Sparsh Hospice Design - Architectural Thesis by Vidhi Wadhawan

SPARSH HOSPICE – FOR TERMINALLY ILL CANCER PATIENTS, HYDERABAD

Thesis submitted in partial fulfilment of the requirements for The award of the degree of

BACHELOR OF ARCHITECTURE

Submitted by VIDHI WADHAWAN 2015BARC005

10TH SEMESTER YEAR: 2020

DEPARTMENT OF ARCHITECTURE SCHOOL OF PLANNING AND ARCHITECTURE, BHOPAL

DECLARATION

I Vidhi Wadhawan, Scholar No. 2015BARC005 hereby declare that, the thesis titled Sparsh Hospice for Terminally Ill Cancer Patients, Hyderabad, submitted by me in partial fulfilment for the award of degree of Bachelor of Architecture at School of Planning and Architecture, Bhopal, India, is a record of bonafide work carried out by me. The design work presented and submitted herewith is my original work and I take sole responsibility for its authenticity. The matter/result embodied in this thesis has not been submitted to any other University or Institute for the award of any degree or diploma.

Vidhi Wadhawan Date: 20.07.2020

CERTIFICATE

This is to certify that the student Ms. Vidhi Wadhawan Scholar No. 2015BARC005 has worked under my guidance in preparing this thesis titled Sparsh Hospice for Terminally Ill Cancer Patients, Hyderabad.

RECOMMENDED

_________________

Ar. Sanmarg Mitra

ACCEPTED

___________________

Ar. Piyush Hajela Head, Department of Architecture

July, 2020, Bhopal

ACKNOWLEDGEMENT This thesis has been a wonderful journey, the light of hope during the strange summer of 2020. While the enthusiasm faded towards the conclusion, it was through the support of numerous people that I could create what I have in this attempt. I feel immense privilege in being able to thank my faculties, officials, peers and my family who made this possible. I take this opportunity to sincerely acknowledge my thesis mentor Ar. Sanmarg Mitra for his constant valuable input and encouragement. Despite his busy schedule, he consistently reviewed my thesis progress, provided valuable suggestions, and constructive criticism. Special thanks to Parama Madam for the way cares for things most people overlook. I’m also grateful to the Thesis Coordinators for propelling this forward the way they did. Their management in these difficult times ensured that the thesis could be successfully completed. I’m especially thankful to Ar. Shweta Saxena to simultaneously guide me through the relevant and culminating Seminar research which helped me design and Ar. Poonam Khan whose kind words and timely response kept all of us motivated. This would also be incomplete without thanking Nitin Bhaiya at Imagination, Abhinav Sir at the Graphics Lab and This thesis which marks the culmination of my five years at School of Planning and Architecture, Bhopal, would’ve been incomplete without the constant support of my peers. The entire batch has constantly proved to be both a cushion and catapult. I would like to extend my special thanks to Sakshi, Priya, Saheel, Adarsh, Ajinkya, Jahnavi, Vikramaditya, Arnav, and Dhruv. Their criticism, wit, humour and tips are the most precious memories of this endeavour. Ankur was a driving force through both the laid and panic hours, pulling me along. The saviours, Abhishek Venkitaraman Iyer and Souvik Row Chowdhury, who ensured me that I’m capable of this and what matters is that we give our best. Mansi, you were missed but that warmth was felt from across seas. Thanks to Rubbersoul team for giving me a renewed perspective on Architecture and life. Rana Da, Dhrubo Da, Kedia Sir, and Unnati Ma’am, your insights not only helped me move ahead, but also made me an evolved person through it. The people who trusted me and selflessly helped me at the case studies deserve my utmost gratitude. Priya P and Mr. Sudarshan at Karunashraya were kind and willing. Mrs. Shanta at Sparsh for her valuable insights. Baig and Chirla at Sudhir Associates who helped me understand the project and the site. Ms. Mohan for her valuable time and talking about the nurses’ perspective.

The free meals and shelter that Sreeja Revur and her beautiful parents provided during a week of drudgery and site visits in Hyderabad were a pleasure. She has saved me from embarrassment multiple times and can be credited with the idea of the project. My thanks to Arjit Sethi for hosting and feeding me during the most intense study days and tolerating my erratic habits and timings. I extend my Thanks to Dimple to be my Thesis Buddy during the early days and share random insights. Your presence gave strength and humour gave respite. My heartiest Gratitude extends to my Family who has made this possible from the very beginning. My Father for believing in me and encouraging me to take care of myself while everything else goes on. My brother for, Jai, for being my sanity during intense situations and the smile that makes my day no matter what. My Mother, for holding me together and taking care of me and cushioning my anxiety with her words, wisdom and nutritious food. It wouldn’t be an understatement to say that her belief in me is what makes me capable of everything. Any amount of thanks would fade for the kind of support that was provided to me by the Love of My Life, Amal. Thanks for believing in me more than I could. Your participation, immense experience and knowledge, tech help, beautiful perspective and kind words at the right time ensured I saw through this. Thank you for being so patient and so loving. I would like to thank all those people who taught me big lessons by just being there. Special thanks to all those who have directly and indirectly helped me complete these five years. I would like to apologize to anyone whose name I’m missing out while I write this in a frenzy of excitement and nostalgia. I am grateful from the bottom of my heart for your presence and encouragement. My final Gratitude to the divine force which saw me worthy of this created this opportunity for me.

ABSTRACT A hospice is a special way of caring for people who are terminally ill, and have no cure options left. Death is inevitable, yet remains a neglected issue in modern healthcare. In patients with terminal cancer this final journey can be difficult and exhausting, making each passing day an ordeal. One of their greatest fears is dying alone in sterile, impersonal surroundings. Most of these patients don’t want to be hooked up to tubes and cut off from family, friends, loved ones and things that are familiar. They would prefer, if possible, to spend their final phase of life as pain free and alert as possible, surrounded by the family, friends and things they love. A hospice focuses on caring, not curing. When a patient’s medical team determines that the disease can no longer be controlled/ cured, medical testing and treatment stops. But the patient care continues. This care focuses on making the patient comfortable. The patient receives medications and treatments to control pain and other symptoms such as constipation, nausea and shortness of breath. Hospice care also provides counselling and mental strength to face the inevitable end. Sparsh is currently functioning in a rented premise, with limited bed strength and with the lease expiring shortly. Finding an alternate accommodation and customizing it is the Herculean task at hand. The new facility will be designed to suit the needs of these vulnerable ‘end of life’ patients and provide all conveniences to make their stay pleasant, comfortable, aesthetic and soothing. The aim of the design will remain to foster a feeling of comfort, contentment, companionship and the best possible health management. Moreover, the typology requires adjustments according to Indian culture to accommodate varying family dynamics and religious beliefs. The attempt will remain to create a ‘Home’ for the suffering and minimize the suffering and accentuate the experience of Living.

iii

TABLE OF CONTENTS Declaration ................................................................................................................ 2 Certificate .................................................................................................................. 3 Acknowledgement ...................................................................................................... i Abstract ..................................................................................................................... iii LIST OF FIGURES .................................................................................................... vi 1.

INTRODUCTION ............................................................................................. 1 1.1

PROJECT BACKGROUND .......................................................................... 1

1.2

PROJECT BRIEF ......................................................................................... 2

1.3

RATIONALE ................................................................................................. 4

1.4

AIM .............................................................................................................. 5

1.5

OBJECTIVES ............................................................................................... 5

LITERATURE STUDY ..................................................................................... 6 2.1

HISTORY ..................................................................................................... 6

2.2

NEED FOR PALLIATIVE CARE ................................................................... 6

2.2.1 Palliation as an alternative to Hospital Wards .......................................... 6 2.2.2 The Need for Palliative Care in India........................................................ 7 2.3 3.

