architecture undergraduate P O R T F O L I O J e s s i c a
C a s e
the lighthouse station 9 roots lifted looking for the lost the habitat the wall the platform
UNDERGRADUATE THESIS
T h e
l i g h t h o u s e
Improving pediatric palliative + hospice care Jessica Case - 4th Year Thesis Project AUSTIN, TX “Today is her future. We don’t think about the past. we don’t think about the future. What is she doing today?” Patty geisinger - Austin, TX
C h a r a c t e r i s t i c s o f P at i e n t s
H o w M a n y C h i l d r e n i n t h e U n i t e d S tat e s w o u l d Benefit? RESPITE
3 m illion
Malignancy
Pa l l i at i v e
400, 000
Genetic/ Congenital
Neuromuscular
Feeding Tube
Central Line
None
Tracheostomy
Ventilator
HOSPICE
+14, 000
Mean Number of Medications per Day
Mortality at 12 month Follow-up
30.3%
Source: "NHPCO's Standards for Pediatric Care." National Hospice and Palliative Care Organization.
Median Time from Consult until Death
How old are the children when they die?
15-19 years 25.3% Neonatal 34.3%
10-14 years 7.6%
Post-neonatal 16.9%
5-9 years 6.4% 1-4 years 9.6%
Source: Friebert S. NHPCO Facts and Figures: Pediatric Palliative and Hospice Case in America. 2009.
107 Days With over 55,000 pediatric deaths per year in the United States, there is a tremendous need for pediatric palliative and hospice care facilities. While this programmatic typology exists in several countries around the world - including over 45 centers in the United Kingdom alone - only two pediatric palliative and hospice facilities are operational in the United States. Offering a spectrum of care that extends from respite to end-of-life, these facilities would benefit over 8,600 children daily in the U.S. In addition to compiling research in order to build a case for the express need for such a facility, I propose that this typology requires a unique organizational scheme that diverges from the traditional program of home or hospital. Rather than adhering to the hierarchies found in a single-family residence, upon which the current model is organized, this new type of design revolves around the Nurses’ Station as the nucleus of the facility. Additionally, the design relies heavily upon biophilic stratagem and play therapy, which further influence the program and form of the building. These tactics are used to enhance the psychological state of the patient, family, and medical staff and to mitigate the impact of a life-threatening or life-limiting illness.
HOW DOES THE U.S. COMPARE? Forget Me Not - Children’s Hospice Darian House - Children’s Hospice Claire House - Children’s Hospice Tŷ Gobaith - Children’s Hospice Northern Ireland - Children’s Hospice L a u r a Ly n n I r e l a n d ’ s - C h i l d r e n ’ s H o s p i c e Acorns - children’s Hospice C h a r lt o n F a r m - C h i l d r e n ’ s H o s p i c e J u l i a’ s H o u s e D o r s e t - C h i l d r e n ’ s H o s p i c e Children’s Hospice sOuth West Little Harbour - Children’s Hospice Naomi House - Children’s Hospice
CANUCK PLACE CHILDREN’S HOSPICE Crescent Cove
Ladybug House
(In Development)
(In Development)
Sarah House (In Development)
GEORGE MARK CHILDREN’S HOUSE
Connor’s House
R a c h e l’ s H o u s e - C h i l d r e n ’ s H o s p i c e C h i l d r e n ’ s H o s p i c e A s s o c i at i o n S c o t l a n d Robin House - Children’s Hospice E a s t A n g l i a’ s C h i l d r e n ’ s H o s p i c e Noah’s Ark - Children’s Hospice Richard House - Children’s Hospice Demelza House - Children’s Hospice T h e S h o o t i n g S ta r - C h i l d r e n ’ s H o s p i c e Alexander Devine - Children’s Hospice Christopher’s Children’s Hospice Chestnut Tree House - Children’s Hospice
(In Development)
Dr. Bob’s Place
R YA N H O U S E
( N o l o n g e r o p e r at i o n a l )
F R E E S TA N D I N G P E D I A T R I C R e s p i t e a n d H o s p i c e C A R E FACILITIES IN OPERATION F R E E S TA N D I N G P E D I A T R I C R e s p i t e A n d H o s p i c e C A R E FACILITIES CLOSED OR IN DEVELOPMENT
Why? Care CANNOT BE ADMINISTERED AT
HOME
NO MODE OF TRANSPORTATION
FAMILY IS GOING ON VACATION
NOT SICK ENOUGH FOR ACUTE CARE
LIVE FAR AWAY FROM GOOD HOME CARE NURSES
FAMILIAL DUTIES OUTSIDE OF PATIENT CARE (IE. SIBLINGS & HUSBAND)
FAMILY NOT CAPABLE OF ADMINISTERING TOTAL CARE
SPACE LIMITATIONS (IE. ONE ROOM APARTMENT)
DOESN’T HAVE TIME BECAUSE OF JOB
EXHAUSTION
Care CANNOT BE ADMINISTERED AT the
H o s p i ta l
W h at d o e s t h e j o u r n e y l o o k l i k e ? Does the primary caretaker need a break?
