5jpGOrEJkE&feature=youtu.be

12. “Nature-Based Design: The New Green." Research Summaries – Herman Miller. 2013. Accessed August 24, 2016. http://www. hermanmiller.com/research/research-summaries/nature-baseddesign-the-new-green.html#source3.

19. Helen Hayes Hospital. “Rehabilitation After Stroke Part One.” Filmed [June 2016]. YouTube Video, 03:09. Posted [June 2016]. https://www.youtube.com/watch?v=WxDOkTUUP4Q&feature=youtu.be

13. Terrapin Bright Green LLC. "The Economics of Biophilia." The Economics of Biophilia. 2012. Accessed August 2016. http:// www.terrapinbrightgreen.com/reports/the-economics-of-biophilia/.

20. Helen Hayes Hospital. “Activities of Daily Living (ADL) After Stroke: Part Two.” Filmed [June 2016]. YouTube Video, 03:47. Posted [June 2016]. https://www.youtube.com/watch?v=6GwGnUJ01tw&feature=youtu.be

14. Terrapin Bright Green LLC. "The Economics of Biophilia." The Economics of Biophilia. 2012. Accessed August 2016. http:// www.terrapinbrightgreen.com/reports/the-economics-of-biophilia/.

21. Helen Hayes Hospital. “Regaining Memory After Stroke.” Filmed [June 2016]. YouTube Video, 03:04. Posted [June 2016]. https:// www.youtube.com/watch?v=BW1EPIaNeZM&feature=youtu.be

15. Facility Guidelines Institute. Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Chicago, IL: American Society for Healthcare Engineering of the American Hospital Association, 2014.

22. Helen Hayes Hospital. “Vision After Stoke.” Filmed [June 2016]. YouTube Video, 03:25. Posted [June 2016]. https://www.youtube. com/watch?v=OwCEobuxQOY&feature=youtu.be 23. Helen Hayes Hospital. “Therapy using the DYNAVISION TM Post Stoke.” Filmed [June 2016]. YouTube Video, 02:05. Posted [June

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2016]. https://www.youtube.com/watch?v=LQBF9sPKJpw&feature=youtu.be 24. Helen Hayes Hospital. “Rehabilitation After Stroke: Aquatic Therapy Improves Pain, Mobility, and Balance.” Filmed [May 2015]. YouTube Video, 05:21. Posted [May 2015]. https://www.youtube. com/watch?v=fEG5_3VWFOU&feature=youtu.be 25. Helen Hayes Hospital. “Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking.” Filmed [February 2015]. YouTube Video, 07:05. Posted [February 2015]. https:// www.youtube.com/watch?v=u5jpGOrEJkE&feature=youtu.be 26. Helen Hayes Hospital. “Locomotor Training.” Filmed [June 2016]. YouTube Video, 03:59. Posted [June 2016]. https://www. youtube.com/watch?v=1BnsQO7a4Og&feature=youtu.be 27. ¬Helen Hayes Hospital. “Locomotor Training.” Filmed [June 2016]. YouTube Video, 03:59. Posted [June 2016]. https://www. youtube.com/watch?v=ieRovfMKQ00&feature=youtu.be

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28. Helen Hayes Hospital. “Activities of Daily Living (ADL) After Stroke: Part 1.” Filmed [June 2016]. YouTube Video, 03:58. Posted [June 2016]. https://www.youtube.com/watch?v=FRmwRqgIJsM&feature=youtu.be

31. Helen Hayes Hospital. “Vision After Stoke.” Filmed [June 2016]. YouTube Video, 03:25. Posted [June 2016]. https://www.youtube. com/watch?v=OwCEobuxQOY&feature=youtu.be 32. Helen Hayes Hospital. “Rehabilitation After Stroke: Aquatic Therapy Improves Pain, Mobility, and Balance.” Filmed [May 2015]. YouTube Video, 05:21. Posted [May 2015]. https://www.youtube. com/watch?v=fEG5_3VWFOU&feature=youtu.be 33. Helen Hayes Hospital. “Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking.” Filmed [February 2015]. YouTube Video, 07:05. Posted [February 2015]. https:// www.youtube.com/watch?v=u5jpGOrEJkE&feature=youtu.be 34. Helen Hayes Hospital. “Mirror Box Therapy & NEUROPLASTICITY Following Stroke.” Filmed [June 2015]. YouTube Video, 03:59. Posted [June 2015]. Helen Hayes Hospital. “Locomotor Training.” Filmed [June 2016]. YouTube Video, 03:59. Posted [June 2016]. https://www.youtube. com/watch?v=ieRovfMKQ00&feature=youtu.be 35. Helen Hayes Hospital. “Locomotor Training.” Filmed [June 2016]. YouTube Video, 03:59. Posted [June 2016]. https://www. youtube.com/watch?v=ieRovfMKQ00&feature=youtu.be

29. Helen Hayes Hospital. “Rehabilitation After Stroke Part One.” Filmed [June 2016]. YouTube Video, 03:09. Posted [June 2016]. https://www.youtube.com/watch?v=WxDOkTUUP4Q&feature=youtu.be 30. Helen Hayes Hospital. “Activities of Daily Living (ADL) After Stroke: Part 1.” Filmed [June 2016]. YouTube Video, 03:58. Posted [June 2016]. https://www.youtube.com/watch?v=FRmwRqgIJsM&feature=youtu.be Chapter 3: Program

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Site Subtitle

Site Identification

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The south Bronx was chosen since it is currently undergoing urban renewal and re-population. This makes the Bronx an ideal location to create a precedent for what future rehabilitation facilities will consist of and offer. As part of the south Bronx renewal plan, community spaces will be critical in helping to activate the facility, giving the facility a sense of place and belonging to those of the community as well as those in need of the facility.

was the prime principle that helped select a site. Additionally, this location is undergoing urban renewal and planning. Currently, the Sheridan Expressway makes the chosen site questionable with the close proximity of cars and trucks just outside, with difficult and somewhat dangerous access for pedestrians. As part of the plan to revitalize the South Bronx, the city is intending to remove the expressway and replace it with a Boulevard. Along the street way a green-way will be implemented for bikes and pedestrians A site in the south Bronx located between the Sheridan Expressway connecting the Starlight Park to the north and abandoned and soon and the Bronx River was chosen. The site will encompass two parcels to be revitalized concrete plant park. These developments as part of land, one currently identified as vacant and the adjacent site has a of the South Bronx revitalization, will make the future Rehabilitation large parking lot with a warehouse associated with it. The warehouse Center immersed within a pedestrian friendly area surrounded by is currently listed for lease. nature. This site was selected since it backs the Bronx River to the east Additionally, the site is served by the 6 train and several buses which and Starlight Park to the north. With the positive healing effects of make the site easily reachable to friends and family of the patients. nature on recovering patients, selecting a site with views of nature Chapter 4: Site

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Both the empty site and the empty warehouse would need to be utilized to allow for the program needed to make a successful rehabilitation center. Chapter 4: Site

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Lots within Proposed Site

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Front of Warehouse on Proposed Site. D

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Far side of Warehouse on the Proposed Site with existing traffic u-turn.

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Buildings and Construction across from the proposed Site. Sheridan Expressway, to the left of the local road, is very under utilized. All the new construction demonstrates the efforts for regrowth in the area. Chapter 4: Site

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Bronx River Side of Warehouse and lots on the Proposed Site. Existing bulkhead protects site from river water level changes.

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When standing at the top of the pedestrian access stairs from the 174th Street bridge, you can see a glimpse of the proposed site just beyond Starlight Park which is adjacent to the site. Includes a soccer field, childrenâ&#x20AC;&#x2122;s playground, toddler playground, and picnic benches. The bike path also runs through the site. Currently under utilized due the limited access points to the site.

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iver

Starlight Park

Bronx R Site

Analysis Bronx, New York

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Today, more than 200,000 people live within a mile of the Expressway. Neighborhoods along the expressway include Crotona Park on the west, West Farms to the north, and Longwood and Hunts Point to the south. The Bronx River and Soundview are to the east.

Transportation The area is served by the number 6 as well as several bus routes. The elevated 6 subway train regional Amtrak line run along the expressway and crosses it near Westchester Ave just south of the selected site. This makes the site accessible to family and friends of patients that will be staying within the facility. It also promotes the possibility for the development of outpatients with its ease of accessibility. There are future plans to utilize the Bronx river to host a ferry service ending at Westchester Ave just south of the bridge that crosses the river. Chapter 4: Site

Park e t e r Conc

5-17 yrs 19% 0-4 yrs 7%

18-64 yrs 63%

65+ 11%

Age of Population

Architecture as a Healing Device: design for health Population Growth The area has seen large population Other swings. In the 1970s through the 80s White 442,514 the population decreased 20 percent 386,497 with the decrease of manufacturing jobs, increase in suburbanization, 1,385,108 and housing disinvestment. Areas Asian west of the site and the Expressway 49,609 experienced up to a two-thirds Black population loss. During the 1980s 505,200 there was some renewal that resulted Population of Bronx by Race in stable residential communities.

1,385,108

8,550,405

In the 1980s and 1990s immigrants began to move into the Bronx leading to a 2.9 percent population increase. The 1990s the Bronx saw a population growth larger of 15 percent, larger than the growth in NYC with a growth of only 11.6 percent. Growth has continued between 2000 and 2010 with population increases larger than in NYC overall. Population growth is expected to continue and is anticipated to reach its 1970 population level once again by 2030. The population currently occupies 1,385,108 people of the 8,550,405 total people in New York City.

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Top: Wind Velocity Range Bottom: Monthly Diurnal Averages Chapter 4: Site

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Sun Chart

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Architecture as a Healing Device: design for health Land Usage Neighborhoods east of the site and the Bronx River are predominately low-scale residences with some newer high rise developments by the New York City Housing Authority. Hunts Point includes some residential within the cities largest industrial business zone. Directly along the Sheridan Expressway, are light industrial uses, auto uses, warehouses, a few schools, an MTA bus depot, and subway stop

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History Bronx, New York

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The Sheridan Expressway (I-895) constructed and the Bronx River Parkway link the Bruckner Expressway (I-278) to the south and the Cross Bronx Expressway (I-95) to the North. Today, the Expressway operates at below 50% occupancy during its peak rush hour.

The Sheridan Expressway was first planned in the 1940s by Robert Moses with the intention of extending Bruckner Expressway north past the Bronx Zoo into Westchester County to create a connection between the Triboro bridge and the New England Thruway. The plan was never completed due to community opposition and resulted in a 1.25 mile expressway that ended at the Cross Bronx Expressway in 1963.

decay in the area. Within the 1960s, housing value decreased and long time residents of the area began to leave the Bronx, and was a process that continued well into the 1970s. With the loss of residents, neglect and arson took over large parts of the South Bronx. By the 1980s, the New York Department of Transportation (NYSDOT) declared the need for improvements to the safety and traffic flow of the Sheridan Expressway. A set of flyover ramps to Oak Point were introduced into the system to solve the problem of getting trucks to Hunts Point, but NYSDOT was unable to come to a decision in regards to removing the expressway.

During planning, to make way for the expressway, thousands of residents and some local businesses were displaced to allow moving By 2001, NYSDOT began a formal study for the redesign of the the Bronx River to make room for a new more linear roadway. The Bruckner-Sheridan interchange and their related transportation barrier this highway created limiting access to the waterfront caused Improvement needs. Chapter 4: Site

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In 2006, the Southern Bronx River Watershed Alliance (SBRWA) began work on a formal plan to remove the Sheridan Expressway, and in its place, build housing and mixed use development to make use of the number 6 train access on Westchester Ave, the proximity of the Bronx River, and the development of parks along the waterfront. City Planning Map showing the proposal of the new expressway for the South Bronx prior to 1945. The section highlighted in blue, is the only portion that was built.

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Starlight Park Just north of the site is Starlight Park which was originally opened in 1918. Starlight Park was a thriving cultural and activity hub and was the Bronx’s version of Brooklyn’s Conney Island. The park had bathing pavilions, shooting gallery, swimming pool, sandy beach,15,000 seat stadium for the circus, opera , and big band shows. The park had also been home for the New York Giants soccer team. The park was only open for 14 years when in 1932, a fire burned down the bathing pavilions. At this point the park became a parking lot and dumping grounds. The Park was reopened in 2013 as part of the Revitalized Bronx River Green-way.