CULTURAL CHALLENGES ......................................................................... 9 SITE STUDY ................................................................................................. 10

3.1

LOCATION ................................................................................................. 10

3.2

SITE SURROUNDINGS ............................................................................. 11

3.3

CONNECTIVITY AND ACESSIBILITY ....................................................... 12

3.4

BYE LAWS ................................................................................................. 13

3.5

SITE CHARACTER .................................................................................... 15

3.5.1 Site Vegetation ...................................................................................... 15 3.5.2 Site Views .............................................................................................. 17 3.6

SITE RELIEF AND SERVICES .................................................................. 19

3.7

CLIMATIC DATA AND INTERPRETATION ................................................ 20

3.7.1 Some Applicable Climate Strategies ...................................................... 21 3.8 4.

SOIL AND WATER TABLE ........................................................................ 22 CASE STUDIES ............................................................................................ 23

4.1

LIVE CASE STUDIES ................................................................................ 23

4.1.1 Existing Premises at Sparsh .................................................................. 23 4.1.2 Karunashraya, Bangalore ...................................................................... 29 4.1.3 Shanti Avedna Sadan, Bandra, Mumbai ................................................ 41 iv

4.2

Literature Case studies .............................................................................. 50

4.2.1 AHI HOSPICE (Aichi Prefecture, Japan) ................................................ 50 4.3

CASE STUDY INFERENCES..................................................................... 56

AREA PROGRAM ......................................................................................... 61

THE LANDSCAPE ......................................................................................... 66 6.1

INTRODUCTION ........................................................................................ 66

6.1.1 Remembrance ....................................................................................... 70 6.1.2 Stone ..................................................................................................... 71 6.2

Case Studies .............................................................................................. 72

6.2.1 National AIDS Memorial Grove, San Francisco, Golden Gate Park ....... 72 6.2.2 Dora Efthim Healing Garden .................................................................. 76 6.3

DERIVATION OF MAJOR ELEMENTS & DESIGN PRINCIPLES .............. 78

6.3.1 Design Elements.................................................................................... 78 6.3.2 Design Principles ................................................................................... 81 6.4 7.

Relevant landscape features in Stone ........................................................ 85 CONCEPT DEVELOPMENT ......................................................................... 86

7.1 8.

Bubble diagram .......................................................................................... 88 DESIGN PROPOSAL .................................................................................... 89

8.1

The site ...................................................................................................... 89

8.1.1 Service Layouts ..................................................................................... 90 8.1.2 Site Sectons .......................................................................................... 91 8.2

LEVEL 1 DESIGN ...................................................................................... 92

8.3

LEVEL 2 DESIGN ...................................................................................... 96

8.4

LEVEL 3 DESIGN ...................................................................................... 98

............................................................................................................................ 98 BIBLIOGRAPHY.................................................................................................... 100

LIST OF FIGURES

Figure 1-1 Characters of the New Facility .................................................................. 5 Figure 2-1 Components of Palliative Care ................................................................. 7 Figure 3-1 Location of Context ................................................................................ 10 Figure 3-2 Location of the Old Premises and New Site............................................ 10 Figure 3-3 Site Surroundings ................................................................................... 11 Figure 3-4 Connectivity to Railway Stations and Airports ......................................... 12 Figure 3-5 Connectivity to Major Cancer Hospitals .................................................. 13 Figure 3-6 Proposed Land use Zoning of Metropolitan Development Plan Hyderabad Metropolitan Region 2031 ................................................................................................... 14 Figure 3-7 Detailed Zoning of Qutubullabur Mandal................................................. 15 Figure 3-8 Site Vegetation ....................................................................................... 16 Figure 3-9 Key Plan for Site Views .......................................................................... 17 Figure 3-10 Views from and at the Site .................................................................... 18 Figure 3-11 The Site Structure ................................................................................ 19 Figure 3-12 Site Sections ........................................................................................ 20 Figure 3-13 Climatic Charts ..................................................................................... 20 Figure 3-14 Sun Path .............................................................................................. 21 Figure 4-1 OPD and Administrative wing ................................................................. 23 Figure 4-2 Residential Premises of Existing facility .................................................. 23 Figure 4-3 Facilities at Sparsh ................................................................................. 24 Figure 4-4 Prayer / Meditation / Outdoor Seating Area ............................................ 24 Figure 4-5 Twin - Sharing used Rooms ................................................................... 25 Figure 4-6 Laundry Drying on Terrace ..................................................................... 25 Figure 4-7 Single In-patient Unit ( space for family, kitchenette and customization ) 26 Figure 4-8 Kitchen ................................................................................................... 26 Figure 4-9 Counselling Clinic ................................................................................... 27 Figure 4-10 Dining Area .......................................................................................... 27 Figure 4-11 Location of Karunashraya ..................................................................... 29 Figure 4-12 Floor Plans ........................................................................................... 29 Figure 4-13 key plan for Views ................................................................................ 31 Figure 4-14 Pathway lined with trees as a precursor to the facility and buffer from the noisy road. .......................................................................................................................... 32 Figure 4-15 Gift Shop and Donation Centre ............................................................. 32

Figure 4-16 Non - Religion specific prayer Area ...................................................... 33 Figure 4-17 Reception and Waiting Lounge ............................................................. 33 Figure 4-18 Audio - Visual Recreation Room ........................................................... 34 Figure 4-19 Kitchen ................................................................................................. 34 Figure 4-20 Water Body facing the Wards and clinics .............................................. 35 Figure 4-21 Nursery................................................................................................. 35 Figure 4-22 Jaalis and Pergolas for shading and visual relief .................................. 36 Figure 4-23 Enclosed courtyards for ventilation and aesthetics ............................... 37 Figure 4-24 Wider corridors for easy movement ...................................................... 38 Figure 4-25 STP ...................................................................................................... 38 Figure 4-26 Back Exit from Mortuary ....................................................................... 39 Figure 4-27 location of Shanti Avedna Sadan .......................................................... 41 Figure 4-28 Back Entrance ...................................................................................... 42 Figure 4-29 Each bed a view of the Arabian ocean ................................................. 43 Figure 4-30 Main Entrance ...................................................................................... 43 Figure 4-31 The Reception ...................................................................................... 44 Figure 4-32 Typical Ward ........................................................................................ 44 Figure 4-33 Internal open courtyard ......................................................................... 45 Figure 4-34 Enclosed Back Garden ......................................................................... 45 Figure 4-35 Courtyard along kitchen and Laundry area ........................................... 46 Figure 4-36 Balconies facing the Sea ...................................................................... 46 Figure 4-37 Backside courtyard ............................................................................... 47 Figure 4-38 Sapling Garden .................................................................................... 47 Figure 4-39 Main Entrance ...................................................................................... 48 Figure 4-40 The Hospice in its Natural Surroundings............................................... 50 Figure 4-41 Floor Plans ........................................................................................... 51 Figure 4-42 A Residentialist image through its massing and materiality palette. ...... 52 Figure 4-43 common areas for Day activities ........................................................... 52 Figure 4-44 A private Ward...................................................................................... 53 Figure 4-45 use of natural materials and glass in corridors and windows ................ 53 Figure 4-46 Typical Section ..................................................................................... 54 Figure 4-47 Outdoor View........................................................................................ 54 Figure 4-48 Flexible Layout ..................................................................................... 55 Figure 4-49 The Outdoor Layout.............................................................................. 57 Figure 4-50 Circulation pattern ................................................................................ 57 Figure 4-51 The Offices and Utility Spaces .............................................................. 58 Figure 4-52 Spiritual and Recreational Spaces ........................................................ 58 vii

Figure 6-1 Painting Depicting hospital conditions in the Middle ages ....................... 67 Figure 6-2 Restorative garden at the Essa Flory Hospice Centre, Lancaster, Pennsylvania, allows for respite and contemplation along paths and semi-private areas .... 68 Figure 6-3Marie Curie Cancer Care, Bradford, U.K. ................................................ 68 Figure 6-4 Christopher House, Austin, Texas resonates remembrance through a wall mural with casts of hands of former patients ....................................................................... 70 Figure 6-5 Granite Boulder Deposits on Site ........................................................... 71 Figure 6-6 Rock deposits on proposed Site ............................................................. 71 Figure 6-7Stone Marking the Entrance .................................................................... 72 Figure 6-8The Circle of friends ................................................................................ 73 Figure 6-9 Engraved Names in The Circle of Friends .............................................. 73 Figure 6-10 The Haemophilia Memorial ................................................................... 74 Figure 6-11 Stone Memorials, Benches, Boulders ................................................... 74 Figure 6-12 The Seating Spaces ............................................................................. 75 Figure 6-13 The Grove ............................................................................................ 75 Figure 6-14 Layout of Garden .................................................................................. 77 Figure 6-15 Dora Efthim Garden Centre .................................................................. 77 Figure 6-16 Gilchrist Center for Hospice Care, Baltimore, Maryland. ....................... 78 Figure 6-17 Houston Hospice restorative Garden integrating all kinds of spaces. Added Gazebo for mediation and small gathering spaces accompanied by the children’s park and naturally shaded pathways. ................................................................................................. 78 Figure 6-18 Dedicated nursery at Sun Health Hospice, Scottsdale, Arizona ............ 79 Figure 6-19 Waterscape adjoining Rooms in AHI Hospice, Japan ........................... 79 Figure 6-20 LaGrange Hospice providing courtyard and a variety of landscape spaces for residents ........................................................................................................................ 80 Figure 6-21 Children's Play Area at George Mark Children’s Hospice, San Leandro, California............................................................................................................................. 80 Figure 6-22 Stainless Steel Tree in North London Hospice...................................... 81 Figure 6-23 Seirei-Mikatagahara Hospital Hospice, Shizuoka Prefecture, Japan ..... 82 Figure 6-24 Bear Cottage Children’s Hospice, New South Wales, Australia demonstates low contact but high visual connection to nature ............................................ 82 Figure 6-25 Sun Health Hospice, Scottsdale, Arizona maintains natural desert landscape ........................................................................................................................... 83 Figure 6-26 Landscape of Stone.............................................................................. 85 Figure 7-1 Component of Palliative Care ................................................................. 86 Figure 7-2 Palliative Architecture as Architecture of Compassion - A concept ......... 86 Figure 7-3 Design Aims of the Project ..................................................................... 87 viii