NO
Are you making frequent visits to the hospital?
NO
Diagnosis
Does the patient have chronic pain?
YES
NO
Is the primary caretaker capable of administering care?
Less than 6 months to live?
YES
Can you afford home care? Is it available to you?
No
NO
Palliative & Respite Care
YES
Hospice Care
NO
Palliative & Respite Care
YES
YES
Does the patient need assistance in activities of daily living? YES Does the patient have less than 6 months to live?
YES
Does the primary caretaker have time to administer 24/7 care?
Can you afford home care? Is it available to you?
No
YES
YES
Is the primary caretaker capable of administering care?
Are you making frequent visits to the hospital?
YES
Long-term Care Facility
YES
Do you have other time commitments like work, a husband or other children?
Yes
NO
Is the patient lonely? YES No
YES
Long-term Care Facility (Palliative & Respite Care)
No
Palliative Home Care Long-term Care Facility (Palliative & Respite Care)
YES No
Does the primary caretaker need a break?
Does the patient dislike the hospital atmosphere?
Home Care
NO
YES
NO
Long-term Care Facility (Palliative & Respite Care)
Is this making the patient or family uncomfortable?
YES
Long-term Care Facility (Palliative & Respite Care)
NO
No Long-term Care Facility (Hospice Care)
Would your child benefit from a supportive community of similar patients?
NO
Palliative Home Care
Home Care Long-term Care Facility (Respite Care)
YES
Can you afford 24/7 care at a hospital?
NO
No
Long-term Care Facility (Respite Care)
NO
Yes
Long-term Care Facility (Palliative & Respite Care) Would you like to stay with your child and fulfill activities of daily living?
Would your child benefit from a supportive community of similar patients?
NO
YES
Long-term Care Facility (Respite Care) Long-term Care Facility (Palliative & Respite Care)
NO
Palliative Home Care
YES
Long-term Care Facility
Long-term Care Facility (Palliative & Respite Care)
W h at d o t h e s e c h i l d r e n s u f f e r f r o m ?
Cancer
Infectious / Immunologic
Cardiopulmonary Primary CNS NEUROMUSCULAR
M e ta b o l i c / Biochemical
M e ta b o l i c / Biochemical
Nobody wants to talk about death, especially the death of a child. Unfortunately, over 45,000 infants, children and teenagers die every year from numerous unavoidable conditions or accidents in America. This makes the discussion worth our time and attention, which is not currently the case in the U.S. I would like to change the perception of care for children with complex care needs and life-threatening conditions by making them the inspiration for great architectural design. To meet this challenge, a multi-use facility in Central Texas will offer long-term care, respite, inpatient hospice and comprehensive care. Working with, and physically adjacent to, Dell Children’s Hospital in Austin, the site will combine the existing Pediatric Palliative and Hospice Team and the Comprehensive Care Clinic from the hospital. The new medical school at UT Austin will also promote and build a relationship with the facility, creating a symbiotic and supportive connection between students and the clinic. Ultimately, the care administered in such a program would ease the pain that is felt by the entire family of a chronically or terminally ill child while helping the child to find a better quality of life within their symptoms.