Starlight Park 1920s

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Today, the Park has a soccer field, basketball court, children’s playground, toddlers playground, and a water sprinkler area for hot days.

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Concrete Plant Park South of the site is the Concrete Plant Park once owned by the Transit Mix Concrete Corporation who operated a concrete batch plant. The plant opened in 1945 and closed in 1987. The site remained abandoned for some time. The site underwent cleanup between 2000 and 2005 and it opened for the public in October 2009. The silos, hoppers, and conveyor structures that still stand on the seven acre site were original to the factory, and signify the sites industrial history.

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The park is accessible from both Westchester Ave and Bruckner Boulevard. The site is often used for organizing community festivals and as a canoe and kayak launch for residents.

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Concrete Plant Park 1948 Chapter 4: Site

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Bronx 1921

Bronx 1951 Chapter 4: Site

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Bronx 1996

Bronx 2012 Chapter 4: Site

Nearby Sites River House: Bronx River Alliance environmental learning laboratory for Bronx River restoration and redevelopment. Scheduled to be completed in fall 2016. The Program is to include a community multi-purpose room, a boathouse, nature classroom, and serve as the headquarters fir the Bronx River Alliance. The project is striving for LEED Platinum level.

Serve children K-12. With Sheridan Highway planning, walking to these schools will become less complicated and be safer. Residential Units: Over 900 units, and a new school are being constructed along the expressway.

Concrete Park: Opened in 2009, as part of the Bronx River and Green-way initiative. The Concrete Park supports and links existing and planned multiuse pedestrian green-ways with other off-road, on-road, bicycle and pedestrian routes, a canoe and kayak launch, waterfront promenade, and a reading circle. The site is often used for organizing community festivals. The silos, hoppers, and conveyor structures that still stand on the seven acre site were original to the factory, and signify the sites industrial history. The site can be accessed from both Sheridan Hotel: Opened in 2005, met with controversy due to its Westchester Avenue and Bruckner Boulevard. In the future, there location amongst warehouses and other industrial use buildings. is a plan to start a ferry that would stop at Concrete park and bring people into Manhattan quickly. Bronx River and the Green-way: being transformed into a recreational and scenic amenity. It will connect with the Bronx River Whitlock Subway Station: This is a local number 6 train stop which Green-way is a 23 mile multi-use path that will extend the full length gives train users access to the site area which runs merges with of the river from the Bronx into Westchester county. 19 miles the 4 and 5 train lines. The 6 train is a local train through Lexington of the proposed 23 miles path have already been realized. There Avenue, but only the local 6 train will bring you to Whitlock Ave. Hunts are currently 44 acres of parkland along the green-way, but once point which is south of the site, is an express stop and Elder ave completed 633 acres of parkland will be available for public access. north of the site and on the eastern side of the river is also a local stop. Manufacturing Currently zoned as manufacturing, but the city has already begun to change lot zoning to multi-use.

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Starlight Park Reopened in 2013 as part of the Revitalized Bronx River Green-way after being closed for The park is 13 acres with two playgrounds, picnic areas, bike trails, ball fields, lawns and waterfront access. Currently only has one access point from the East 174th Street Overpass which has stairs at its mid-span. The park will not be fully accessible until the Sheridan Expressway is removed.

Local Businesses Primarily auto wreckage, storage, and parts. Schools/Institutions Chapter 4: Site

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River House

Starlight Park Pedestrian Bridge

Proposed Site

Residential Units

Sheridan Hotel

Local Businesses

Manufacturing

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Institutions Whitlock Subway Stop Chapter 4: Site

Urban Development Planning The Future of the Bronx

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Reconnecting the Neighborhoods around the Sheridan Expressway Future of the Sheridan Expressway and Improving Access to Hunts Point Improvement of pedestrian and biker safety with designated areas Previous Mayor Michael Bloomburg began the imitative of a for travel. community planning process to improve the southeast Bronx. Conversion of expressway into a boulevard and removing truck traffic from the local roads with new ramps at Oak Point making it â&#x20AC;&#x153;By Transforming a highway into an accessible safer for pedestrian.

neighborhood boulevard, establishing new connections to the Bronx River waterfront, steering truck traffic off residential streets, and enabling more direct access for trucks to Hunts Point, the recommendation s offer benefits to residents and businesses alike and will help foster the continued revitalization of the South Bronx. And the residents and the businesses of the South Bronx deserve no less.â&#x20AC;? - Bloomburg

Increase Pedestrian Access to the Bronx River and waterfront amenities with over 1,600 linear feet of publicly accessible waterfront along the river. As part of the redevelopment initiative, the site along the waterfront will be rezoned from industrial to mixed uses to focus on job opportunities and growth along this sector rich with transportation routes.

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Area for redevelopment

Sheridan-Hunts Point Land Use and Transportation Study

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Physical Characteristics

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The Site proposed is located along the Bronx River with a bulk head separation providing protection from flooding and the rising river. The site is 1.43 aces making up 62,253 SF. The idea is to redevelop the Sheridan Expressway to provide a wider lot when the highway gets converted to a boulevard. This can provide an additional 20 feet to include safe pedestrian walkways and a bike dedicated lane. The additional SF can be used to enlarge the site and create a dedicated public space for the site.

There are some design challenges with site as there is a 20â&#x20AC;&#x2122; grade difference from the waters edge to the street level. Additionally, the 100 year floor zone goes from the waters edge up to 13.6 feet meaning that anything beyond 6 feet below the street grade is in the flood zone. This will require spaces that it does not matter if it floods, or careful designing with sludge walls that will prevent the interior of the facility from flooding. Section A

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134.88’

256.11’

254.43’

80.83’

184.76’

81.28’

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Section B

Section C

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Buildable Area

Visual Access to Waterfront

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Bike Path Extension

Regulatory Environment Zoning and Site Regulations

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The site is located on a 0.2% flood zone, and is bordered by the 1% annual flood zone. This will need to be taken into consideration when designing on the site, especially if underground parking or other sub level floors will be considered in the design.

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The Site is located in Zoning area 3-D in a M1-1 Manufacturing district. M1 districts have the ability to host commercial, institutional, and schools. With special permits M1-1 districts can host hospitals. With the rezoning development happening in the site location, their should be no problem getting the site zoned for an institution. With the FAR set to 1.0, for the selected site, the building would be able to be a max of 62, 253 SF. However, if the facility houses community elements, it is likely that the FAR can be set up to 2.4 FAR making the building have a max capacity of 149,407 SF.

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There is talk of completely rezoning the area to a mid-rise commercial and residential district, which tend to have FARs between 3 and 5.

Currently, the residential buildings across the street are17 floors. This would lead one the believe that a building built in this M1-1 zone would be allowed to be built taller than 30â&#x20AC;&#x2122; with a special permit, especially with a community element added to the building. For this site, located on an FAR ration less than 4.0, and on a waterfront property, at least 15 percent of the Chapter 4: Site

Architecture as a Healing Device: design for health site must be public access. This may include public walkways, upland connections and supplemental public access areas. The location of parking on the ground floor of a building adjoining a public street or public access area is controlled so that more active uses, such as shops and restaurants, will enliven public spaces at and near the waterâ&#x20AC;&#x2122;s edge. All parking lots on waterfront blocks are subject to planting and screening requirements. M1-1 districts require one off-street parking space per 2,000 square feet of floor area or one per every three employees, whichever would be less.

Chapter 4: Site

Code Requirements Use and Occupancy

Since the facility will include health functions as well as public functions for gathering the facility will be a mixed use with Institutional (group I-2) functions as well as Assembly (group A-2 and group A-3)

nications, and related clerical areas may open to corridor if spaces are constructed as required for corridors Gift Shops/Storage: May open to Corridor if less than 500 SF

A rehabilitation facility would be considered I-2 since it would be a 24 hour supervised facility with patients whom may be unable to respond to an emergency situation or be capable of self-preservation without the assistance of staff members.

Smoke Barriers

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Corridors

Shall be continuous to the exits and separated from other areas Waiting and Similar Areas: may open to a corridor if the spaces are not opening to patients sleeping units, treatment rooms, or hazardous or incidental occupancies and that the space is arranged to not obstruct access to required exits. Nurses Stations: Spaces for doctors and nurses charting, commu-

Used to subdivide every story used for patients for sleeping or treatment and to divide other stories with occupant loads of more than 50 persons into at least 2 smoke compartments. Refuge Area: at least 30SF per patient shall be provides with the aggregate area of corridors, patient rooms, lounge, or dining areas on each side of a smoke barrier. On floors not housing patients confined to a bed, at least 6SF must be provided for each side of a smoke barrier for the total number of occupants in adjoining smoke compartments.

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Egress

Yards, patios, courts and similar outdoor areas accessible to and usable by the building occupants shall be provided with means of egress. Doors,when fully opened, and handrails shall not reduce the required means of egress width by more than 7 inches When outdoor areas are to be used by people in addition to the occupants of the building, and the path of egress travel from the outdoor areas passes through the building, means of egress requirements for the building shall be based on the sum of the occupant loads of the building plus the outdoor areas. The total width of means of egress in inches shall not be less than the total occupant load served by the means of egress multiplied by 0.3 inches per occupant for stairways and by 0.2 inches per occupant for other egress components. Width shall not be less than 44 inches unless serving less than 50 people.

Architecture as a Healing Device: design for health door is not greater than 50 feet. For exit access through suites, exit access from all other portions of a building not classified as a suite in a Group I-2 occupancy shall not pass through a suite. The travel distance between any point in a Group I-2 occupancy patient sleeping room and an exit access door in that room shall not exceed 50 feet. Suites in Group I-2 occupancies shall be separated from other portions of the building by a smoke partition Common path of egress travel. The common path of egress travel shall not exceed 75 feet The length of a common path of egress travel in Group I-2 occupancies between any point in a suite of sleeping rooms and an exit access door of that suite shall not be more than 100 feet. Other areas have a max of 200 feet with a sprinkler system as displayed in the table below. (Table 1016.1)

Areas of rescue assistance: Every required area of rescue assistance shall be accessible from the space it serves by one or more accessible means of egress components as listed in Section 1007.2. The maximum travel distance from any accessible space to an area of rescue assistance shall not exceed the travel distance permitted for the occupancy in accordance with Section 1016.1. Every required area of rescue assistance shall have direct access to a stairway within an exit enclosure. Size: Each area of rescue assistance shall be sized to accommodate one wheelchair space of 30 inches by 48 inches for each 200 occupants, based on the occupant load of the area of rescue assistance and areas served by the area of rescue assistance. Such wheelchair spaces shall not reduce the required means of egress width. For rooms other than patient sleeping rooms located within a suite, exit access travel from within the suite shall be permitted through two intervening rooms where the travel distance to the exit access Chapter 4: Site

Building Height and Area Limitations

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For institutional buildings, the following heights and areas limitations are as follows:

Type I-A Construction: building height and area are unlimited. Type I-B Construction: building height is limited to 6 floors and area is unlimited. Type II-A Construction: building height is limited to 4 floors, and area is limited to 7,000SF per floor. Type II-B Construction: building height is limited to 4 floors, and area is limited to 3,500SF per floor. Type III-A Construction: building height is limited to 5 floors, and area is limited to 5,000SF per floor. Type III-B Construction: building height is limited to 3 floors, and area is limited to 1,200SF per floor. Type IV-HT: Construction: building height is limited to 5 floors, and area is limited to 6,500SF per floor. Type V-A Construction: building height is limited to 3 floors, and area is limited to 2,000SF per floor. Type V-B: Not Permitted. Not permitted in Fire District Not permitted in Fire District without sprinklers Chapter 4: Site

Architecture as a Healing Device: design for health For Group A buildings there is no restriction for heights and area when equipped with automatic sprinklers.

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Occupant Loads

The possible functions with its associated floor area per SF per occupant is displayed in the table to the right (Table 1004.1.1 from NYC 2014 Building Codes Manual). Highlighted in yellow are the possible functions that may occur within the rehabilitation facility. Within the Community dedicated portion of the facility, a cafe, kitchen, with associated seating would be found. The Institutional portion of the building will contain inpatient treatment rooms, outpatient rooms, and sleeping areas. It may also contain exercise rooms, and a gymnasium with may be shared with community functions.