Figure 7-4 Stone, Landscape and Remembrance - A concept................................. 87 Figure 8-1 Site Plan ................................................................................................. 89 Figure 8-2 Site Section ............................................................................................ 90 Figure 8-3 Service Layouts ...................................................................................... 90 Figure 8-4 Site Sections .......................................................................................... 91 Figure 8-5 LEVEL 1 GROUND PLAN (Plinth at +450mm) ....................................... 92 Figure 8-6 LEVEL 1 - 2ND FLOOR PLAN (FFL at +3950) ....................................... 93 Figure 8-7 WAITING, OPD and Day-care Plan ........................................................ 93 Figure 8-8 Section XX' ............................................................................................. 94 Figure 8-9 COMMERCIAL AND ADMIN BLOCK PLAN ........................................... 94 Figure 8-10 Section XX' (COMM. BLOCK) .............................................................. 94 Figure 8-11 Staff Residence Plans .......................................................................... 95 Figure 8-12 Staff residence Section XX' .................................................................. 95 Figure 8-13 LEVEL 2 GROUND PLAN .................................................................... 96 Figure 8-14 LEVEL 2 East Wing Plan ...................................................................... 97 Figure 8-15 LEVEL2 West Wing Plan ...................................................................... 97 Figure 8-16 LEVEL2 Section YY' ............................................................................. 97 Figure 8-17 LEVEL2 Section YY' ............................................................................. 97 Figure 8-18 LEVEL 3 GROUND PLAN .................................................................... 98 Figure 8-19 Section XX' ........................................................................................... 99 Figure 8-20 Variable Ward Layout ........................................................................... 99 Figure 8-21 The Rememberance Garden ................................................................ 99

1. INTRODUCTION 1.1 PROJECT BACKGROUND The Palliative Care policy in India is a new development and the infrastructure is viewed as a medical facility, an extension of specialized hospitals. This is an attempt to understand the new Hospice vocabulary in India as an Architectural Challenge. The element of cultural challenges in the hospice perception in the country also acts as a deterrent in the growth of the concept. The research hopes to explore the current conditions, challenges, and scope of the palliative care sector through consolidation of practitioner’s and designer’s perspective. It is to be established that Hospices need to be experiential and homely healing spaces rather than a sanitary isolations. The study aims to highlight how the palliative care model at any scale can be aided by architecture. The Sparsh Hospice is a significant step forward as this shows the Government recognition for the cause and awareness among independent NGOs. The infrastructure proposed aligns with the ideology of creating a space for experience of life and not a sanitary healthcare facility. The focus is also on mental health and how to help patients and their families cope with the inevitable. From the above, it may be observed that spaces when designed for the dying have massive considerations. The psychological impact of minor decisions can be amplified within the mind and experience of the inhabitant. Similarly, it is not just important to control the comfort and the immediate surroundings, but also the impact of the stimulations in sound, visuals and interactions. “The very first requirement of a hospice is that it shall do no harm.” -

Stephen Verdeber

Our exploration faces the challenge whether the hospice philosophy developed and being prevalently practiced in the Developed World, can be functionally replicated in India within the context of traditional Indian culture and thought process which heavily influenced by contrasting religious undertones. This raises questions whether a possible alternative should be developed in India that maybe more in line with the cultural needs and general approach of the people.

Sparsh Hospice, Hyderabad

1.2 PROJECT BRIEF Sparsh Hospice was started by members of Rotary Club of Banjara Hills in 2011. Sparsh is a registered Trust and has featured in several newspapers and TV shows over the past few years. The trust leased a building in Road No.12, Banjara Hills to care for 14 patients in August 2011. Each year the number of patients utilizing Sparsh Hospice has grown, and to date, over 2500 (in-patients and Out-patients) patients have been admitted and cared for by the staff, of which, over 80% breathed their last peacefully at this facility. Sparsh is currently functioning in a rented premise, with limited bed strength and with the lease expiring shortly. Finding an alternate accommodation and customizing it is the Herculean task at hand. The new facility will be designed to suit the needs of these vulnerable ‘end of life’ patients and provide all conveniences to make their stay pleasant, comfortable, aesthetic and soothing. A modern building will be constructed with to cater to 100 patients. There will be mix of wards. The client has specified that the facility must feature aesthetics that will soothe, like water bodies, greenery and open spaces. There will be an AV rooms, Gym and Library for entertainment and an open air auditorium for patients and families. The facility will also have a dining room and self- contained kitchen along with other allied requirements.

SPARSH HOSPICE - Requirements I. General: 

Reception and waiting lounge



Admin office... Space for Chairman/Managing Trustee/Treasure, CEO, 4 Manager cubicles, 4 – 6 work stations and one small discussion room



Board Room (Trustees). 10 to 12 capacity



Rooms for Counsellors. Minimum 4



One class room-cum-care givers meeting for 20 – 24 persons



Charity Shop/Café



Space for Faith Hall or Prayer room or meditation



Laundry with store room and provision for drying clothes



Kitchen and Pantry with dining facility & store room



Indoor Games Room



Library and Lounge

Sparsh Hospice, Hyderabad



A V Room for 40 to 50 capacity



Health club



Attached rest rooms for some of the above facilities as appropriate and common restrooms for visitors/care givers and housekeeping staff



Bikes/Cars/Ambulances parking provision... Exclusive for the Hospice II. Patients related:



Day Care patients... Min 4 beds with facility for screening, dressing etc., and rest room



In-Patients general ward/s … 100 beds (with restrooms and Nursing station in each ward/unit)



Special Rooms for patients... 1 or 2 rooms with rest rooms attached and one nursing station



One room for Medical Director



Doctor’s consulting Rooms... Min 3



Space for one Physio Therapist



Space for one Nursing Head



Store room one each for Linen and mattresses, oxygen cylinder/machines, Wheel chairs & Stretcher



Pharmacy dispensary and storage



Mortuary... 2 beds preferably with dressing space



Centralized Room for Bio waste bins



One general storage room



Saloon and Spa (steam batch etc.) (Note: All the patients in dormitory or special rooms will have a caregiver/family

attendant who require some space for sitting/sleeping) III. Accommodation: 

Nurses dormitory for 25 – 30 with common rest rooms.



Single/two bedroom residential quarters for Doctor.



Single Guest Room with rest room for visiting faculty/Doctor/any international visitor IV. Retail space:



Diagnostic center



OP Clinic/s



Pharmacy store



Food Court

Sparsh Hospice, Hyderabad



Groceries Stores



Florist/gift stores



Exclusive car and bike parking for shop owners

1.3 RATIONALE Less than 1% of India’s 1.2 billion population has access to palliative care. On the national level, recent years saw several improvements, including the creation of a National Program for Palliative Care (NPPC) by the government of India in 2012. The year 2014 saw the landmark action by the Indian Parliament, which amended India’s infamous Narcotic Drugs and Psychotropic Substances Act, thus overcoming many of the legal barriers to opioid access. Education of professionals and public awareness are now seen to be the greatest needs for improving access to palliative care in India. Hospice is considered to be a Western Concept slowly gaining Global Recognition. The need for the same arises with the advancement and formalization of medical and palliative care. While death amongst family still remains the norm, the prevention, containment and care for health issues is what has prompted the need for separate care units, independently or within hospitals. Since the psychological and medical needs are of utmost importance, the Hospices are usually designated for a particular age group or treatment typology. As new concept, these units are either ancillary spaces within a hospital or orphanages. While cancer hospices are widespread, people dealing with disorders attached to stigma such as Leprosy or Aids require more acceptance. The finality and the importance that this space carries for individuals, is what has prompted me to delve deeper into the ratio of how many patients require palliative care as compared to the percentage who receive it. Architects and allied designers are well advised to first immerse themselves in the inner profundities of the hospice experience, and these principles of palliative architecture, in order to fully appreciate and comprehend the commitment, compassion, mutual support, and warmth as well as the stark realities of hospice. (Verderber & Refuerzo, 2006)

Sparsh Hospice, Hyderabad

1.4 AIM The aim of the design will remain to foster a feeling of comfort, contentment, companionship and the best possible health management. The attempt will remain to create a ‘Home’ for the suffering and minimize the suffering and accentuate the experience of Living.