WHO ARE THE PRIMARY USERS?
Ob st e tric ia
n
-
-
Ma t e r n
ospice RN
-
lists cia
agers - H Man
a se
ity/NICU Lea ders hip
Complete Patient and Perinatal Care TEAM
C al at rin
Pe
&
M ot he
urs yN
i ng
al Social Work - Perin rinat ata - Pe lC ha
pla in
-z
CAL STAF FEDI -M
ne
D/
TY NI
VOLUNTEE
RS
~45,000
Me dic i
- L&
Less than 19 years old
ativ e
e Sp
~19,000
PRIMARY USERS
tologist - Pediatric Palli
ric
Less than 1 month (50% congenital or prematurity)
S - COMM ING U
~28,000
a eon -N
at
During Infancy (less than 1 year)
S
L IB
C
Pe
at rin
t gis o lo
di Pe
63,732
- PARENTS LD I H
ab
Total Pediatric deaths per year
r-B
How Many Children Die in the U n i t e d S tat e s ?
Ages 20-24
Cardiac problems, Enlarged heart
Weakened smooth muscles
Low blood pressure
Unusual bone structures
Early cataracts.
Loss of coordination, trouble walking
Dental abnormalities, single incisor tooth
Immunodeficiency
Liver enlargement
Close set, crossed or downward gazing eyes
Ambiguous genitalia
Disturbance of bladder and bowl function
Excessive Urination
Dental abnormalities
Abnormally sized head, seizures, brain malformation Vomiting, gastrointestinal problems
Weakened cardiac muscles
Jaundice
Blocked bile duct
Upset stomach, diarrhea. Brain or nervous system problems, seizures
Vision loss, Unusual Facial Features
Bone deformity
Reproductive system complications
Persistent coughing, wheezing, pneumonia
Red or purplish rash
Osteoporosis
Problems with blood circulation (stroke, infection, tissue damage, and fatigue) Learning disabilities Loss of control over movements of arms, legs, torso, or facial muscles Chromosomal Abnormality
Difficulty breathing
Learning disabilities, epilepsy Muscle cells break down Chromosomal abnormality
Cardiopulmonary
Muscle weakness
Frequent infections
Neuromuscular
Slow growth, restricted movement
C h r o m o s o m a l / M u lt i - o r g a n
Depression/Psychosis
Poor weight gain and growth
Intestinal obstruction
Low blood pressure, diabetes Respiratory failure, Pneumothorax, coughing up blood, damaged airways Increased heart rate, fatigue, weakness
Infectious/Immunologic
Skin rash
Primary CNS
M e ta b o l i c / b i o c h e m i c a l
18,664
Muscle aches, failure to gain weight or grow, difficulty walking Lung infections, tuberculosis, pneumonia Staphylococcus and other skin infections
HIV/AIDS, infectious mononucleosis Bone and joint infections
WHERE DO CHILDREN SPEND THEIR END-of-life?
HOME
HOSPICE
HOSPITAL
When all locations are made relatively accessible for a patient to die, each is chosen roughly 1/3 of the time.
When pediatric palliative / hospice facilities are not easily accessible
( Typic al in th e UN ITED STATE S)
When pediatric palliative / hospice facilities made accessible
( T ypi ca l i n t he U ni t ed K i ngdom)
When extremely well-integrated
into the community, like BC’s Canuck Place, most children and their families choose hospice.