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The site is also very likely to need to incorporated a parking garage into its design

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Conceptual/Schematic Design Presented September 20, 2016

& October 21, 2016

Sheridan Expressway

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Conversion to a Boulevard

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Chapter 5: Conceptual/Schematic Design

Architecture as a Healing Device: design for health The first design challenge was to redesign/remove the Sheridan Expressway (as proposed in 2006). The new design of what would replace the highway has not been formally proposed so based on the surrounding sites, and what would benefit the rehabilitation facility the best, propose a scheme that would put in two lanes of traffic moving northbound and two lanes moving southbound. Each side would have street parking, the southbound side with parallel parking and the northbound, particularity in front of the park would be 45 degree back in parking.

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Mid-Review

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There were many great suggestions to help steer my design for the final review. One of the biggest criticism for the design at mid-review was that the building footprint was not at the street edge and that parking was along the street which made the building not activate the boulevard that I had designed. Additionally, the critics felt that my design would benefit from the patient exterior spaces facing the river rather than towards each other inwardly. Also, with the park to the north, it was thought that I could possibly get some perpendicular exterior views in to activate the resource of the park. Additionally, critics felt that it would be great if I could expand the central courtyard to become larger and open up to the river. These suggestions helped steer my design from what I presented at mid-review to my final design.

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UNIT A

UNIT B REHAB GYM

TREATM ENT OUTPATIENT

STAFF PARKING

INTENSIVE CARE UNIT BUILDING SERVICES STAFF PARKING

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UNIT B

UNIT A CAFE

LOBBY

ADM INISTRATION ADM INISTRATION

STAFF PARKING

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UNIT B

ENTRY

GYM STAFF PARKING

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Program Relationships/Adjacency

Outpatient Visitor

Incoming Patient Inpatient

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Design Sketches

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Final Design Presented December 16, 2016

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Chapter 6: Final Design

Architecture as a Healing Device: design for health The boulevard in its conversion from the Sheridan Expressway, now has the potential of being an active street safe for both pedestrians and bikers. The cafe sits on the street to activate the front facade of the rehabilitation center with public and visitors and has the ability to expand out into the sidewalk on nice clear days. This location is better suited for the cafe since it is visible to those on their daily routes home, to work and any errands as well as to those on the river walk.

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Chapter 6: Final Design

Architecture as a Healing Device: design for health The proximity to Starlight park provides the opportunity to create a river walk connecting the bike path in Starlight Park north of the site to connect to Concrete Park south of the Site. Existing conditions detour the bike path from along to water in front of the chosen site and a few other sites directly south of the site. By routing the bike path along the water, it provides a place for bikers and pedestrians to travel who donâ&#x20AC;&#x2122;t want to see or navigate around any cars. The proposed rehabilitation facility meshes with its surrounding green scape with its incorporation of green visibly on its terraces. Standing in Starlight Park, traveling on the bike path, (image to the right) you see the facility rising from the ground overlooking the Bronx River with its stepping terraces opening up to the water.

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The central courtyard opening up to the river connecting the river walk to the cafe is meant to be a place where the public, visitors and staff can go to enjoy the outdoors, as well as connect the river walk to the cafe on the first floor. A stair runs along the terraces to allow users to climb the 12â&#x20AC;&#x2122; grade difference from the river walk to the main level. To accommodate for those that are unable to use the stairs, a ramp brings them into the parking garage level located only 1â&#x20AC;&#x2122; above the river walk grade to the main elevator.

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With a building that shares program between the public and users that demand privacy, program adjacencies and circulation had to be carefully designed. Visitor/Public: These users may enter from the terraced courtyard that steps down to the river or by the street. These users are likely to use the building to the river walk or the street, or to utilize the cafe for food or as a place to do work. They may also be visiting a friend or family member staying at the facility, visiting the administration department for financial/ insurance support or looking to talk to someone in regards of admitting someone. All of these uses can be directly accessed from the central atrium. If visiting someone in the facility they can take the elevator up to the upper floors with units without crossing paths that are in-route to treatment areas. Outpatient: These patients are likely to be dropped off at the main door where they can go the main reception desk and be directed to the outpatient area beyond.

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Inpatient: These patient will be coming from the upper levels down to the 1st or 2nd floor for treatment. The elevator opens up into a private hallway overlooking a line of trees outside for access to the rehabilitation gym. This prevents treatment seekers from interacting with public users.

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Incoming/New Patients: These patients will come via an ambulance from a hospital directly to the facility via an entry located within the service area away from the public eye. From there they will be brought directly into an elevator into an admitting/receiving suite for examination before they are brought into the ICU or one of the units on the 3rd-6th floor.

Chapter 6: Final Design

Architecture as a Healing Device: design for health The main idea of the massing of the rehabilitation facility was to provide private outdoor space for patients with nature. This idea was resolved with every patient unit opening up to a large outdoor terrace that would face the river. The Inpatient units are located on the uppermost floors to grant patient privacy.

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Chapter 6: Final Design

Architecture as a Healing Device: design for health The back facade reinforces the integration of nature into the building with its stepping terraces that provide patient access to nature and fresh air. They can look out from the inside living areas or sit outside with the nature. Not only will they be sitting amongst the nature, but they will be looking out towards the river and planted Amtrak buffer zone that runs along the other side of the river.

Back facade (west) Chapter 6: Final Design

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Chapter 6: Final Design

Architecture as a Healing Device: design for health The rendering to the left shows the view inpatient patients receive when they exit the elevator from their units to the treatment zone. This green space is meant to be tranquil with its row of trees leading to Starlight Park beyond. Outpatients would also pass by this view on their way to the outpatient rehabilitation treatment zone located through the doors to the right. As patients travel down the corridor to their treatment, windows puncture Patient Unit the wall to provide natural light, as well as pictures into courtyard. Treatment Receiving/Admitting Parking/Services

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This courtyard also separates the semi-public administration and reception area. It also allows the inpatient units above to view into the living space above and below other living spaces.

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The program is organized so that the visitor and staff parking is located below the first floor below grade at the street ground level, but at grade to the river walk allowing the space to be utilized which would otherwise not be due to the 100 year flood zone. The ground floor has primarily public and service spaces for easy access to the street as well as the service entry. On the second floor is the ICU where patients will not have the ability to leave their room and therefore do not have a need for an accessible outdoor terrace. The patient units located on levels 3-6 each step back to allow an outdoor space for patients to enjoy fresh air and sun. Patient Unit ICU Receiving/Admitting cafe/public

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Parking/Services

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Architecture as a Healing Device: design for health Parking is located below street grade and holds has 92 spaces. Since the building is 180,000 SF and requires 1 off street parking space per 2,000 SF, the parking garage provides 2 extra spaces than the code requires for an M1-1 zoned space. The garage is open to the elements on the western side facing the river preventing an design needs for ventilation.

00 Parking 1/32" = 1'-0"

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Architecture as a Healing Device: design for health The Main Level contains the greeting point for visitors and guests with the reception desk, administration offices, public cafe, outpatient care treatment, and inpatient rehabilitation gym and pool.

Public zone (Reception/Cafe) Administration In/Out-patient Rehab Services Ambulance Entry/ Patient Receiving

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Architecture as a Healing Device: design for health On the second floor, treatment rooms for occupational therapy, as well as other therapy such as speech and hearing are located. Additionally, an open work space for administration support can be found. The cafe continues onto the second floor for quiet study/work. To the south is the Intensive care unit for patients who are unable to function without assistance. The Admitting/receiving suite is located directly next to the ICU suite for easy transfer of patients to this suite as well as easy access to the main elevators to be received by any of the inpatient units above. An elevator brings patients from the ambulance entry below into the receiving suite.

Public zone (Cafe) Administration In/Out-patient Rehab ICU Ambulance Entry/ Patient Receiving

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Architecture as a Healing Device: design for health On the third floor, there are several patient amenities such as a chapel, a learning classroom and a multi-function room. This is also the first level designated towards inpatient living with 2 units, one to the north and one to the south. Each unit has access to the outdoors with a terraces with doors that can be opened if the weather permits for fresh air. When Patents leave their unit to receive treatment, they enter the central atrium that overlooks the river and terraced courtyard. The atrium glazing is equip with planters that contain a variety of plants that screen the sun. (Rendering on Left)

Multi-function rm Patient Services (Chapel/Class rm) Unit Service Elevator

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Typical Unit Organization: (sleeping) Every unit has patient rooms stacked in an angled bar at the north or south of the site. (living) Patient Living spaces such as dining/ nourishment, living room, TV room and a quiet room are adjacent to the outdoor terrace. These spaces can open up to the outdoors if the weather permits by a nano-wall like installation. (-/nature space) Outdoor spaces offer landscaping with trees along the perimeter of the terrace to offer privacy with bench seating interwoven into the landscaping. Some of the terraces have a water feature with seating privatized seating boxes pushed into the water to provide patients with the feeling of being alone while still being able to see others around.

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(patient support) Patient support services such as bathing, laundry, storage, and nurse/staff area are located along the street perimeter.

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Architecture as a Healing Device: design for health Patient room location: Patient rooms were located along in the bars at the north and south side so that ever room would have a view looking up or down the river. The rooms looking out over the patient rooftop terraces are angled to provide for a clear view to the river and the landscape of trees beyond. The angeling of the patient room bar also provides a perspective lens into nature as patients walk down the patient room corridor back towards their rooms.

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Chapter 6: Final Design

Architecture as a Healing Device: design for health On the fourth floor, there is a space for staff dining off the atrium that pushes out to overlook the boulevard. This space can also be utilized for building-wide staff meetings and events. This is the second level designated towards inpatient living with 2 units, one to the north and one to the south. Each unit has access to the outdoors for fresh air. Some units at the North of the site adjacent to the interior courtyard that looks out to Starlight Park have the ability to see into other patient living areas creating the sense that their community is more than those directly in their unit. (Rendering to left)

Staff dining Unit Service Elevator

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Architecture as a Healing Device: design for health On the fifth floor, there are 2 more inpatient living units, one to the north and one to the south. Each unit has access to the outdoors with a terrace with doors that can be opened if the weather permits for fresh air. Due to all the step backs, on the river side, this unit needs to step out over the sidewalk to give back needed space to patient living and patient support spaces.

Staff dining Unit Service Elevator

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The modernize the front facade, tie the upper four inpatient living unit floors together and to provide privacy from the public street, a metal screen spans the front facade bending and folding along the facades length to tie the bump outs on the upper levels together behind one common material linking all four inpatient floors as the same function. The lower two floors that do not get covered with the screen are more public spaces such as administration and the cafe.

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Architecture as a Healing Device: design for health On the sixth floor, there are the last 2 inpatient living units, one to the north and one to the south. Each unit has access to the outdoors with a terrace with doors that can be opened if the weather permits for fresh air. Due to all the step backs, on the river side, these units also need to step out over the sidewalk to give back needed space to patient living and patient support spaces.

Staff dining Unit Service Elevator

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The North and south elevations are treated similar with white/gray brick covering the facades with patient units beyond and dark gray brick fenestrating the services and patient support spaces. The south facade right), below the units does not have many openings due to the space utilized as a service entry for ambulances and delivery vehicles. On the northern facade (below) large transparent windows bring light into patient support spaces such as the gym. You can also identify the space in which patients can look through from the patent elevator out towards Starlight Park.

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The future of design for rehabilitation facilities should always incorporate nature. With all the evidence of nature-based design and the effects on patient well-being, nature should be used to lead a patients journey from their beds, to their living spaces, to the outside of their unit, the journey to treatment, from within treatment, and back to their rooms. They should have the choice for where they are the most comfortable, from sitting outside with the nature from watching the nature from inside. Regardless of location with views into nature, there are always opportunities to explore the use of nature inside and within the architecture. Additionally, the use of public spaces should always be incorporated into the design to activate the facility for use outside health and well-being. This helps to create a sense of place for users within a building where people can go even when they are well. This ideology will help break the stigma that a rehabilitation facility is a place where people only go when they are ill.