1.5 OBJECTIVES

Figure 1-1 Characters of the New Facility



To recognize the broadening scope of Hospices in Indian context as challenging but necessary to establish better care.



To shift the focus of Hospices from service oriented spacial design to experience and healing oriented.



To identify the needs of a Hospice in the context of our country’s cultural background.



To Design a facility adhering to the context and surroundings.



To attempt to design a facility that is comfortable, aesthetic, pleasant, soothing and biophilic.

Sparsh Hospice, Hyderabad

2. LITERATURE STUDY 2.1 HISTORY The Sisters of Charity in France were the first to come up with hospices in the late 18th century with the ideology of compassion and kindness. Later in the 19th century, Florence Nightingale was also a part of the Sisters of Charity and assimilated her ideas for nursing reform from this involvement. This idea of caring unambiguously for the dying, where psychological health is given equal importance, is believed to have originated in Dublin approximately in the 19th century wherein the focus of the care shifted to emphasize on the newly recognized sympathy and acceptance of the needs of the people in the last stages of their life. Similarly in 1905, The Irish Sisters of Charity founded the St. Joseph’s Hospice, London to ease the insufferable circumstances across East End in London (Manning 1984). It is apparent from the above that the history of origination has strong Christian religious influence. The evolution of the current hospice movement in European, usually traced to St.Christopher’s Hospice, London was opened by Cicely Saunders in 1968, displays strong Christian roots. (Davis, Konishi and Mitoh, 2002)

The USA has 3000 fully functional hospices serving 450,000 patients and their families. These number of patients seeking the services has gone up as the population of patients infected with acquired immune deficiency syndrome (AIDS) seeking hospice facilities has increased. Also a shift can be observed wherein many more patients now seek and choose a hospice when closer death than previously observed. Despite the choice and means it is unfortunate to note that, 60% of patients in the States still breathe their last in hospitals, of which one-third are still in pain when they die. (Kaufman, 1997).

2.2 NEED FOR PALLIATIVE CARE 2.2.1

Palliation as an alternative to Hospital Wards It has been observed and concluded that patients who are aware of their approaching

mortality and the causal their terminal illness cope in a much better way and spend further meaningful and quality time in a more eased and communicative relationship with their family. Physicians, Nurses and practitioners emphasize the significance of patients not feeling lonely, neglected or pitied and the need for specific palliative care, which may be defined as an institution or safe space for patients to continue to live their last remaining days with dignity,

Sparsh Hospice, Hyderabad

least amount of pain, and an atmosphere based on communication and free of falsity (Yamazaki 1990). Research shows that being a long- term inhabitant, particularly in an oncological ward or wing, is evidently and even observationally a very isolated and morose experience with inadequate social contact or personal interaction or rejuvenating activity. Hospice patients, in contrast, were significantly less lonely, spending considerable amount of their time either engaged in some activity or with their relatives or nurses. Although almost none of the patients spend the majority part of their day or night with nurses, patients and nurses within the hospice setup spend significantly more time together, and these meetings or interactions more frequently last longer. Nursing care, however, is mostly oriented at `doing' a particular task for the patient that they are required to rather than `being' as a companion, jester or listener, i.e. when attending to the patients, nurses have a particular task to accomplish within stipulated time and are also burdened with the responsibility of multiple patients. (Ramussen and Sandman, 1997) For now, it is difficult to determine as to how much patients preferably and in actuality spend their waking time or limited good days in different surroundings. It is so because the only available data is from observational studies at similar functioning institutions for the elderly (Nolan, 1995), and of terminally ill patients in medical wards (Mills, 1994). Neither paints a joyful picture of a setting. Images people assume are patients reading as is revealed usually happens. Patients spend most of their time unaware, uninvolved, amongst themselves and isolated. This can have a negative impact even on the mental health, affecting other physiological symptoms. Information about hospice practice and its evolution can be gained by examining patient activities at a hospice.

Figure 2-1 Components of Palliative Care

2.2.2

The Need for Palliative Care in India Of the 2.1 billion people living in India, less than 1 percent have access to palliative

care. However, massive progress can be seen in the last 50 years. (Rajagopal, 2015). Initially pioneered by non-government organization, the issue and need has now been recognized by Sparsh Hospice, Hyderabad

the Government and the National Program for Palliative Care (NPCC) was put in place in 2012. The landmark improvement however may attributed to the amendment of the, Narcotic Drugs and Psychotropic Substances Act, thereby providing access to opioids to the ones in dire need of it for pain management and palliative care. The formation of the Indian Association of Palliative Care in 1994 was also a major step forward. The growth, however, is limited when compared to the volume of population and the patients who go without the knowledge of the existence of an option or even pain relief at the end of life. Patients in India often suffer from physical, psychological and financial trauma where loans due to healthcare needs are passed onto generations. Some practitioners and pioneers recognized the trend and introduced the concept of formal palliative care. In India, the movement began primarily with the introduction of home visit programs and education of relatives and nurses. There were no funds and the organisations depended on voluntarism. The High Court Case by Mr. Ranjan Ghooi, opened gates of accessing opioids for Cancer patients as late as 1998. States like Kerala however made rapid progress by putting in place programs like “Neighborhood Networks in Palliative Care” (NNPC). The petitioner who identify palliative Care as a fundamental Right under Right to Dignitya ask that a policy should be in place, medication available without hassle and nursing staff be adequately trained. The NDPS Amendment Act has now been adopted but it the gigantic task of its implementation still hangs on the shoulders of the handful of equipped or capable individuals. The non-government agencies have to take charge to ensure expansion and implementation of the policy. The shortage of trained staff and doctors still remains a major barrier. It is hoped that the recent mandate by the World Health Association asking all member nations to align Palliative care with Mainstream Healthcare will help in the growth of awareness and infrastructure for the same.

Sparsh Hospice, Hyderabad

2.3 CULTURAL CHALLENGES Our exploration faces the challenge whether the hospice philosophy developed and being prevalently practiced in the Developed World, can be functionally replicated in India within the context of traditional Indian culture and thought process which heavily influenced by contrasting religious undertones. This raises questions whether a possible alternative should be developed in India that maybe more in line with the cultural needs and general approach of the people. Trusting traditional values and social norms, patients often authorize their family and relatives to take important decisions, even those that involve the procedure for action at the end of life. Therefore, the need for more research, observation and dialogue arises on understanding the impact of these socio ethical issues on end-of-life care. Nurses repeatedly emphasize how lack of information to the patient and absence of consent leads to impatience and is the most basic and recurrent problem in palliative care ethics. (Konishi & Davis 1999). While the caregivers find ethical interaction most challenging in cases of misinformed of information deprived patients, the issue has multiple dimensions. Those closely in contact with patients also emphasized how patients had only trace or close to none self-determination. This is vital issue along with what is referred to as over treatment of elderly or terminally ill patients and the lack of hospice information to patients or their wellwishers who can take decisions creates a predicament for numerous terminally ill individuals, their families and the nurses. Nurses moreover note that lack of consensus within families and subjugation of the opinion of the direct beneficiary also causes many to be deprived of the care at the right time. It is also highly concerning to observe how the Hospice care is also being routinized and being absorbed into the mainstream commercial healthcare. This can lead to similar budget constraints for those that actually benefit from Hospice Care. Similarly, privately run hospices are also observed who run Stage-I drug tests and alternative medicine. (Abel, 1986, Mor, 1987, Seale 1989, James Field 1992, McNamara, Waddell & Colvin 1994).

Sparsh Hospice, Hyderabad

3. SITE STUDY 3.1 LOCATION The site has been acquired on a long lease agreement (30 years) with the Government of Telangana adjacent to Oakbridge School, Bachupally. Location: Bachupally, Hyderabad, Telangana Site Area: 23,900 sqm Hyderabad is the Capital of Telangana State. The Site for the New Facility is located along the Outer Ring Road Growth corridor which gives a connectivity boost and development scope. The old location lies within the Old city where Land crunch and unsuitable premises are restricting the working of the staff and patient’s well-being.