T r a j e c t o r i e s o f P e d i at r i c E n d - o f - l i f e
Quality of Life
Steady Decline 50
Quality of Life
100
100
Sudden Death 50
0
0
Time
Time
Fragile
100
Quality of Life
Quality of Life
100
50
0
Fluctuating Decline
50
0 Time
Time
As a member of the Honors College at ASU, I was one of three undergraduate architecture students completing an independent thesis project. My goal was to raise awareness about the severe lack of infrastructure for the families of complex care children. Changing the perception of pediatric palliative and hospice care will be the key to widening the discussion about care and support. Architecture has the power to transform environments that are as stressful, fragile, painful and rigid as a facility with this type of user. After touring and studying several precedents, gathering research for over a year and shadowing pediatric medical professionals, I have begun to design a facility that will supply a place of much-needed support for the families and children who need it the most. Unlike the hospital, which can be over a thousand dollars a night and is oftentimes psychologically stressful or damaging to the child, and as an alternative to home, where many families do not have the time and/or resources to administer 24/7 care, The Lighthouse will provide an intermediate location. With an atmosphere that is reminiscent of home and interconnected to both the community and the existing medical infrastructure, a new typology of care center will arise in the U.S. Neither institutional or sterile, children and families will have a place to deal with the unthinkable without being further isolated by a society who simply doesn’t understand that a problem exists.
Isolation Anxiety Fear Loneliness Sterile Boring Foreign
peaceful familiar imaginative supportive Natural playful familiar
9
8
10
7
12 11
16
13
15
14
1
1 2
3
17
4
18 6
2
5
19
22
20
23
24 25
21 27
3 26
5 4
FLOOR 1
1/16” : 1’
FAMILY / UTILITY 7. Family Room 8. Game Room 9. Staff Break Room 10. Staff Sleep Room 11. Family Conference 12. Laundry 13. Linen 14. Oxygen 15. Family Room 1 16. Family Room 2 17. Medicine Room 18. Tub Room 19. Waste Room 20. Nurses’ Station
PLAY 1. Sensory Room 2. Art Room 3. Media Room 4. Theatre Room 5. Multi-Use Play Room 6. Hydrotherapy ADMINISTRATION 21. Music Room 23. Break Room 24. Large Conference 25. Small Conference 26. Main Office 27. Welcome Desk
FLOOR 2 1/16” : 1’
1. Patio 2. Event Space / Multi-Use Gathering 3. Kitchen / Dining 4. Chapel 5. Bereavement
STUDIO PROJECTS
S T A T I O N
9
Fighting Fires While Saving Water Jessica Case & Jacob Wilhelm - 4th year Studio Project Phoenix, AZ
While water is a precious resource in the desert, it is often rejected by the urban fabric. As desertification spreads throughout the world and weather patterns become much more erratic, it has become crucial to minimize the water that is wasted. Harnessing the opportunity of water collection in Phoenix, AZ, we propose a new prototype for the future of a city’s soft infrastructure, transforming it into a living system that is responsive, participatory and cooperative. While still fulfilling the rigid programmatic requirements of an emergency response location, the station works with existing constraints of a developing city to conserve and extend the building’s lifespan. Water is the literal and figurative foundation for the future of firefighting. In this system, the water will be collected from the surrounding streets, side-lots and the site itself to be filtered and stored in the heart of the fire station.
Central Ave Extreme Impermeability in the Urban Condition. White designates the permeable ground within the vicinity of the site.
The exterior skin acts as a shade structure for the facade while recalling imagery of the water hoses that used to be hung from the firefighters’ tower to dry.
Floor -1
Ground Floor
Floor 1
Floor 2
Central to the fire station is a tower that serves several purposes within the building. As a training tower, it is iconic to the community and to the firemen as a symbol of safety and watchfulness. This also serves as the core for systems of circulation, passive cooling and water collection. As part of the steroetomic section of the building, which consists of the underground level and the tower, it protrudes through the tectonic upper levels. There is a clear juxtaposition between the heaviness of the lower levels and the more transparent floors. To further this floating tectonic symbolism, a corten steel shading structure wraps around the top two floors, influencing the envelope of the structure. Each corten strip is twisted to emulate the traditional drying technique for hoses, where they would be hung from the training tower. This seemingly randomized twisting creates an undulating surface with a likeness to the surface of water. This holds great significance, considering the main objective is to conserve and protect the water within the building and to educate the community about the massive need to protect the precious resource. If this design alteration to the soft infrastructure were translated to fire stations around Phoenix, or better yet, around the world, the benefits to our global ecosystem would be astounding.