Lastly, a building should never make one feel that they are hidden away where they can be forgotten, but should empower users to be better, to inspire not only those that are located here to get better but those that work, and visit to be better for themselves and the people that they are helping.

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1. Traveling through the Unit

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Solutions

Structure

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The rehabilitation facility uses steel framing with concrete cores for fire-resistance around stairways and as the elevator shaft. In addition to fire-resistance, the concrete cores provide the needed lateral shear resistance. Wide-flange columns are used in areas that align with walls, and are within back of house spaces. Along curtain walls and any occupied open space, hollow black galvanized steel columns are used for aesthetics. Spans between columns range from 15’ to 30’. Spanning the service garage are steel trusses that can span the required 40’.

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The foundation is a poured 12” concrete wall and slab system.

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1 2

{3D} Copy 1 Copy 1

{3D} Copy 1

8 9

10 11

16 A

Typical structure Grid Chapter 7: Solutions

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2' - 6 1/2"

SHEET METAL FLASHING ROOF MEMBRANE

07 Roof 93' - 6"

CANT STRIP

TAPERED INSULATION SLOPED TO DRAIN RIGID INSULATION CONCRETE TOPPING STEEL CONCRETE DECKING

14' - 0"

STEEL ANGLE TIED INTO STEEL STRUCTURE TO FASTEN SCREEN IN PLACE

SUSPENDED GWB CEILING

4x4 CHANNELS 6' O.C. PERFERATED ALUMINUM SCREEN

4" WHITE MIXED SIZE BRICK / STONE W/ 13/32" MORTAR JOINT 1-5/8" AIR SPACE CAVITY AIR BARRIER 3-1/2" RIGID INSULATION

MASONRY TIE SCREWED TO STEEL STUD 6' O.C. VERTICLE 3-5/8" STEEL STUDS AND GLASS FIBER INSULATION VAPOR RETARDER 0-5/8" GWB, PAINTED

162

12' - 0"

05 Level 5 67' - 6"

STEEL ANGLE TIED INTO STEEL STRUCTURE TO FASTEN SCREEN IN PLACE HEAD OF ALUMINUM WINDOW STEEL SHELF ANGLE

Chapter 7: Solutions 12' - 0"

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06 Level 6 79' - 6"

ALUMINUM WINDOW

Wall section

FIBER INSULATION VAPOR RETARDER 0-5/8" GWB, PAINTED

06 Level 6 79' - 6"

12' - 0"

Architecture as a Healing Device: design for health

05 Level 5 67' - 6"

STEEL ANGLE TIED INTO STEEL STRUCTURE TO FASTEN SCREEN IN PLACE HEAD OF ALUMINUM WINDOW

12' - 0"

STEEL SHELF ANGLE

ALUMINUM WINDOW

SILL OF ALUMINUM WINDOW BACKER ROD

04 Level 4 55' - 6"

79' - 6 1/2"

FLASHING AND WEEP HOLES

STEEL SHELF ANGLE FLASHING AND WEEP HOLES

12' - 0"

90' - 6 1/2"

STEEL STRUT TO FASTEN SCREEN IN PLACE

31' 02 Level - 6" 2

15' - 0" 12'

03 Level 3 43' - 6"

4" DARK GREY BRICK W/ 13/32" MORTAR JOINT MASONRY TIE SCREWED TO STEEL STUD 6' O.C. VERTICLE 1-5/8" AIR SPACE CAVITY AIR BARRIER 3-1/2" RIGID INSULATION

3-5/8" STEEL STUDS AND GLASS FIBER INSULATION 6' - 7 1/2"

11' - 0"

01 Level 1 16' - 6"

9' 00- Flood 10 1/2" Line

VAPOR RETARDER 0-5/8" GWB, PAINTED

00 Parking 5' - 6"

MOISTURE BARRIER SHEET FIBROUS JOINT FILLER STRIP SAND EXPANSION LAYER

PERFORATED PERIMETER DRAIN IN COURSE CRUSHED ROCK 2X4 KEY CONCRETE FOOTING 4" CRUSHED STONE

Wall Section Option 1 1/2" = 1'-0"

6" FLOOR SLAB REINFORCED WITH WIRE MESH

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Program

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Inpatient Rehabilitation

Program Treatment Room Studio Open Gym space Storage Clean Room Soiled Room Bathroom/changing Sauna pool mechanical Pool Staff Room

Chapter 7: Solutions Occupational Therapy Vocational Service Unit office and work

SF 80 382 3331 84 83 82 80 81 226 1093 494

130 208

# of rooms

Total SF Floor comme 9 1 1 1 1 1 3 1 1 1 1

720 382 3331 84 83 82 240 81 226 1093 494 6816

1 1 1 1 1 1 1 1 1 1 1

17 1

2210 208

2 2

Shared b

Pool Staff Room

Treatment Spaces

Outpatient Rehabilitation

Administration

Public

1093 1 494 1 Shared betw 6816 Architecture as a Healing Device: design for health

Occupational Therapy Vocational Service Unit office and work Occupational Therapy Classroom ADL Unit 1 ADL Unit 2 Restroom Male Restroom Female

1093 494

1 1

130 208 522 627 607 285 316

17 1 1 1 1 1 1

2210 208 522 627 607 285 316 4775

2 2 2 2 2 2 2

Outpatient Gym Waiting Area Treatment Room

2484 145 83

1 1 10

2484 145 830 3459

1 1 1 1

Reception Security Visitor Lounge Waiting Office Conference Printing Zone Restroom Female Restroom Male Janitor Closet Open Office Space Medical Records Storage

260 92 287 232 115 318 127 228 207 26 3000 285 175

1 1 1 1 6 1 1 1 1 1 1 1 1

260 92 287 232 690 318 127 228 207 26 3000 285 175 5927

1 1 1 1 1 1 1 1 1 1 2 2 2

Café Café (Quiet) Chapter 7: Solutions Gift Shop Atrium/Lobby Classroom/Multi-funtion

3258 2300 490 2160 1065

1 1 1 1 1

3258 2300 490 2160 1065

1 2 1 1 2

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Medical Records Storage

Public

Café Café (Quiet) Gift Shop Atrium/Lobby Classroom/Multi-funtion Chapel

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Ambulance Garage Lobby/Circulation Head Office Support Office Evaluation Exam Receiving/Pick-up Airbourne Infection Isolation Room Isolation Bathroom Isolation Anteroom Family Waiting Bathroom Storage

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Intensive Care Unit

Patient Room (Single Bed) Bathroom (Patient) Patient Suite Non-Sterile Storage Clean Room Soil Room Nourshment Prep Nurses Station Secure Medicine Room Head Nurse Office StaffChapter Area 7: Solutions Bathing Visitors

285 175

1 1

285 175 5927

2 2

3258 2300 490 2160 1065 620

1 1 1 1 1 1

3258 2300 490 2160 1065 620 9893

1 2 1 1 2 2

790 350 213 140 153 135 136 45 64 155 45 300

1 1 1 1 1 1 1 1 1 1 1 1

790 350 213 140 153 135 136 45 64 155 45 300 2526

1 1 2 2 2 2 2 2 2 2 2 2

238 43 400 300 160 140 330 330 150 210 420 200 500

9 9 1 1 1 1 1 1 1 1 1 2 1

2142 387 400 300 160 140 330 330 150 210 420 400 500

2 2 2 2 2 2 2 2 2 2 2 2 2

Shared W

Intensive Care Unit

Unit A

Unit B

Soil Room Nourshment Prep Nurses Station Secure Medicine Room Head Nurse Office Staff Area Bathing Visitors

140 1 140 2 330 1 330 2 330 1 330 2 Architecture as 150 a Healing Device: for health 1 design 150 2 210 1 210 2 420 1 420 2 Shared With Re 200 2 400 2 500 1 500 2 5869

Patient Room Single Patient Room Double Bathroom Bathing Suite Clean Room Soil Room Storage Staff Room Nurses Station Nurses Office Workroom Head Nurse Office Secure Medicine TV/Comp Room Laundry Quiet Room Living Room Nourishment Prep Dinning

168 240 43 370 67 67 270 500 500 190 124 124 475 220 200 1092 265 745

16 1 17 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2688 240 731 370 67 67 270 500 500 190 124 124 475 220 200 1092 265 745 8868

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Patient Room Bathroom Bathing Suite Clean Room Soil Room Storage Staff Room Nurses Station Chapter 7: Solutions Nurses Office Workroom Head Nurse Office

160 53 370 73 70 195 500 370 215 140

14 14 1 1 1 1 1 1 1 1

2240 742 370 73 70 195 500 370 215 140

3 3 3 3 3 3 3 3 3 3

2 tub rooms, an

167

Unit B

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Unit C

168

Bathing Suite Clean Room Soil Room Storage Staff Room Nurses Station Nurses Office Workroom Head Nurse Office Secure Medicine TV/Comp Room Laundry Quiet Room Living Room Nourishment Prep Dinning

370 73 70 195 500 370 215 140 150 240 135 320 900 180 640

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

370 73 70 195 500 370 215 140 150 240 135 320 900 180 640 7480

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Patient Room Bathroom Bathing Suite Clean Room Soil Room Storage Staff Room Nurses Station Nurses Office Workroom Head Nurse Office Secure Medicine TV/Comp Room Laundry Quiet Room Living Room Nourishment Prep Dinning

160 53 370 67 67 260 511 345 217 120 102 607 222 300 855 187 610

19 19 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

3040 1007 370 67 67 260 511 345 217 120 102 607 222 300 855 187 610 8887

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Patient Room Chapter 7: Solutions Bathroom Bathing Suite Clean Room

160 53 370 67

14 14 1 1

2240 742 370 67

4 4 4 4

2 tub roo

Nourishment Prep Dinning

Unit D

Unit E

187 610

1 1

187 4 610 4 8887 Architecture as a Healing Device: design for health

160 53 370 67 67 765 500 315 200 100 70 600 195 60 600 190 590

14 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2240 742 370 67 67 765 500 315 200 100 70 600 195 60 600 190 590 7671

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

160 53 370 67 67 290 500 231 165 105 60 350 82 450 830 150

21 21 1 1 1 1 1 1 1 1 1 1 1 1 1 1

3360 1113 370 67 67 290 500 231 165 105 60 350 82 450 830 150

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

169

PANZARINO

Unit F

Unit G 170

Secure Medicine TV/Comp Room Laundry Quiet Room Living Room Nourishment Prep Dinning

60 350 82 450 830 150 480

1 1 1 1 1 1 1

60 350 82 450 830 150 480 8670

5 5 5 5 5 5 5

Patient Room Bathroom Bathing Suite Clean Room Soil Room Staff Room Nurses Station Nurses Office Workroom Head Nurse Office Secure Medicine TV/Comp Room Laundry Quiet Room Living Room Nourishment Prep Dinning

160 53 370 67 67 380 230 225 110 110 365 194 177 730 150 665

14 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2240 742 370 67 67 380 230 225 110 110 365 194 177 730 150 665 6822

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

Patient Room Bathroom Bathing Suite Clean Room Soil Room Storage Staff Room Nurses Station Nurses Office7:Workroom Chapter Solutions Head Nurse Office Secure Medicine

160 53 370

20 20 1 1 1 1 1 1 1 1 1

3200 1060 370 0 0 140 360 300 190 112 70

4 4 4 4 4 4 4 4 4 4 4

140 360 300 190 112 70

Unit G

Unit H

Soil Room Storage Staff Room Nurses Station Nurses Office Workroom Head Nurse Office Secure Medicine Laundry Quiet Room Living Room Nourishment Prep Dinning

Kitchen Linens Building Services Pharmacy Storage/Mechanical Chapter 7: Solutions

1 0 4 140 1 140 4 360 1 360 4 Architecture as a300 Healing Device:1 design300 for health 4 190 1 190 4 112 1 112 4 70 1 70 4 82 1 82 4 246 1 246 4 502 1 502 4 160 1 160 4 580 1 580 4 7372 160 53 370 74 74 112 380 260 235 177 112 365 195 177 680 150 665

2750 500 1150 3396

14 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2240 742 370 74 74 112 380 260 235 177 112 365 195 177 680 150 665 7008

1 1 1 1

2750 500 1150 3396 7796

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

171

Nourishment Prep Dinning

Kitchen Linens Building Services Pharmacy Storage/Mechanical

TOTAL SF

GSF by Floor 1 2 3 4 5 6

PANZARINO 172

1 1

150 665 7008

2750 500 1150 3396

1 1 1 1

2750 500 1150 3396 7796

4 4

109839 186000 (1.7)

TOTAL GSF

150 665

35870 35528 33094 30676 27515 23319 186002

The Rehabilitation facility comes out to 186,000 GSF with 109,840 SF. This is a factor 1.7 which is normal for a facility of this type. This includes horizontal and vertical circulation as well as spaces such as gathering spaces that are a part of the circulation such as the atrium and elevator lobbies.