Figure 3-1 Location of Context

Figure 3-2 Location of the Old Premises and New Site

Sparsh Hospice, Hyderabad

3.2 SITE SURROUNDINGS

Figure 3-3 Site Surroundings

The Site, though in the high Growth Development character, is surrounded by institutional and residential developments. While the Ring Road provides easy connectivity to other parts of the City, the Lake in the vicinity in a visual and climatic relief. The Oakridge International School acts as the closest landmark to the Site. The presence of basic amenities like a supermarket, school and pharmacies make the site ideal a potential space of comfort and calm.

Sparsh Hospice, Hyderabad

3.3 CONNECTIVITY AND ACESSIBILITY

Figure 3-4 Connectivity to Railway Stations and Airports

Sparsh Hospice, Hyderabad

Figure 3-5 Connectivity to Major Cancer Hospitals

While the accessibility through the spinal and radial roads is maintained, the proximity to the ORR cuts travel time in case of emergencies and traffic jams.

3.4 BYE LAWS Applicable Building Laws SDZ Laws (Special Development Regulations for the Hyderabad Outer Ring Road Growth Corridor (ORR-GC))

No Maximum permissible Building Height



Buildings abutting 30 m wide road have common building line (front setback) of 9 m

Sparsh Hospice, Hyderabad



Permissible Ground Coverage of 50 %.



Requisite: Independent Sewage, Drainage and Solid Waste Disposal

Municipal Bye-Laws (Municipal Administration and Urban Development Department - Model Building Bye-Laws 2016) 

Side Setbacks - Height up to 7m - 5m 15m - 6m 18m - 7m



No FAR restrictions.

Figure 3-6 Proposed Land use Zoning of Metropolitan Development Plan Hyderabad Metropolitan Region 2031

Sparsh Hospice, Hyderabad

Figure 3-7 Detailed Zoning of Qutubullabur Mandal

3.5 SITE CHARACTER 3.5.1

Site Vegetation

Sparsh Hospice, Hyderabad

Figure 3-8 Site Vegetation

Sparsh Hospice, Hyderabad

3.5.2

Site Views

Figure 3-9 Key Plan for Site Views

Sparsh Hospice, Hyderabad

Figure 3-10 Views from and at the Site

Sparsh Hospice, Hyderabad

3.6 SITE RELIEF AND SERVICES

Figure 3-11 The Site Structure

Sparsh Hospice, Hyderabad

Figure 3-12 Site Sections

3.7 CLIMATIC DATA AND INTERPRETATION

Figure 3-13 Climatic Charts

Sparsh Hospice, Hyderabad

The challenge is mainly in the summer months when temperatures touch 45 degrees Celsius. Winter months exhibit pleasant temperature ranges with low precipitation.

Figure 3-14 Sun Path

3.7.1

Some Applicable Climate Strategies

Sparsh Hospice, Hyderabad

3.8 SOIL AND WATER TABLE 

Red Sandy Soil - poor nutrient quality.



Soil Bearing Capacity - 40kN/sq.m.



10% unbuildable stone covered area. (Pink Granite Boulders)



Rock Bed at 6ft below the soil.



Footing generally established at 1.5 + 2 ft below the soil.



Ground Water Depth – Pre Monsoon- 19m Post Minsoon-12 m

Sparsh Hospice, Hyderabad

4. CASE STUDIES 4.1 LIVE CASE STUDIES The criteria for choosing the live Case Studies, apart from proximity, remained to understand the cultural context and the derivative needs. 4.1.1

Existing Premises at Sparsh

Sparsh Hospice is a 14 bed rented facility, where 12 beds are for inpatients and 2 for outpatients. Since its inception, Sparsh has provided palliative care services to over 1800 patients up to 31st March 2018. These include service to inpatients, home care and outpatients. With the lease expiring shortly, a new facility will be designed to provide the vulnerable patients the best care at the End of Life.

Figure 4-2 Residential Premises of Existing facility

Sparsh Hospice, Hyderabad

Figure 4-1 OPD and Administrative wing

Figure 4-3 Facilities at Sparsh

Figure 4-4 Prayer / Meditation / Outdoor Seating Area

Sparsh Hospice, Hyderabad

Figure 4-5 Twin - Sharing used Rooms

Figure 4-6 Laundry Drying on Terrace

Sparsh Hospice, Hyderabad

Figure 4-7 Single In-patient Unit ( space for family, kitchenette and customization )

Figure 4-8 Kitchen

Sparsh Hospice, Hyderabad

Figure 4-9 Counselling Clinic

Figure 4-10 Dining Area

Sparsh Hospice, Hyderabad

Some Notable Observations: 

Repurposing of Apartments into Wards.



Assisted Vertical Circulation through Balconies.



Enabling of Homely environment through wide scope of customization of room.



Attached Bathrooms for Patients.



Permanent Side-Bed for family Caregiver.



Multi -Use Spaces for Maximum space Utilization

Sparsh Hospice, Hyderabad

4.1.2



Karunashraya, Bangalore

Established: 1999 (Extension on 1st floor built in 2016)



Architect: Sanjay Mohey



Capacity: 55 beds (75 beds after extension)



Plot Area: 8200 sq. m.



Built Up Area: 3.400 sq.m (35% ground coverage)

Relevance of the Case Study –

Figure 4-11 Location of Karunashraya



Urban context



Similar Capacity



Linear Plot



Cultural Context in Alignment



Award Winning and Renowned Design



Load Bearing Structure in Stone

Figure 4-12 Floor Plans

Sparsh Hospice, Hyderabad

Facility Details 

Solar capacity -104kv



236 panels



Required -32kv



265 kv generator



14kv UPS (Office and Pharmacy)/ ward solar back-ups



Earth Pit - There are generally 3 electrical lines. i.e, +ve, -ve and neutral, in order to balance these, neutral lines are connected to the ground (grounding). Is serviced once in a year. i.e, generally charcoal, which is non-conductor of electricity is filled.



50,000 litres water required per day



Sump capacity – 1 lakh litres



Pump – 2hp / 1hp



Oht- 20k / 5k litres



STP tank size - 30k



Rain water harvest – 2 sump to recharge the well



5 bore well



2hp aerator x 5 number for water body



Solar water each ward has 500 litres

Karunashraya is a non- profitable, non - government organization and a registered charitable trust by the Indian Cancer Society. Their aim remains to professional palliative care free of cost to last stage cancer patients irrespective of their economic strength. The organization offers flexibility of alternation of stay between the hospice facility and the patient’s home. The motive is to help patients live pain-free, with dignity, peace and companionship. The home care facility was established in 1995 while the Hospice with in-patient beds has been functional since 1999. The Hospice is also special as the architect received the JK Cement Architect of the Year Award for the year 2000. SERVICE AVAILABILITY 

55 bed in-patient beds for full time accommodation ( rejected patient’s notified of availability)



Patients can stay in constant touch with their home and may also move out and return to a place of choice under the guidance of a doctor or the care of a trained nurse.



People of all ages, if suffering from terminal cancer, where cure is not possible are welcome.

Sparsh Hospice, Hyderabad



There is provision to collect patients directly from the hospital oncological units.



Alongside a 55 bed In-Patient Facility currently available, a future expansion for 85 patients is planned with the expansion of the structure.



Patients who may denied accommodation due to non-availability of beds or resources are provided with care at home.



Residential Health Assistants Training Programme is conducted within the premises for women. Trainees are eventually employed as health assistants within the institute or deployed to patient’s homes.



Charity Sales are conducted to sell off donated goods that cannot be directly utilised to generate funds. Crafts or things produced by the capable patients are also part of the events



Medical treatments for curing is not encouraged or provided. The nurses however, look after symptom relief and preventive care. Basic pain inhibition support like morphine which is given to patients suffering from severe pain and also systematic check-ups are done.



Educational enterprises include events such as workshops, conferences and awareness programs on palliative care in partnership with the Indian Association of Palliative Care (IAPC).

Views within the Facility

Figure 4-13 key plan for Views

Sparsh Hospice, Hyderabad

Figure 4-14 Pathway lined with trees as a precursor to the facility and buffer from the noisy road.