East-West Section
9
North-South Section
r o o t s
Adaptive Reuse Co-Work Space & Water Conservation Center Jessica Case - 3rd Year Studio Project 220 North Leroux St., Flagstaff, AZ
Flagstaff is known for its advocation of a healthy lifestyle and unique identity. The Roots community work space will foster this identity and way of life by providing a place for residents and visitors to interact with each other and collaborate on a multitude of projects and activities. Roots will extend the quirky Flagstaff character while promoting a sustainable practices. This will be made possible by providing a “maker-space� workshop for hands-on construction projects, several garden plots to be rented out, a market-friendly space of the South side of the building, a rood that collects rainwater and a greenhouse that can sustain gardening through the winter months. Most importantly, the project will recycle the existing building - a mid-century style Federal building - to influence the new program, aesthetic and materiality. The space is designed to be flexible and welcoming to both the residents of Flagstaff and the many visitors to the area.
Existing Building elevations Arizona Economic Security Department The existing Arizona Economic Security Department building is located between downtown Flagstaff and a large residential area, creating an opportunity for business and home to coexist. The building itself will be directly representative of the architect and user’s goals. The reuse of the existing structure and curtain walls will be a testament to preserving the uniqueness of the city while adding a level of clarity and transparency with the addition. The internal structure is revealed and celebrated rather than covered up. The massive truss system used to carry the existing span is showcased to all who use the space. It is the hope that members will in turn strive to create different levels of involvement that promote an active, healthy and sustainable lifestyle by exposing and developing the systems and technologies needed to get the that point. Several iterations, exposed on this page and the next, were explored before arriving at the ultimate design for a co-work space that embodied all of the aforementioned characteristics.
To understand the underlying concept of Adaptive Reuse, I found an artifact and transform it while preserving the identity of the piece. After choosing a bamboo and rattan bowl from the nearest Goodwill, I researched the history of such materials and the emulated techniques used to combine them. Using the ideas of weaving and continuity, I created a chime that used only string represent the different patterns used in such a craft as weaving. These patterns, “X” and “O”, are seen only from the different angles as the chime turns over time.
Original - Bamboo & Rattan Bowl
Transformed - Bamboo & Rattan Wind Chime
Mountain Views
Majority of Sunlight
220 North Leroux St. First Floor
Site Plan
Second Floor
Jessica Case - ADE 322
North Elevation (A) Scale: 1"=16’
West Elevation (B) Scale: 1"=16’
South Elevation (C) Scale: 1"=16’
East Elevation (D) Scale: 1"=16’
Section 1 Scale: 1"=16’
Usin g th e E xi sti n g Pl an to influence th e si ze o f N e w Space s
East Elevation
West Elevation
South Elevation
North Elevation
L i f t e d
artist loft housing Jessica Case - 3rd year studio project PHOENIX, AZ
Walking
Public Transit
Driving
A low-income, multi-family housing complex situated in the art district of downtown Phoenix fulfills the city’s need to densify while encouraging artists so stay locally. Following zoning restrictions and a strict program for the site, the aim was to create a pedestrianoriented, dynamic urban residential environment for the creative population in and around the downtown area. The residences would sit atop amenities such as shared studios, a gallery space and a commercial space that would attract artistic endeavors to the area. Flexibility is key when designing for such a population because of the wide variety of individuals and families. Within one “unit�, four separate apartments would be housed around a single stairwell and central lightwell. This core will allow for the passage of light and circulation regardless of the apartment one chooses. Each unit hold two double-hight, threebedroom apartments, one two-bedroom apartment and one single-bedroom apartment.