Chapter 7: Solutions

Architecture as a Healing Device: design for health

Occupancy Loads Lobby

(148)

Cafe

(794)

Gyms

(139)

Inpatient Treatment Rooms Outpatient Treatment Rooms

(87) (38)

Sleeping Kitchen Pool

(252) (14) (24)

Storage/Back of House

(45)

Office Total Occupancy of Building

(177) (1,718)

=20 occupants Chapter 7: Solutions

173

Appendix

References SDfca Andraos, A. and Wood, D. Program Primer v.1.0: A Manual for Architects in PRAXIS issue 8 2006, pp. 111-121 Bloomburg, Michael. “The Sheridan Expressway Study: Reconnecting the Neighborhoods Around the Sheridan Expressway and Improving Access to Hunts Point,” NYC City of New York, December 2013. Accessed March 3, 2016 from http://www1.nyc.gov/assets/planning/download/pdf/plansstudies/sheridan-hunts-point/final_full_report.pdf Betsky, Aaron, “Framing the Hospital: the Failure of Architecture in the Realm of Medicine.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 68‐75. Rotterdamn: NAi Publishers, 2006.

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Bronx River Alliance Partners, “Green Way.” Bronx River Alliance. Accessed April 6, 2016. http://www.bronxriver.org/greenway

176

Ellis, Mike. “Inside/Out.” Digital image. Herman Miller. Accessed August 23, 2016. Ephemeral New York, “Starlight Park: The Bronx’s answer to Coney Island.” Wordpress, July 2013. Accessed April 5, 2016 from https:// ephemeralnewyork.wordpress.com/2013/07/08/starlight-park-the-bronxs-answer-to-coney-island/ Photos: George Bain Collection, Library of Congress Facility Guidelines Institute. Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Chicago, IL: American Society for Healthcare Engineering of the American Hospital Association, 2014.

Chapter 8: Appendix

Architecture as a Healing Device: design for health Gonzalez, Sonia. Starlight Park in the Bronx Reopens after a Stunning Renovation. May 2013. Accessed April 5, 2016, from http://mommypoppins. com/content/starlight-park-in-the-bronx-reopens-after-a-stunning-renovation Gow, Catherine. “Designing for Safety.” Health Care Design. November 11, 2011. Accessed August 23, 2016. http://www. healthcaredesignmagazine.com/article/designing-safety-0. Heerwagen, Judith. Psychosocial Value of Space. Psychosocial Value of Space. May 23, 2008. Helen Hayes Hospital. “Activities of Daily Living (ADL) After Stroke: Part 1.” Filmed [June 2016]. YouTube Video, 03:58. Posted [June 2016]. https:// www.youtube.com/watch?v=FRmwRqgIJsM&feature=youtu.be Helen Hayes Hospital. “Activities of Daily Living (ADL) After Stroke: Part Two.” Filmed [June 2016]. YouTube Video, 03:47. Posted [June 2016]. https://www.youtube.com/watch?v=6GwGnUJ01tw&feature=youtu.be Helen Hayes Hospital. “Locomotor Training.” Filmed [June 2016]. YouTube Video, 03:59. Posted [June 2016]. https://www.youtube.com/ watch?v=ieRovfMKQ00&feature=youtu.be Helen Hayes Hospital. “Mirror Box Therapy & NEUROPLASTICITY Following Stroke.” Filmed [June 2015]. YouTube Video, 03:59. Posted [June 2015]. Helen Hayes Hospital. “Regaining Memory After Stroke.” Filmed [June 2016]. YouTube Video, 03:04. Posted [June 2016]. Helen Hayes Hospital. “Rehab Following a Stroke: A Personal Story of Recovery.” Filmed [June 2016]. YouTube Video, 20:44. Posted [June 2016]. https://www.youtube.com/watch?v=WxDOkTUUP4Q&feature=youtu.be Helen Hayes Hospital. “Rehabilitation After Stroke: Aquatic Therapy Improves Pain, Mobility, and Balance.” Filmed [May 2015]. YouTube Video, 05:21. Posted [May 2015]. Helen Hayes Hospital. “Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking.” Filmed [February 2015]. YouTube Video, 07:05. Posted [February 2015]. https://www.youtube.com/watch?v=u5jpGOrEJkE&feature=youtu.be Helen Hayes Hospital. “Therapy using the DYNAVISION TM Post Stoke.” Filmed [June 2016]. YouTube Video, 02:05. Posted [June 2016]. Helen Hayes Hospital. “Vision After Stoke.” Filmed [June 2016]. YouTube Video, 03:25. Posted [June 2016]. https://www.youtube.com/ watch?v=OwCEobuxQOY&feature=youtu.be HermanMiller Healthcare. “Bringing Out Your Workers’ True Colors.” Herman Miller. N.p., n.d. Web. 23 Aug. 2016.

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177

HermanMiller Healthcare. “Patient Rooms: A Changing Scene of Healing.” Research – Herman Miller. 2010. Accessed August 23, 2016. http://www. hermanmiller.com/research/research-summaries/patient-rooms-a-changing-scene-of-healing.html. Israel, Toby. Some Place like Home: Using Design Psychology to Create Ideal Places. Chichester, West Sussex, England: Wiley-Academy, 2003. Kiss + Cathcart Architects, “Productive Architecture; Bronx River Greenway River House.” 2010. Accessed April 5, 2016 from http://www. kisscathcart.com/bronx/overview.html Kopec, David Alan. Environmental Psychology for Design. New York: Fairchild, 2006. Malkin, Jain, “Healing Environments as the Century ark: the Quest for Optimal Patient Experiences.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 258‐265. Rotterdamn: NAi Publishers, 2006. Nemschoff. “Making Room for Guests.” Research – Herman Miller. 2014. Accessed August 23, 2016. http://www.hermanmiller.com/research/ topics/all-topics/making-room-for-guests.html. Nevzgodin, Ivan, “Revolutionizing Hospital Architecture: Experiments in the Soviet Union.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 42‐57. Rotterdamn: NAi Publishers, 2006. NYC Parks. “Concrete Plant Park.” City of New York. April 6, 2016, http://www.nycgovparks.org/park-features/concrete-plant-park/planyc

NYC Planning. “Manufacturing Districts: M1.” Accessed August 27, 2016. http://www1.nyc.gov/site/planning/zoning/districts-tools/ m1.page. NYC Planning. “Waterfront Zoning.” Waterfront Zoning. Accessed August 27, 2016. http://www1.nyc.gov/site/planning/zoning/districts-tools/waterfront-zoning.page.

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Moses, Nalina. “Environmental Psychology: Building with Feeling.” AIA RSS. December 14, 2012. Accessed February 03, 2016. http://www.aia.org/ practicing/AIAB096792.

178

Van den Berg, Agnes, “Healing by Architecture.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 255-257. Rotterdamn: NAi Publishers, 2006. Wagenaar, Cor, “Five Revolutions: a short History of Hospital Architecture.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 26‐41. Rotterdamn: NAi Publishers, 2006.

Chapter 8: Appendix

Architecture as a Healing Device: design for health

Chapter 8: Appendix

179

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Thesis Prep Presentation Boards

180

the environment and recovery incorporate environmental and design psychology to design a space to help lessen the burden of the recovery journey for patients and their support system.

elizabeth panzarino

Chapter 8: Appendix Thesis Prep Presentations

Architecture as a Healing Device: design for health

Rehabilitation Center 

Explore methods of creating a space that promotes faster healing and recovery through the use of architectural expression and design



Research into environmental/design psychology for evidence based design



Explore courtyards, gardens, color, layout, sectional quality

Project Statement If various elements within an environment have such a powerful response to the people that experience them, architecture can evoke healing through carefully designed spaces.

ARCHITECTURE AS A HEALING DEVICE

Color strategies

ELIZABETH PANZARINO

Nature incorporation

Layout strategies – fluid walls break rigidity/create system

One castilla Place, Quezon City, DMCI

Youth hospital proposal, Skejby, C.F. Moller architects

Chapter 8: Appendix Thesis Prep Presentations

181

Problem

CROWN SKY GARDEN – LURLE CHILDRENS HOSPITAL

• Rehabilitation facilities • • • • • •

often depressing/lack sociability between appointments Adds stress during an already stressful time Placeless – not an excited place to attend/visit Typically a series of spaces along static hallways that all look the same Lack visibility/openness Users and supporters sit and wait in waiting rooms during/between appointments

Mikyoung Kim Design, Chicago

• Integration of light, space, sound, and color to encourage exercise and social activity • Identification with someplace special

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GROW BOX – RESIDENTIAL HOME

182

Merge Architects, Lexington, MA

• Section quality creates dynamic visual connections • Green spaces break up the size into intimate spaces

Chapter 8: Appendix Thesis Prep Presentations

Architecture as a Healing Device: design for health

PROJECT STATEMENT/PROBLEM If various elements within an environment have such a powerful response to the people that experience them, architecture can evoke healing through carefully designed spaces.

ARCHITECTURE AS A HEALING DEVICE

• Rehabilitation facilities • often depressing/lack sociability between appointments • Adds stress during an already stressful time • Placeless – not an excited place to attend/visit • Typically a series of spaces along static hallways that all look the same • Lack visibility/openness • Users and supporters sit and wait in waiting rooms during/between appointments

ELIZABETH PANZARINO

Program Receiving Area – private for patients Lobby – For family and guests Offices Group Spaces Garden Atriums Specialized units -patient beds -dinning -group room -quiet room -exam rooms -support staff

Program Café – family guests and staff Kitchen – for café and patient dinning Back of house services -laundry -lab -pharmacy -staff lounge/support Therapy -occupational therapy -gym -clinical support

Chapter 8: Appendix Thesis Prep Presentations

183

Helen Hayes Hospital, W. Haverstraw, NY

• provides optimum conditions for restorative and recreational care

• Visitor/family friendly

• The green belt extends through the hospital, bringing light and a green aspects right into the heart of the hospital.

Spalding Rehabilitation Hospital Perkins + Will Charleston, MA

• Variety of landscaped terraces for physical therapy

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C.F. Moller, ong&ong Singapore

• Views to Hudson River, parks and outdoor spaces

• Proven track record for getting patients quickly back to being able to support themselves

184

Woodlands Integrated Healthcare Campus,

• Abundance of natural light with curtain walls – make open and inviting

• Welcoming and simple wayfinding, whereby various patients pass directly from the arrival area to the specific function areas.

Ann B. Barshinger Cancer Insitute Ballinger Lancaster, PA

• Combines cancer many cancer patient needs into one facility • Spiral plan allows optimal views to gardens and water • Breaks up long hallways with double spaces and views, and green walls

• Inpatient and outpatient services • Views of Boston Harbor – diversions to patients

Chapter 8: Appendix Thesis Prep Presentations

Architecture as a Healing Device: design for health

Lancaster Rehabilitation Hospital

Lancaster Patient Room Widdall Architects Lancaster, PA

Ramseur-Peterson Architects Lancaster, PA • Abundant natural light provide openness and freedom

• Wood panels bring comfort, softness and tranquility into a space

• Color breaks the feeling that you are in a doctors office

• Colored walls help break the sterile environment and attempts to create an inspirational environment

• Waving color panel strips bring movement into the space

Architecture as a Healing Device (2016)

Site Identification

Bronx, New York

A site in the south Bronx located between the Sheridan Expressway and the Bronx River was chosen. The site will encompass two parcels of land, one currently identified as vacant and the adjacent site has a large parking lot with a warehouse associated with it. The warehouse is currently listed for lease.