Figure 4-15 Gift Shop and Donation Centre Sparsh Hospice, Hyderabad

Figure 4-16 Non - Religion specific prayer Area

Figure 4-17 Reception and Waiting Lounge Sparsh Hospice, Hyderabad

Figure 4-18 Audio - Visual Recreation Room

Figure 4-19 Kitchen Sparsh Hospice, Hyderabad

Figure 4-20 Water Body facing the Wards and clinics

Figure 4-21 Nursery Sparsh Hospice, Hyderabad

Figure 4-22 Jaalis and Pergolas for shading and visual relief

Sparsh Hospice, Hyderabad

Figure 4-23 Enclosed courtyards for ventilation and aesthetics

Sparsh Hospice, Hyderabad

Figure 4-24 Wider corridors for easy movement

Figure 4-25 STP Sparsh Hospice, Hyderabad

Figure 4-26 Back Exit from Mortuary ARCHITECTURAL CHARACTERISTICS 

8200 sq.m plot area containing 3400 sq.m. of built up area



Stone structure comprising of composite masonry.



The building design ensures that all rooms housing patients receive abundant natural lighting and sufficient ventilation.



The wards are provided with a view of garden and water bodies on either of the ward.to create an atmosphere of relaxation.



The building contains five wards to provide beds and care for in house -patients



Recreational spaces are provided to facilitate activities including indoor games, watching T.V, reading of newspaper etc.



A fully equipped 100 seat auditorium is provided with modern communication facilities for conferences and training programs.

Sparsh Hospice, Hyderabad



The kitchen caters to approximately 100 people during each meal and provides food thrice daily.



Initially dug bore wells (four in number) yielded about 10,000 litres per hour. This was used to fill the two overhead tanks.



Solar energy is efficiently used to provide power for the interior lightning within the wards after sundown and also exterior façade lights.



Visitor’s parking can accommodates up to 8 cars and bikes are parked in the open space.



Presence of several courtyards and open spaces wiith water pools adjoining living quarters.



Meditation room and prayer room with calming colours and view of greenery to help relax and provide peace of mind.



Dining halls feeding staff and residents.



Patients’ wards are kept as close to the relaxing spaces as possible on the ground floor.



The first floor is for the staff accommodation where accessibility is not an issue.

Sparsh Hospice, Hyderabad

4.1.3

Shanti Avedna Sadan, Bandra, Mumbai



Established: 1986 (Extension on 1st floor built in 2016)



Capacity: 100 beds (6 X 10 plus 20 X 2)



Plot Area: 500 sq. m. Figure 4-27 location of Shanti Avedna Sadan

Reason for Case Study 

Urban Context



Higher capacity on a shrunk Area



Understanding the Management

SERVICE AVAILABILITY 

100 beds for in-house patients.



Emphasis on symptomatic care which entails curbing cancer augmentation symptoms like pain, breathing difficulty, nausea, cough, sleeplessness etc. These can lead to severe psychological distress and therefore Analgesics and opiates like NSAIDS, Codeine and Morphine are administered. The patients ate then regularly monitored to control the effects of the medication.



While alternative medicine such as Ayurveda and homoeopathy are avoided because of the unknown reaction it may cause with the existing medication, the Sadan recognizes the need for holistic care and the need for healing of the Mind and the Soul. In-house psychologist and counsellor are appointed to help patients and thei families deal better with the situation.



Spiritual guidance and help to come to terms with the disease and impending death is also tried. Patients are encouraged to make peace with themselves, their families and their God.



Patients are encouraged to leave after painful symptoms subside. The discharged patients are provided their dosage of medicine in two week instalments on logging gin the condition and progress. Patients are always welcome to return if pain is unbearable or the family finds it difficult to keep the patient at home due to advanced symptoms.

Sparsh Hospice, Hyderabad



Nurses are trained by and are qualified members of the Nursing Order of the Holy Cross Sisters. They are assisted by paramedics and other nursing aides.



Relatives may visit freely as frequently as possible and may also stay with the inmate when intensive care is needed.



The Sadan does not have provision for deployment of staff to patient homes but provides Out Patient Department Day Care Services for the discharged or other needy patients.



Occupational therapy is also practiced wherein patients in suitable conditions are encouraged to practice a skill of their choice. They may make decorative articles, paintings, writings etc. Playing of musical instruments and other performing arts are also encouraged.

Figure 4-28 Back Entrance

Sparsh Hospice, Hyderabad

Figure 4-29 Each bed a view of the Arabian ocean

Figure 4-30 Main Entrance

Sparsh Hospice, Hyderabad

Figure 4-31 The Reception

Figure 4-32 Typical Ward Beds also have direct access to a private balcony for relaxation and introspection. It is preferred to keep the patients in Wards for easy observation and it also helps them feel less lonely. The staff is always around within the ward and the inhabitants can get to know each other better. Wards are located on the first and second floors while the third floor is occupied by the in-house nursing staff.

Sparsh Hospice, Hyderabad

Figure 4-33 Internal open courtyard

Figure 4-34 Enclosed Back Garden

Sparsh Hospice, Hyderabad

Figure 4-35 Courtyard along kitchen and Laundry area

Figure 4-36 Balconies facing the Sea

Sparsh Hospice, Hyderabad

Figure 4-37 Backside courtyard

Figure 4-38 Sapling Garden

Sparsh Hospice, Hyderabad

Figure 4-39 Main Entrance

ARCHITECTURAL CHARACTERISTICS 

With the completion of the new extension, the Sadan can accommodate 100 inpatients. There six patient wards of 10 bed each. The remaining 40 beds are arranged in double bedded rooms.



Each bed a view of the Arabian ocean.



It is preferred to keep the patients in Wards for easy observation and it also helps them feel less lonely. The staff is always around within the ward and the inhabitants can get to know each other better.



The wards are wonderfully daylit and have efficient ventilation to capture the ongoing sea breeze.



The private double bedded rooms are allotted only to the very critical patients on the recommendation of the nursing staff.



Beds also have direct access to a private balcony for relaxation and introspection.



There is also provision for cordoning off one bed area with curtains in case privacy is required.



An elaborate garden is maintained to keep the atmosphere breathable and calming to the eyes.



Wards are located on the first and second floors while the third floor is occupied by the in-house nursing staff.

Sparsh Hospice, Hyderabad



The ground floor is for the services such as the laundry area, the kitchen and prayer spaces.



The circulation plays an important role where the back entrance leads to the kitchen, laundry area and the pathway to the mortuary is as concealed as possible.



The Prayer room is for individual meditation along with sessions with the spiritual counsellors who are invited. These counsellors are from different religions. The nursing staff is also trained to provide spiritual support when needed.



Relaxation facilities such as television, reading, games and garden walks are also organized. Children visits or small functions during festivals are also encouraged.



Service Lifts and emergency ramps are provided for ease of movement of patients and nurses.

Sparsh Hospice, Hyderabad

4.2 LITERATURE CASE STUDIES 4.2.1

AHI HOSPICE (Aichi Prefecture, Japan)



ARCHITECT: Yangi-sa Ijima Architects, Tokyo



CLIENT: Aisen Society Group medical Practice/Aichi International Hospital



CONSTRUCTION: reinforced steel, masonry, laminated wood beams and floors, asphalt roof, composite polymer structural system; two levels



COMPLETED: 1999



INPATIENT BEDS: 20



SITE/PARKING: 3.2 acres/18

Reasons for Case Study 

Designing multilevel for contours



Similar International Cultural Context



Innovative use of Materials

Figure 4-40 The Hospice in its Natural Surroundings

Sparsh Hospice, Hyderabad

Figure 4-41 Floor Plans

Sparsh Hospice, Hyderabad

Figure 4-42 A Residentialist image through its massing and materiality palette.

Figure 4-43 common areas for Day activities

A spacious dayroom on the patient housing floor is used for consultation, art therapy, and social events.

Sparsh Hospice, Hyderabad

Figure 4-44 A private Ward

The inpatient rooms are private, and have ample personal space and various options of use, with privacy screens, operable sliding doors, furnishings, lighting, and tatami mats available for meditation or sleeping.

Figure 4-45 use of natural materials and glass in corridors and windows

Sparsh Hospice, Hyderabad

The structural system is wood beams. Natural wood is employed throughout, and on the exterior balconies. The terrace decking is of wood, and the exterior doors from inpatients’ rooms slide horizontally, as do the doors connecting inpatients’ rooms with the corridor.

Figure 4-46 Typical Section

The upper level’s attributes include the saw tooth fenestration pattern in the inpatient bedrooms facing the plaza, meditation spaces furnished with tatami mats, for use by patients and family. The main level houses overnight accommodation for family members, and staff and patient support functions.

Figure 4-47 Outdoor View

Outdoor ground level porches on the right side embedded in the site and the left side consisting of cantilevered terraces. The building’s cantilevered second level affords shade to the spaces below. The hospice conveys the scale and appearance of a private residence. This

Sparsh Hospice, Hyderabad

is reinforced through the use of wood structural elements and finishes throughout, transparency, terraces and balconies, and connectivity with its site.