*Master Plan graphic sourced from the City of Phoenix
The future developments of the Margaret T. Hance Park and surrounding green space - an initiative of the City of Phoenix - will be pulled into the program of the building, transforming into increasingly private spaces as one ascends into the upper floors.
l o o k i n g
f o r
t h e
l o s t
Pioneer + military memorial park cemetery jessica case - 2nd year studio project PHOENIX, AZ
252
History Center Floor Plans
3600
The Walls Unknown / Unmarked - Black Granite Known / Marked - Concrete
Conference
WC
WC
Archive Closet Office
80
70
3600
Kitchen
Level 1
3600
19 3600
8 3600
3 3600
Outdoor Patio
Level 2
4979 5263 5463 5263 5645 6500 miles away
Pioneer Military and Memorial Park holds over 3600 bodies in and around its property located in Downtown Phoenix. The number represented by the gravestones, however, is less than 600. The headstones that are still standing within the park are mostly those who could afford a longer lasting headstone, leaving hundreds of anonymous souls buried underground. In memorializing those who are unnamed, it is important to study who is represented. By knowing the origin of these know people, we can begin to paint a picture of those who are unknown. With this information, we can better understand where they and their family came from, their culture, their socioeconomic status and many other characteristics that helped to form the diverse city of Phoenix, Arizona. A cemetery to memorialize those who have been forgotten will carry their legacy into the future. A series of walls, which symbolize the number of individuals that hailed from a particular country, will pay homage to the wide range of ethnicities in the park. Proceeding through the central thoroughfare, it becomes clear that the topography sinks into the Earth on either side, further revealing the tombs and memorial walls as one walks further down the slope.
design studies
THE Habitat Burrowing Owl Observatory jessica case - 2nd year studio project Phoenix, AZ
Just as the burrow of the burrowing owl provides shelter to the bird through seclusion, so shall the viewing structure provide isolation to its visitors while still providing a sweeping view of both the bird habitat and city. Within the encapsulated pocket of Moeur Park sits a thin transect of land. This holds two of the highest ridges in the park, creating a deep, secluded valley. Along the wash that runs between these undulating hills, there lies a space suitable for observation and contemplation. Surprisingly bold and approachable, the Burrowing Owl is fairly tolerant to humans. Most active during the morning and evening, catching large arthropods in the earlier hours and small mammals later in the day. It is crucial that the burrowing owl be given land to nest in without human interaction. While preserving the habitat of this species, this observatory will provide a comfortable, informative and interesting experience for the visitor. It will also enliven the seemingly dull and desolate desert landscape to direct the visitor’s focus to the park’s vibrant history and wildlife.
THE Wall
Mesquite Tree Habitat & Viewing Platform Jessica Case - 1st Year studio Project Phoenix, AZ
The interactive wall is designed to house a live mesquite tree while encouraging visitors to experience the structure and surrounding landscape. The mesquite becomes a central characteristic of the wall, supported by the strict programming of the main deck. Within a live mesquite tree, the rigid root and branch structure is necessary to support the living organism. Similarly, the external structure of the wall is extremely organized, symbolizing the intricate yet rigid plant structure of the mesquite. This suggests the complete convergence of rigidity in programing and fluidity of appearance. Thick walls define the space inside of the “wall�, encouraging movement in and out of the structure while allowing ample airflow and shading. Seating becomes ingrained into the main platforms, allowing visitors to interpret ledges and walls as seating areas. The supporting structure becomes the main focus of the building, bringing to light the necessity of the internal root and branch system of the mesquite.
THE PLATFORM MOUNTAIN PAVILION jessica case - 1st year studio project Phoenix, AZ
In my first undergraduate project, hand-drawing and model building were utilized to understand the site and its surrounding context. I expressed the “contained” nature of Arizona State University’s beloved ‘A-Mountain’ by translating the idea into an group of structures that encircle a portion of the South side of the mountain. I then went further to create a single enclosure that could shelter visitors as a refuge from the city. The interplay between nature and man, illustrated in the collage above, is a vital component to the successful integration of the design into existing the site. The contrast between man versus nature is explored in the study of Tempe Butte, a natural landmark nestled into the urban fabric of Tempe, AZ. As the structure was designed, it was meant to symbolize the domestication and containment of the mountain.
J e s s i ca Ca s e Ba r r e tt, T h e H on or s Col l e g e T h e De s i g n S ch ool - A r ch i te ctur e S p r i n g 201 8 j e s s i caca s e 1 6 @ g ma i l .com 5 1 2- 289 - 89 4 9