PANZARINO

Site

This site was selected since it backs the Bronx River to the east and Starlight Park to the north. With the positive healing effects of natire on recovering patients, selecting a site with views of nature was the prime princible that helped select a site. Additionally, this location is undergoing urban renewal and planning. Currently, the Sheridan Expressway makes the chosen site questionable with the close proximity of cars and trucks just outside, with difficult and somewhat dangerous access for pedestrians. As

part of the plan to revitalize the South Bronx, the city is intending to remove the expressway and replace it with a Boulevard. Along the street way a greenway will be implemented for bikes and pedestrians connecting the Starlight Park to the north and abandoned and soon to be revitalized concrete plant park. These developements as part of the South Bronx revitilization, will make the future Rehabilitation Center immersed within a pedestrian friendly area surronded by nature. Additionally, the site is served by the 6 train and several buses which make the site easily reachable to friends and family of the patients. Both the empty site and the empty warehouse would need to be utilized to allow for the program needed to make a successful rehabilitaion center.

Chapter 4: Site

Chapter 8: Appendix Thesis Prep Presentations

Chapter 4: Site

185

Architecture as a Healing Device (2016)

134.88’

256.11’

254.43’

Concre

80.83’

Starlight Park 184.76’

81.28’

Site

Bronx Riv

te Park

Analysis

Population Growth The area has seen large population swings. In the 1970s through the 80s the population decreased 20 percent with the decrease of manufacturing jobs, increase in suburbanization, and housing disinvestment. Areas west of the site and the Expressway experienced up to a two-thirds population loss. During the 1980s there was some renewal that resulted in stable residential communities.

1970 population level once again by 2030. The population currently occupies 1,385,108 people of the 8,550,405 total people in New York City.

In the 1980s and 1990s immigrants began to move into the Bronx leading to a 2.9 percent population increase. The 1990s the Bronx saw a popuation growth larger of 15 percent, larger than the growth in NYC with a growth of only 11.6 percent. Growth has continued between 2000 and 2010 with population increases larger than in NYC overall. Population growth is expected to continue and is anticipated to reach its

8,550,405

1,385,108

Population of Bronx

Bronx, New York

PANZARINO

Chapter 4: Site

to host a ferry service ending at Westchester Ave just south of the bridge that crosses the river.

5-17 yrs 19%

Transportation The area is served by the number 6 as well as several bus routes. The elevated 6 subway train regional Amtrak line run along the expressway and crosses it near Westchester Ave just south of the selected site. This makes the site accessable to family and friends of patients that will be staying within the facility. It also promotes the possibility for the development of outpatients with its ease of accessability. There are future plans to utilize the Bronx river

0-4 yrs 7% 65+ 11%

1,385,108 Asian 49,609 Black 505,200

Age of Population

Population of Bronx by Race

MTA Subway lines in Bronx, NY

Chapter 4: Site

Architecture as a Healing Device (2016) Land Usage Neighboorhoods east of the site and the Bronx River are predominatly low-scale residences with some newer high rise developements by the New York City Housing Authority. Hunts Point includes some residential within

Sun Chart

Temperture Range

Monthly Diurnal Averages

Psychrometric Chart Chapter 4: Site

the cities largest industrial business zone. Directly along the Sheridan Expressway, are light industrual uses, auto uses, warehouses, a few schools, an MTA bus depot, and subway stop

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PANZARINO 186

Chapter 4: Site

Architecture as a Healing Device (2016) Climate Date for NY, New York

Wind Velocity Range

Other 442,514

White 386,497 18-64 yrs 63%

Chapter 4: Site

Chapter 8: Appendix Thesis Prep Presentations

Chapter 4: Site

Architecture as a Healing Device: design for health Architecture as a Healing Device (2016)

Starlight Park Pedestrian Bridge

River House

Proposed Site Residential Units

Sheridan Hotel

Institutions Local Businesses

Starlight Park Reopened in 2013 as part of the Revitalized Bronx River Greenway after being closed for The park is 13 acres with two playgrounds, picnic areas, bike trails, ball feilds, lawns and waterfront access. Currently only has one access point from the East 174th Street Overpass which has stairs at its mid-span. The park will not be fully accessible until the Sheridan Expressway is removed. Sheridan Hotel: Opened in 2005, met with controversy due to its location amonst warehouses and other industrial use buildings. Bronx River and the Greenway: being transfored into a recreational and scenic amenity. It will connect with the Bronx River Greenway is a 23 mile multi-use path that will extend the full length of the river from the Bronx into Westchester county. 19 miles of the proposed 23 miles path have already been realized. There are currently 44 acres of parkland along the greenway, but once completed 633 acres of parkland will be available for public access.

Residential Units: Over 900 units, and a new school are being constructed along the expressway. Concrete Park: Opened in 2009, as part of the Bronx River and Greenway initiative. The Contians facilites supporting and linking exisitng and planned multi-use pedestrian greenways with other off-road, on-road, bicycle and pedestrian routes, a conoe and kayal launch, waterfront promenade, and a reading circle. The site is often used for organizing community festivals. The silos, hoppers, and conveyor structors that still stand on the seven acre site were original to the factoy, and signify the sites industrial history. The site can be accessed from both Westchester Avenue and Bruckner Boulevard

History

Bronx, New York

Concrete Park

Whitlock Subway Station: This is a local number 6 train stop which gives train users access to the site area which runs merges with the 4 and 5 train lines. The 6 train is a local train through Lexington Avenue, but only the local 6 train will bring you to Whitlock Ave. Hunts point which is south of the site, is an express stop and Elder ave noth of the site and on the eastern side of the river is also a local stop.

Local Businesses Primarily auto wreckage, storage, and parts.

Chapter 4: Site

Sheridan-Hunts Point Land Use and Transportation Study

City Planning Map showing the proposal of the new expressway for the South Bronx prior to 1945. The section highlighted in blue, is the only portion that was built.

Manufacturing Currently zoned as manufactoring, but the city has already begun to change lot zoning to multi-use. Whitlock Subway Stop

Architecture as a Healing Device (2016)

Schools/Institutions serve children K-12. With Sheridan Highway plannig, walking to these schools will become less complicated and be safer.

PANZARINO

Manufactoring

The Sheridan Expressway was first planned in the 1940s by Rovert Moses with the intention of extending Bruckner Expressway north past the Bronx Zoo into Westchester County to create a connection between the Triboro bridge and the New Englan Thruway. The plan was never completed due to community opposition and resulted in a 1.25 mile expressway that ended at the Cross Bronx Expressway in 1963. During planning, to make way for the

expressway, thousands of residents and some local businesses were displaced to allow moving the Bronx River to make room for a new more linear roadway. The barrier this highway created limiting access to the waterfront caused decay in the area. Within the 1960s, housing value decreased and long time residents of the area began to leave the Bronx, and was a process that continued well into the 1970s. With the loss of residents, neglect and arson took over large parts of the South Bronx. By the 1980s, the New York Department of Transportation (NYSDOT) declared the need for improvements to the safety and traffic flow of the Sheridan Expressway. A set of flyover ramps to Oak Point were

introduced into the system to solve the problem of getting trucks to Hunts Point, but NYSDOT was unable to come to a decision in regards to removiing the expressway. By 2001, NYSDOT began a formal study for the redesign of the Bruckner-Sheridan interchange and their related transportation improvement needs. In 2006, the Southern Bronx River Watershed Alliance (SBRWA) began work on a formal plan to remove the Sheridan Expressway, and in its place, build housing and mixed use development to make use of the number 6 train access on Westchester Ave, the proximity of the Bronx River, and the development of parks along the waterfront.

Chapter 4: Site

Starlight Park Just north of the site is Starlight Park which was originally opened in 1918. Starlight Park was a thriving cultural and activity hub and was the Bronxâ&#x20AC;&#x2122;s version of Brooklynâ&#x20AC;&#x2122;s Coney Island. The park had bathing paviollions, shooting gallery, swimming pool, sandy beach,15,000 seat stadium for the circus, opera , and big band shows. the park had also been home for the New York Giants soccer team. The park was only open for 14 years when in 1932, a fire burned down the bathing pavillions. At this point the park became a parking lot and dumping grounds. The Park was reopened in 2013 as part of the Revitalized Bronx River Greenway. Concrete Plant Park South of the site is the Concrete Plant Park

Chapter 4: Site

Architecture as a Healing Device (2016) once owned by the Transit Mix Concrete Corporation who operated a concrete batch plant. The plant opened in 1945 and closed in 1987. The site remained abandoned for some time. The site underwent cleanup between 2000 and 2005 and it opened for the public in October 2009. The silos, hoppers, and conveyor structors that still stand on the seven acre site were original to the factoy, and signify the sites industrial history.

Architecture as a Healing Device (2016)

Concrete Plant Park Prior to being a Park

The park is accessable from both Westchester Ave and Bruckner Boulevard. The site is often used for organizing community festivals and as a canoe and kyack launch for residents.

Concrete Plant Park 1948

Starlight Park 1920s

Starlight Park 1921

Starlight Park 1920 Chapter 4: Site

Chapter 4: Site

Bronx 1996

Bronx 1921

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Concrete Plant Park Prior to being a Park

Bronx 2012

Bronx 1951 Chapter 4: Site

Chapter 8: Appendix Thesis Prep Presentations

Chapter 4: Site

187

Architecture as a Healing Device (2016)

Future of the Sheridan Expressway

starlight-park-in-the-bronx-reopens-after-a-stunning-renovation Heerwagen, Judith. Psychosocial Value of Space. Psychosocial Value of Space. May 23, 2008. Israel, Toby. Some Place like Home: Using Design Psychology to Create Ideal Places. Chichester, West Sussex, England: Wiley-Academy, 2003. Kiss + Cathcart Architects, “Productive Architecture; Bronx River Greenway River House.” 2010. Accessed April 5, 2016 from http://www.kisscathcart.com/bronx/ overview.html

Sheridan-Hunts Point Land Use and Transportation Study

Improval of pedestrian and biker safety with designated areas for travel.

Kopec, David Alan. Environmental Psychology for Design. New York: Fairchild, 2006. Malkin, Jain, “Healing Environments as the Century ark: the Quest for Optimal Patient Experiences.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 258‐265. Rotterdamn: NAi Publishers, 2006.

Urban Develpment Planning The Future of the Bronx

As part of the redevelopment initiative, the site along the waterfront will be rezoned from industrial to mixed uses to focus on job oppertunities and growth along this sector rich with transporation routes.

Sheridan-Hunts Point Land Use and Transportation Study

“By Transforming a highway into an accessable neighborhood boulevard, establishing new connections to the Bronx River waterfront, steering truck traffic off residential streets, and enabling more direct access for trucks to Hunts Point, the recommendation s offer benefits to residents and businesses alike and will help foster the continued revitilazation of the South Bronx. And the residents and the businesses of the South Bronx deserve no less.” - Bloomburg

Bloomburg, Michael. “The Sheridan Expressway Study: Reconnecting the Neighborhoods Around the Sheridan Expressway and Improving Access to Hunts Point,” NYC City of New York, December 2013. Accessed March 3, 2016 from http://www1.nyc.gov/assets/planning/download/pdf/plans-studies/sheridanhunts-point/final_full_report.pdf Betsky, Aaron, “Framing the Hospital: the Failure of Architecture in the Realm of Medicine.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 68‐75. Rotterdamn: NAi Publishers, 2006.

Moses, Nalina. “Environmental Psychology: Building with Feeling.” AIA RSS. December 14, 2012. Accessed February 03, 2016. http://www.aia.org/practicing/ AIAB096792. Van den Berg, Agnes, “Healing by Architecture.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 255-257. Rotterdamn: NAi Publishers, 2006. Wagenaar, Cor, “Five Revolutions: a short History of Hospital Architecture.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 26‐41. Rotterdamn: NAi Publishers, 2006.