Figure 4-48 Flexible Layout

The layout of the in-patient Room is kept flexible and each patient has the choice of arranging it according to preference.

Sparsh Hospice, Hyderabad

4.3 CASE STUDY INFERENCES

From the above, it may be observed that spaces when designed for the dying have massive considerations. The psychological impact of minor decisions can be amplified within the mind and experience of the inhabitant. Similarly, it is not just important to control the comfort and the immediate surroundings, but also the impact of the stimulations in sound, visuals and interactions. Some of the following can be solidly identified: THE ROOMS The isolation we associate with comfort and hospital healing is to be avoided. While peace, privacy and dignity are essential, what keeps one going and joyful is companionship, mutual respect and sense of belonging. The rooms therefore must be equipped with: 

Pleasurable visual connections which may be in the form of water bodies, gardens, activity areas etc.



The rooms should enable a flexible transition between being private areas and also an abode of co-living.



Functionally, the rooms should be spacious, well-lit, ventilated and conducive to minor indoor movements and activities. Spaces for visitors, volunteers and doctors should be sufficient.



Rooms also shouldn’t be too large to ensure that a sense of isolation is prevented.



The Ward should be an entity free of any disturbance. This can be assured through passive green belts, distance or circulation measures.



Wards, wherever provided should also be controlled in size to ensure competent supervision by the staff.



While artificial life support systems are discouraged, equipment like oxygenator, defibrillator, drips and monitoring equipment must be accommodatable and provided to ensure complete care.



The supervision should not be too obvious to ensure comfort and independence of communication.

THE OUTDOORS Though the outdoors are seldom actively used, except for sitting and enjoying the view, the landscaping forms the most essential part of the design and the overall experience. The outdoors must have the following features: 

Variety of landscape features.

Sparsh Hospice, Hyderabad



To provide variation and flora, for aesthetic and olfactory sensations.



Preferably common outdoor spaces for multiple inhabitants to ensure conversations and mutual uplifting.



Waterbodies may be included to create micro-climate and water bodies also induce a sense of calm and serenity.



The features should, however be accessible and welcoming.



Plants may be identifies that provide pest control and soil binding.

Figure 4-49 The Outdoor Layout

THE CIRCULATION The circulation of the Hospice of essence as the patients are usually dependent on assistance for mobility. 

Proximity to nurse station of wards for constant supervision and assistance.



Staff accommodation to be separate to ensure privacy



The accessibility to open spaces needs to be close and less level differences for independent movement of patients.



A common main entrance to all spaces to ensure a welcoming and non-discriminatory environment.



Further and enhance inter-departmental movement for quick action in case of emergencies.



Separate entrance and exit for services and mortuary hidden from inhabitants to eliminate disturbance and moroseness.

Figure 4-50 Circulation pattern

Sparsh Hospice, Hyderabad

THE OFFICES AND UTILITY SPACES 

Ancillary spaces such as offices, auditoriums to be places at a distance to minimize disturbance and interference.



Offices should be designed on an open plan to promote interaction and exchange of information.



Staff accommodation may be integrated within the hospice to promote companionship and provide sense of homeliness and security.

Figure 4-51 The Offices and Utility Spaces

SIRITUAL AND RECREATIONAL SPACES 

Meditation and counselling spaces should be free of religious undertones and free of any possible mental triggers.



Can be placed adjacent to open landscape spaces or be enclosed for privacy as the need may be.

Figure 4-52 Spiritual and Recreational Spaces

From the above, it may be observed that the spaces we are considering have loads of contingencies and different aspect may ensure a welcoming environment for different Sparsh Hospice, Hyderabad

individuals. Details of design such as materials, chosen plants, cultural innuendos and preferred indoor activities can be highly contextual, but the following principles may be followed:

The Hospice, from the point of view of designer is a complex typology. The Hospices in India, due to lack of options and limited resources usually function at more than the designed capacity and may be obligated to provide out -patient consultancy and services as well. The Indian Context also requires one to put greater importance on religious spirituality. While pain relief and sense of calm for patients is the priority, counselling sessions and similar sessions and awareness programs for the nurses and relatives is equally important at this stage of growth of the concept in the country. Modern Hospices being designed also need to Sparsh Hospice, Hyderabad

incorporate this need while serving their primary purpose. As most of these spaces function on volunteer funds, Trust Funds or donations, the revenue models can be also be enhanced by incorporating cultural spaces which can be let out when possible and contribute to the patient’s recreation and participation. Though the architectural requirements have been identifies above, the scope still remains at large to understand what other avenues may be explored to ensure more comfort and better mental health of inhabitants. This research has been an attempt at understanding how the spaces may be designed and planned for better experience and low expenditure, the core of palliative care growth relies on mainstream awareness and policy level recognition. Hoping that the growing Movement in India will benefit from this research when more frequent and widespread units are planned across the country.

Sparsh Hospice, Hyderabad

5. AREA PROGRAM

Sno

Description

Unit Area as per

Nos

Norms (sqm)

Case Study Unit Areas (sqm)

Proposed Unit

Proposed

Areas

Area (Sqm)

Admin / Workspace Reception and waiting lounge

90 to 110

Chairman

Managing Trustee

Treasurer

CEO

Manager Cubicles (4 Nos)

Work Stations (4 to 6 Nos)

Small Discussion Room

Board Room (Trustees) 10 to 12 capacity

55 to 60

103

100

One class room-cum-care givers meeting for 20 – 24 persons Counsellor's office

One room for Medical Director

Space for one Nursing Head

Sparsh Hospice, Hyderabad

Sno

II.

III.

Description

Nos

Norms (sqm)

Case Study Unit Areas (sqm)

Proposed Unit

Proposed

Areas

Area (Sqm)

Open / Semi-Open Nursery

Pets

150

Remembrance Space and OPD waiting area

Parking / Secluded Bikes/Cars/Ambulances parking provision exclusive for the Hospice Exclusive car and bike parking for shop owners

IV.

Unit Area as per

1166

8 x 18

1000

Patient Spaces Rooms for Counselors (4 nos)

Space for Meditation ( 5 people)

Prayer room / Faith Hall

Indoor Games Room and Gym

N/A

125

Sparsh Hospice, Hyderabad

125

Sno

Description

Unit Area as per

Nos

Norms (sqm)

Case Study Unit Areas (sqm)

Proposed Unit

Proposed

Areas

Area (Sqm)

Library and Lounge

125

150

A V Room for 40 to 50 capacity

70 to 90

103

100

Art Room

Day Care patients. Min 4 beds with facility for screening, dressing etc., and rest room In-Patients general ward/s with rest rooms and Nursing station in each ward/unit

32 to 40

200

100

1100

360

Private Wards Doctor’s consulting Rooms

Space for one Physio Therapist

Mortuary 2 beds preferably with dressing space

Saloon and Spa (steam batch etc.)

Gasp Room

Sparsh Hospice, Hyderabad

18 45

Sno

Description

Nos

Nurses and Staff dormitory with rest rooms Single/two bed room residential quarters for Doctor. Single Guest Room with rest room for visiting faculty/Doctor/any special guest Staff Lounge V.

Unit Area as per Norms (sqm)

Case Study Unit Areas (sqm)

Proposed Unit

Proposed

Areas

Area (Sqm)

800

75 to 90

520

100

Services Store room one each for Linen and mattresses, oxygen cylinder/machines, Wheel chairs &

Stretcher for each ward/unit.

VI.

Pharmacy dispensary and storage

Centralized Room for Bio waste bins

110 to 140

Utility Areas Laundry with store room and provision for drying clothes Kitchen

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140

113

150

Sno

Description

Nos

Dining Area Kitchen Store Common rest rooms for visitors/care givers and housekeeping staff One general storage room VII.