Bronx River Alliance Partners, “Green Way.” Bronx River Alliance. Accessed April 6, 2016. http://www.bronxriver.org/greenway Sheridan-Hunts Point Land Use and Transportation Study

Increase Pedestrian Access to the Bronx River and waterfront amenities with over 1,600 linear feet of publically accessable waterfront along the rIver. Sheridan-Hunts Point Land Use and Transportation Study

Area for redevelopment

Chapter 4: Site

NYC Parks. “Concrete Plant Park.” City of New York. April 6, 2016, http://www. nycgovparks.org/park-features/concrete-plant-park/planyc

SDfca Andraos, A. and Wood, D. Program Primer v.1.0: A Manual for Architects in PRAXIS issue 8 2006, pp. 111-121

Conversion of expressway into a boulevard and removing truck traffic from the local roads with new ramps at Oak Point making it safer for pedestrian.

Chapter 4: Site

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Reconnecting the Neighboorhoods around the Sheridan Expressway and Improving Access to Hunts Point Previous Mayor Michael Bloomburg began the initative of a community planning process to improve the southeast Bronx.

Nevzgodin, Ivan, “Revolutionizing Hospital Architecture: Experiments in the Soviet Union.” In The Architecture of Hospitals 2006, edited by Cor Wagenaar, 42‐57. Rotterdamn: NAi Publishers, 2006.

References

Ephemeral New York, “Starlight Park: The Bronx’s answer to Coney Island.” Wordpress, July 2013. Accessed April 5, 2016 from https://ephemeralnewyork. wordpress.com/2013/07/08/starlight-park-the-bronxs-answer-to-coney-island/ Photos: George Bain Collection, Library of Congress Gonzalez, Sonia. Starlight Park in the Bronx Reopens after a Stunning Renovation. May 2013. Accessed April 5, 2016, from http://mommypoppins.com/content/

Appendix

188

Bronx Development Center Richard Mier & Partners, Bronx NY

The Bronx Developmental Center was originally planned as a total-care residential facility for 750 physically disabled and mentally handicapped children. The project, as built, accommodated 380 residents, as well as served as an out-patient facility.

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Precedents subtitle

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Architecture as a Healing Device (2016)

While the program’s complex technical requirements demanded particular attention, the design is above all an attempt to create a sense of place that responds to the special feelings and needs of the residents. The triangular site occupies part of a blighted industrial no-man’s land – a traffic island – bounded by the Hutchinson River Parkway to the east and a network of railroad tracks to the west. Although a large, dilapidated warehouse by the rail yards was to be renovated, the new building could not be related to its setting in a conventional sense- there being no defining contextual organization or architectural reference on which to base a set of design propositions.

The logical strategy was, then, to allow the new structure to create its own context, and the general layout opens inward to a realm where the resident is protected from the external setting. The two major programmatic elements divide around the lateral axis of the composition: the support services wing in the rectangular block on the west, and the residential units and services in the stepped volumes on the east. The gymnasium and physical therapy building on the south, and the two large courtyards, each with a corridor at its northern edge, stitch the composition together.

Chapter 2: Precedents

Chapter 8: Appendix Thesis Prep Presentations

Chapter 2: Precedents

Architecture as a Healing Device: design for health

Architecture as a Healing Device (2016)

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Architecture as a Healing Device (2016)

Chapter 2: Precedents

Architecture as a Healing Device (2016)

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Located on a remediated brownfield parcel in the Charlestown Navy Yard, the building is a newgathering place for the community – dedicating 75 percent of the first floor to public use and integrating with the Boston Harbor Walk. The site takes full advantage of waterfront views of the Boston skyline. A trail running along the waterfront features therapeutic equipment and offers patients the opportunity to encourage the healing process by performing physical therapy on a variety of different landscaped surfaces.

The scale of the building is visually reduced by dividing the structure into two connected sections – an eight-story patient tower and a three-story therapeutic gymnasium and pool. The building can be viewed from all sides – there is no back. Each section of the divided structure utilizes a variety of materials to create visual interest and reveal a slightly different building from each angle. Glass curtainwall is generously integrated

262,000 sq. feet completed 2003

into the design creating transparency and an abundance of natural light throughout the interior resulting in an atmosphere that is open and inviting. The team worked with accessibility experts and conducted extensive research on their own to create a hospital of the future, one that went beyond only meeting ADA requirements. Every aspect of the building design has been considered – the entry is at street level; the reception desk is low and rounded; the patient rooms have custom cabinetry and automated shades, patient lifts, private bathrooms, and amenities such as private refrigerators, sleeping accommodations for family members and a wireless connection for patients and guests. The building program includes outpatient services, a pool for aquatherapy, two large gymnasiums, an activities-of-daily-living suite, transitional patient apartment, and satellite gyms embedded on two inpatient

Chapter 2: Precedents

floors. “For far too long, rehabilitative care was an afterthought to many, relegated to the basements of hospitals and out of sight. This hospital makes a bold statement that a new era of rehabilitative medicine is hereby bringing together scientific innovation and patient-centered design that puts this institution on par with the major centers of healing in the world,” said David Storto, President, Spaulding Rehabilitation Hospital. “It’s truly an honor to lead Spaulding and serve this region with its leaders who have the forethought to understand how vital Spaulding will be for decades to come.”

Architecture as a Healing Device (2016)

Vegetated roofs mitigate storm water runoff and reduce cooling loads and heat-island effect. Therapeutic terraces on the third and fourth floors serve as places of respite for patients, staff and families. Gardens and views of Boston Harbor provide further uplifting diversions to the occupants. The project has achieved LEED™ Gold certification.

In response to climate change and probable rising sea levels, the main floor was raised one foot and all of the HVAC equipment was located on the roof. Gymnasiums, multi-purpose rooms, and educational rooms utilize automatic operable windows for natural ventilation. Operable windows allow the building to remain operational even if mechanical systems are interrupted.

Chapter 2: Precedents

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Spaulding Rehabilitation Hospital Perkins and Will, Boston, MA

Chapter 2: Precedents

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Chapter 2: Precedents

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Architecture as a Healing Device (2016)

Chapter 2: Precedents

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Chapter 8: Appendix Thesis Prep Presentations

Architecture as a Healing Device: design for health

Architecture as a Healing Device: Rehabilitation for the future Elizabeth Panzarino I Spring 2016

Problem Statement:

With health issues and problems on the rise in America, there is a need for rehabilitation centers all over the globe. Many hospitals and facilities for rehabilitation services are often an after thought space that appear depressing and lack the happy inspirational atmosphere that is really needed for the journey to recovery. Therefore, is it possible to create a space that can inspire faster recovery to allow people to return to their lifestyles? Can architectural elements provide a sense of place, comfort and aid in healing to make injury and health issues easier to endure and get through?

Site Selection: GropG

Criteria that inﬂuenced the selection of the site was its proximity to: -green community parks -waterfront views -transportation and accessibility

Buildable Footprint= 62,253 SF (1.43 Acres) NYC population: 8,550,405

Bronx population 1,385,108

Thesis Statement:

Design and environmental psychology has proven that certain implementations have encouraged overall wellbeing, happiness and motivation. If various elements within design have such a powerful response to the people that experience a particular environment, architecture can evoke healing through carefully designed spaces. There are two important elements to consider for a successful rehabilitation center. Environmental elements that produce healthy outcomes, metal wellbeing, and happiness for patients, visitors and doctors. Experimentation with the incorporation of nature, views, fresh air, materials, and layouts will be important to create a space that feels safe and comforting during a high stress time. With the broad scope of rehabilitation, I will focus on inpatient post-surgery recovery for when a patient leaves a hospital post-operation. At this point, patients have a journey ahead of them to return to the health they were once at prior to the incident that landed them in the hospital in the ﬁrst place. The inpatient facility will be geared towards the comfort of patients, family and doctors, while oﬀering services for community activities will help give the rehabilitation facility a sense of place and become a landmark for the recovering community.

Themes:

1. Sectional views and transparency of space. 2. Views into nature and landscaping. 3. Design psychology. 4. User experience. 5. Community integration

Site in Context

Site Perspective in Context

Site Identiﬁcation

Starlight Park, North of Site

Precedents:

Spaulding Rehabilitation Hospital; Perkins+Will I Boston MA I 2013 I 378,367 SF

Concrete Park, South of Site

Master planning of Area Underway Built along the Boston Harbor, on a parcel of the Charlestown Navy Yard, the Spalding Rehabilitation Hospital takes advantage of views of the waterfront and the Boston Skyline. The facility offers inpatient and outpatient facilities, as well as community spaces integrated into the first floor. Various landscaped surface types are incorporated into the design to encourage physical therapy for a variety of patient types. Each section of the divided structure utilizes a variety of materials to create visual interest and reveal a slightly different building from each angle. Glass curtainwall is generously integrated into the design creating transparency and an abundance of natural light throughout the interior resulting in an atmosphere that is open and inviting.

Groot Klimmendall Rehab. Center; Koen Van Velson I Netherlands I 2011 I 150,694 SF

Program: http://www1.nyc.gov/assets/planning/download/pdf/plans-studies/sheridan-hunts-point/ﬁnal_full_report.pdf

Existing Redevelopment Initiative: -Site along the waterfront will be rezoned from industrial to mixed uses -Conversion of expressway into a boulevard to remove truck traﬃc from the local roads making it safer for pedestrians. -Increase Pedestrian Access to the Bronx River and waterfront amenities -Establish over 1,600 linear feet of publicly accessible waterfront along the Bronx River.

Full height glazing along the central space allows for continuity between indoor and outdoor spaces creating a strong visual connection to the surrounding nature. This facility also incorporates the local community to use the building making the building identify as the “centre of the community.” The spaces were designed with the intention of creating a stimulating environment that would differ from the traditional appearance of a health care facility. Large and small voids as well as light wells create spatial connections between different floor levels as well as to bring natural lighting into some of the interior spaces.

Program:

Community/Visitors

-Vestibule -Lobby -Reception -Multi-Function Hall -Meeting/Conference Rooms -Cafe -Public Bathrooms

Administration

-Oﬃces -Financial/Insurance -Administration

Therapy Spaces

-Pool -Studios - yoga, stretching etc -Gym -Occupational therapy -Library

Specialized Inpatient Units (3)

-Patient beds with associated bathrooms -Dinning -Quiet room -Exam rooms -Bathrooms -Interior green spaces/atriums -Counseling -Patient support -Visitor room -Clinical Support -Nurses Station -Charting -Conference Room -Clean room -Storage -Equipment

Exterior Community Components -Waterfront walk -outdoor courtyard spaces

Back of House -Kitchen -Service Entry -Storage -Waste -Lab -Mechanical -Laundry -Staﬀ Lounge

6. 3.

1. 1. Starlight Park I 2. Bronx River I 3. Proposed Site I 4. Proposed Pedestrian Park Connection I 5. Sheridan Expressway I 6. Concrete Park

Chapter 8: Appendix Thesis Prep Presentations

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Thesis Review Boards

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Chapter 8: Appendix

Architecture as a Healing Device: design for health Rehabilitation for the Future

Elizabeth Panzarino 134.88’

iver Bronx R

Starlight Park

k ete Par Concr

256.11’

254.43’

80.83’

Site

184.76’

81.28’

The Sheridan Highway Proposed

Existing Roadways

Sheridan Expressway Path

Section A

Section C

Section B

SITE

Flood Map

Program Relationships/Adjacency

Buildable Area

Visual Access to Waterfront Bike Path Extension

Site Plan

Special Space Aims

Scheme 1

Chapter 8: Appendix Schematic Design Review

193

USERS

CONCRETE PARK STARLIGHT PARK

AMTRACK TRACKS

BRONX RIVER

Program Relationships/Adjacency

1,385,108

8,550,405

Outpatient Visitor Incoming Patient Inpatient

City Planning Map showing the proposal of the new expressway for the South Bronx prior to 1945. The section highlighted in blue, is the only portion that was built.

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Program Relationships/Adjacency

194

Typical Circulation paths

UNIT A

UNIT B STARLIGHT PARK

REHAB GYM

TREATM ENT OUTPATIENT

STAFF PARKING

INTENSIVE CARE UNIT BUILDING SERVICES STAFF PARKING

Chapter 8: Appendix Mid-Review

Architecture as a Healing Device: design for health

UNIT B

ENTRY

GYM STAFF PARKING

CAFE

UNIT B

UNIT A LOBBY

ADM INISTRATION

ENTRY

ADM INISTRATION STAFF PARKING

GYM STAFF PARKING

Chapter 8: Appendix Mid-Review

195

Design for Health

CONCRETE PARK AMTRACK TRACKS

STARLIGHT PARK

Architecture as a Healing Device

BRONX RIVER SITE

SHERIDAN EXPRESSWAY

With all the expensive machines, people fighting for recovery and doctors working hard to bring them back to health, wouldn’t it make sense for the medium in which all these activities take place to influence healing as well? Why is it that the building is only a backdrop to the actives occurring within? Design and environmental psychology has proven that certain implementations have encouraged overall well-being, happiness and motivation. If various elements within design have such a powerful response to the people that experience a particular environment, architecture can evoke healing through carefully designed spaces.

site proposal: site in context

134.88’

256.11’

With the broad scope of rehabilitation, I will focus on inpatient post-stoke and brain injury recovery for when a patient leaves a hospital after surviving a stoke or other brain injury. At this point, patients have a journey ahead of them to return to the health they were once at prior to the incident that landed them in the hospital in the first place. The inpatient facility will be geared towards the comfort of patients, family and doctors, while offering services for community activities will help give the rehabilitation facility a sense of place and become a landmark for the recovering community. Community activities may include free workout classes to nurture the body, and a cafe lounge for people to study, socialize, and work.

254.43’

80.83’

site axon: northeast N

184.76’

81.28’

site identification

USERS

flood zone: partially in the 100 year flood zone until grade 13.3’

proposed site: existing site conditions

proposed (1945)

DIAGRAM TO BE UPFATED TO REFLECT DESIGN CHANGE

exisiting today (2016)

sheridan expressway history, proposed vs existing

site axon: southwest

Level 1 :

existing sheridan expressway at site location

public: reception, waiting area, cafe, admin private: outpatient care, inpatient rehab gy pharmacy, loading dock/truck garage, stora

01 Level 1 1/16" = 1'-0"

patien

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ICU

196

receiv

treatm

cafe/p

parkin proposed site plan

context site plan 1

proposed removal of sheridan expressway at site location

Site 1/64" = 1'-0"

Chapter 8: Appendix Gate

exterior terrace walk from river to main enty/cafe access

program relationships / adjacency

section pro

Architecture as a Healing Device: design for health Int View Patient Unit Elevator Lobby

STUDIO

program list here

REHAB GYM

POOL

MECH

VISITOR LOUNGE OUTPATIENT GYM SEC.

patient living looking over exterior terraced gardens

WAITING

INt View Patient living onto terrace

1 A

Coming Soon: Structural Axon

PHARMACY RECEIVEING

KITCHEN

GIFT SHOP

ORDER

LINENS RECEIVING

SERVICES -MECH -LINEN -STORAGE

CAFE B

TRASH

level 0: Parking staff and visitor parking; 67 spaces 00 1

1/32" = 1'-0"

view when exiting elevator to treatment zone 1

Int View elevator exit

30' - 5 27/32"

UP DN

35' - 2 1/32"

2 3 4

n support ym, ambulance entry garage, kitchen, age/other related back of house

5 UP

UP DN

8 9

nt unit

ving

sleeping

ment

public

living

ng/services

outdoor nature space

ogram organization

unit organization

12 O

patient support patient rooms oriented for river view

patient unit elevator lobby/ atrium space

unit/terrace relationship 2

Typical structure grid

Int View Patient Unit Elevator Lobby

01 Level 1 1/32" = 1'-0"

INt View Patient living onto terrace

Chapter 8: Appendix Gate

197

MED REC

BATH UNIT

CLEAN

SOIL

MED

STORAGE OT

VOC

VOC OFFICE

LAUNDRY

QUIET

STAFF ROOM TV /COMP ROOM

section AA OT

ADL

STAFF LOUNGE

LIVING ROOM

ADL

UNIT B CHAPEL

NOURISH

IS O

ELEV. MECH

CLEAN

SOIL

UNIT A

COMPUTER/ TV

NURSES STATION

LIVING ROOM

NONSTERILE STOR

QUIET WORK ZONE (ASSOCIATION WITH CAFE)

section BB

CLASSROOM

EVAL

NORISH PREP

ADMIT / RECEIV

MED

H. NURSE OFFICE

STAFF ROOM

QUIET

EXAM

OFFICE

LAUNDRY

STAFF AREA

N. STATION

STORAGE CLEAN STOR.

BATH UNIT

VISITORS

02 Level 2 1/16" = 1'-0"

Back Elevation 1/32" = 1'-0"

Level 2 :

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outpatient

198

visitor/public incoming patient inpatient

Program Relationships/Adjacency

west elevation (boulevard facing)

south elevation 1

South Elevation 1/32" = 1'-0" 2

Chapter 8: Appendix Gate

03 Level 3 1/16" = 1'-0"

Level 3 :

public access: quiet cafe/work space, admin support Private: patient admission department, treatment, ICU

section CC

Front Elevation 1/32" = 1'-0"

H. NURSE

SOIL

Semi-public access: classroom, chapel Private: units a and b

MED

Architecture as a Healing Device: design for health

BATH UNIT

N. STATION

CLEAN

STAFF

MED

OFFICE

SOIL

LAUND

NOUR

TV/ COMP

Coming Soon: Wall Section/bay study

LIVING RM

UNIT F

UNIT E

LIVING ROOM

QUIET

TV/COMP

Back Elevation 1/32" = 1'-0"

STORAGE NURISH

STAFF ROOM

LAUND

CLEAN MED SOIL

BATH UNIT

Level 4 :

Semi-public access: staff private dining Private: units c and d

05 Level 5 1/16" = 1'-0"

Level 5:

Semi-public access: staff private dining Private: units e and f

Level 5:

Semi-public access: staff private dining Private: units g and h

east elevation (river facing)

Front Elevation 1/32" = 1'-0"

north elevation (Starlight park facing)

Back Elevation 1/32" = 1'-0"

Front Elevation 1/32" = 1'-0"

North Elevation 1/32" = 1'-0"

Chapter 8: Appendix Gate

199

Design for Health

CONCRETE PARK AMTRACK TRACKS

STARLIGHT PARK

Architecture as a Healing Device Elizabeth Panzarino I Fall 2016 I Professor: Andrew Cohen

Abstract: With health issues and problems on the rise in America, there is a need for rehabilitation centers all over the globe. Many hospitals and facilities for rehabilitation services are often an after thought space that appear depressing and lack the happy inspirational atmosphere that is really needed for the journey to recovery. Therefore, is it possible to create a space that can inspire faster recovery to allow people to return to their lifestyles? Can architectural elements provide a sense of place, comfort and aid in healing to make injury and health issues easier to endure and get through? With all the expensive machines, people fighting for recovery and doctors working hard to bring them back to health, wouldn’t it make sense for the medium in which all these activities take place to influence healing as well? Why is it that the building is only a backdrop to the actives occurring within? Design and environmental psychology has proven that certain implementations have encouraged overall well-being, happiness and motivation. If various elements within design have such a powerful response to the people that experience a particular environment, architecture can evoke healing through carefully designed spaces.

BRONX RIVER SITE

SHERIDAN EXPRESSWAY site proposal: site in context

program relationships / adjacency

134.88’

256.11’

254.43’

80.83’

184.76’

81.28’

patient unit ICU

site identification

flood zone: partially in the 100 year flood zone until grade 13.3’

receiving treatment

exterior view taken from Starligjt

cafe/public parking/services section program organization

users

proposed site: existing site conditions

proposed (1945) exisiting today (2016)

patient rooms oriented for river view

sheridan expressway history, proposed vs existing

exterior view taken from pedestrian access way across West Farms Boulevard

sleeping living existing sheridan expressway at site location

outdoor nature space unit organization

proposed site plan

proposed removal of sheridan expressway at site location

unit/terrace relationship

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context site plan

200

Chapter 8: Appendix Final Review

patient support

section AA

Architecture as a Healing Device: design for health {3D} Copy 1

{3D} Copy 1

2' - 6 1/2"

{3D} Copy 1 Copy 1

{3D} Copy 2

SHEET METAL FLASHING ROOF MEMBRANE

07 Roof 93' - 6"

CANT STRIP

TAPERED INSULATION SLOPED TO DRAIN RIGID INSULATION CONCRETE TOPPING STEEL CONCRETE DECKING

14' - 0"

STEEL ANGLE TIED INTO STEEL STRUCTURE TO FASTEN SCREEN IN PLACE

SUSPENDED GWB CEILING

4x4 CHANNELS 6' O.C. PERFERATED ALUMINUM SCREEN

{3D} Copy 1 Copy 1

00 Parking

{3D} Copy 2

4" WHITE MIXED SIZE BRICK / STONE W/ 13/32" MORTAR JOINT

= 1'-0" level 1/32" 0: staff and visitor parking; 67 spaces

1-5/8" AIR SPACE CAVITY AIR BARRIER 3-1/2" RIGID INSULATION

exterior terrace walk from river to main enty/cafe access

MASONRY TIE SCREWED TO STEEL STUD 6' O.C. VERTICLE

patient living looking over exterior terraced gardens

3-5/8" STEEL STUDS AND GLASS FIBER INSULATION VAPOR RETARDER

0-5/8" GWB, PAINTED

06 Level 6 79' - 6"

1 2

12' - 0"

05 Level 5 67' - 6"

STEEL ANGLE TIED INTO STEEL STRUCTURE TO FASTEN SCREEN IN PLACE HEAD OF ALUMINUM WINDOW

STEEL SHELF ANGLE

12' - 0"

8 9

ALUMINUM WINDOW 10

SILL OF ALUMINUM WINDOW

BACKER ROD

04 Level 4 55' - 6"

79' - 6 1/2"

FLASHING AND WEEP HOLES 12

STEEL SHELF ANGLE FLASHING AND WEEP HOLES

12' - 0"

90' - 6 1/2"

STEEL STRUT TO FASTEN SCREEN IN PLACE

16 A

Typical structure grid 03 Level 3 43' - 6"

patient living area opening towards interior courtyard and out terraces

31' 02 Level - 6" 2

15' - 0" 12'

axonometric view of site and surronding context

4" DARK GREY BRICK W/ 13/32" MORTAR JOINT MASONRY TIE SCREWED TO STEEL STUD 6' O.C. VERTICLE 1-5/8" AIR SPACE CAVITY AIR BARRIER 3-1/2" RIGID INSULATION

00 Parking 5' - 6"

6' - 7 1/2"

11' - 0"

9' 00- Flood 10 1/2" Line

VAPOR RETARDER 0-5/8" GWB, PAINTED

3-5/8" STEEL STUDS AND GLASS FIBER INSULATION

01 Level 1 16' - 6"

MOISTURE BARRIER SHEET FIBROUS JOINT FILLER STRIP SAND EXPANSION LAYER

PERFORATED PERIMETER DRAIN IN COURSE CRUSHED ROCK 2X4 KEY CONCRETE FOOTING 4" CRUSHED STONE

section BB

section CC

Chapter 8: Appendix Final Review

Wall Section Option 1/2" = 1'-0"

6" FLOOR SLAB REINFORCED WITH WIRE MESH

201

Level 1 :

Level 2 :

public: reception, waiting area, cafe, admin support private: outpatient care, inpatient rehab gym, ambulance entry garage, kitchen, pharmacy, loading dock/truck garage, storage/other related back of house

public access: quiet cafe/work space, admin support Private: patient admission department, treatment, ICU

outpatient visitor/public incoming patient inpatient

west elevation (boulevard facing)

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Program Relationships/Adjacency

202

Chapter 8: Appendix Final Review

Level 3 :

Semi-public access: classroom, cha Private: units a and b

Architecture as a Healing Device: design for health

Level 4 :

apel

Semi-public access: staff private dining Private: units c and d

Level 5:

Level 6:

Semi-public access: staff private dining Private: units e and f

Private: units g and h

view when exiting elevator to treatment zone

patient unit elevator lobby/ atrium space

north elevation (Starlight park facing)

east elevation (river facing)

south elevation

Chapter 8: Appendix Final Review

203