Unit Area as per Norms (sqm)

Case Study Unit Areas (sqm)

Proposed Unit

Proposed

Areas

Area (Sqm)

2 to 2.5

160

Visitor Space Charity Shop/Café

Diagnostic center

116

OP Clinic/s

Pharmacy store

Food Court

230

Florist/gift stores

Built up Area

6690

Circulation Area

2510

Total Built- Up Area

9200

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6. THE LANDSCAPE The significance of the outdoors in enhancing the building experience is indispensable. For any building that intends to provide a feeling of refuge or sanctuary, the relationship to the outdoor spaces is of essence. In the buildings such as hospitals, asylums, sanitariums and hospices where mental health and physical comfort are primary motives, the Garden is where patients prefer to spend majority of their waking hours. Within the Garden Setting, most outdoor elements have their roles in mental rejuvenation and physical reassurance. Vegetation, artwork, installation, natural elements, water bodies, seating spaces and fellow users have a way of making the garden a sanctuary for the weary eyes. As a building designer, the design of the outdoor then becomes the primary concern. The accessibility, visual connections, simplicity, inclusivity and natural preservation are the focus of the design. A healing or therapeutic Garden, as it is popularly known, may target a certain group or simply promote general well-being. Through the following research, focus has been laid on determining the essential elements and their relevance in a garden where the primary benefactors are terminal patients. Here the idea of healing is streamlined to comforting and recreation. Alongside, the idea of Memorial landscape is explored wherein the two can be interwoven to create a holistic landscape for hospice premises. The case Studies included are successful experiments in Memorial Landscapes, which are usually designed as Healing gardens, being utilized for purposes beyond and how minor strategies have gone a long way in impacting individuals in matters of stress relief, acceptance and self-actualization.

6.1 INTRODUCTION People in charge of healthcare in Ancient Greece, until the fifth century BC, gave due importance to outdoor activity and exposure to Sun and air as tools of mental and physical recovery. (Thompson & Goldin, 1975) As land became more and more scarce and healthcare grew into an industry which relied on modern machinery and technology, the hospitals became imposing institutional buildings which emphasized on facades and holding capacities. While the spiritual of Sunlight was recognized its role in hygiene was unknown up until 19th century. Similarly, natural ventilation was also treated as a contaminant in the strictly controlled environments of hospital wards. Gardens, trees and courtyards also became dispensable as demand for healthcare capacity boomed and healthcare was redefined as a money-making venture as opposed to a State Service. As hospitals came to be defined as confines sanitary spaces, the wealthy and the terminally ill tended to avoid the hospital treatments. (Verderber & Refuerzo, 2006, pp. 30-31) Sparsh Hospice, Hyderabad

Figure 6-1 Painting Depicting hospital conditions in the Middle ages

As this occurred, and housing of medical infrastructure was equally important, the hospice Movement gained momentum Worldwide. These advocates pressed for a homely environment of care and proximity to Nature and facilities to accommodate other activities and families. “Early on, we all thought of hospice as a place that would be an alternative to the medical centre with its cold architecture and emphasis on procedures. Visions of vine-covered sanctuaries in wooded settings where patients would be surrounded by nature, have good home cooked meals and where their families could stay as long as they pleased, filled our head. “ (Flood, 1984)

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Figure 6-2 Restorative garden at the Essa Flory Hospice Centre, Lancaster, Pennsylvania, allows for respite and contemplation along paths and semi-private areas

Figure 6-3Marie Curie Cancer Care, Bradford, U.K.

The discussion around the incorporation of nature in the hospice environment was introduced as a contrast to the hi-tech environment of the mega hospitals. The images above are of Modern Hospice Gardens and they adhere to the idea that proximity and exposure to outdoor elements have immense impact on general well-being. Sparsh Hospice, Hyderabad

While designing these gardens, the constraints of accessibility, space constraints, and skilled labour availability are the issues that usually arise. And as explained further, these institutions also require provision for small scale commemoration and symbolic representation of inhabitants. This results in the need for a new type of garden arrangement incorporating memorial landscape and therapeutic gardens. Recently, however, the influence of Gardens and Horticulture has gained recognition in the form of formal research. Roger Ulrich’s research in 1984 established how patients with simply an access to the view of natural outdoors required low doses of medication for pain and recovered faster. The engagement of the residents in the viewing or maintenance of the Garden has a multi-fold impact on general well-being. While taking care of plants and saplings provides a sense of engagement and purpose. This also enhances observation skills and self-esteem. The attention span and introspection also improve. Group activity and mutual interaction is also facilitated in these nurturing environments. Adapting of saplings by recovering individuals reverses dependency and is a wonderful way of battling redundancy. Similarly, simple formations, favourite spots can add layers of memories and recreational habits in an otherwise new or unknown environment. Even more widely observed is the sense of reassurance nonhuman living objects or natural elements provide for stress release and emotional expression. Small walks, assisted or otherwise, sunbathing, or even observing fauna can be not just distracting, but highly boosting for mental health. The standing feature of such setups also to facilitate exchange of knowledge about life skills and coping mechanisms. These environments provide a better platform for one on one informal interaction where knowledge on perspectives, inspiration, disability management and faith can freely flow and be passed on. As further observed in Case Studies and observed, if a substantial portion of land is available and voluntary programs are efficient, nurseries and gardens within the facility can also create fresh produce and act a source of revenue at times. Public events, school functions and horticulture patches can not only be economically viable, but windows to normal life for the patients who, if they choose to, can engage in observing or participating. Most importantly, though unmeasurable, the aesthetics of a garden are its most important feature. The oxygenated air, sky and flora are undeniably some of the simplest pleasures of life which no living being should be deprived of. (Faurest, 2020)

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6.1.1

Remembrance

Figure 6-4 Christopher House, Austin, Texas resonates remembrance through a wall mural with casts of hands of former patients

The concept of incorporating a memorial is of pressing importance in Hospitals, hospices, and therapeutic setups for both for patrons and residing patients. This can be both an indoor and outdoor feature and something of utility as well. The concept of a memorial may be permanent in the form of ward names, benches, fountains, pathways etc. An artistic rendition, such as murals, paintings, plaques, glass paintings, inscriptions are also common and can replace standard interior decorations. Semi-permanent attempts are also common in providing a lingering remembrance of former patients. These usually include plants, pets, tapestries, instruments, sports equipment or patient created artwork. The outdoor elements from the above are included within the gardens and the walkways. Moreover, these gardens are kept visible and accessible to the patients. the memorial element however demands free footfall and public engagement. Thus, the idea of creating landscapes and facility gardens that fulfil the dual need of being sanctuaries and symbolic repositories.

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6.1.2

Stone The aim of this research was to essentially understand the design requirements of the

garden for a Hospice facility. While I am fortunate enough to discover a variety of indigenous varieties of flora in and around the proposed site, what was intriguing was the exiting granite deposits on the site in the form of boulders, pebbles, red soil and outcrops. Some deposits are massive and contribute magnificently to the natural beauty of the landscape. This Research aims at understanding how to maximise the use of this rock to create the required outdoor spaces. The explorative nature of the report collects ideas applicable ideas from multiple sources to be able to identify elements that can aesthetically and functionally adorn the spaces and highlight the natural terrain and resources.

Figure 6-5 Granite Boulder Deposits on Site

Figure 6-6 Rock deposits on proposed Site

Sparsh Hospice, Hyderabad

6.2 CASE STUDIES 6.2.1

National AIDS Memorial Grove, San Francisco, Golden Gate Park Millions of people directly or indirectly affected by AIDS are able to gather in this

healing garden to heal, hope and remember. The Garden recognizes all who have faced this tragic pandemic. Both those who died and those who have shared their fight, kept vigils, and supported each other in the remaining few hours. These grounds are considered Sacred by them and are designed for to remember their pain and recognize their bravery. The National AIDS Memorial Grove stands to represent that we are never to forget the worldwide AIDS tragedy and it serves as a place to find comfort for the relatives of and friends of the victims of AIDS. A small group of San Franciscans who had lost their loved ones to AIDS conceived the National Aids Memorial in 1989. Grove 's development started in 1991. The Grove, a 7acre wooded dell, is governed by a dedicated board of directors who, through San Francisco Recreation and Park Department, have signed a 99-year renewable agreement with the City of San Francisco to maintain the Grove. It is financed privately by private and foundation’s donations. Grove 's primary gateway is the main gateway. Set up here on the 1st December 1995 World AIDS Day to mark the 7-ton boulder made of Sierra granite.

Figure 6-7Stone Marking the Entrance

Visitors can then reach an accessibility access ramp on the Woodlands Road, which extends from the main portal to the eastern part of the grove.

Sparsh Hospice, Hyderabad

Going down from the bridge, one gets to the Dogwood Crescent, home to the Circle of Friends.

Figure 6-8The Circle of friends

The access to the Friends' Circle invites you to enter one of the Grove's most visited areas. The Circle contains the names of those who have been affected by AIDS, both living and deceased. Visitors often place in the circle flowers or other memorials. 1,524 names in floor of the flagstone are presently carved. This place serves both as a Memorial and a place for gathering and healing for survivors and caregivers. (Shibley, Axelrod, & Farbstein, 2000)

Figure 6-9 Engraved Names in The Circle of Friends

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The core area serves as both a centre of group meditational activity and the space for remembrance of those who suffered.it is peculiar in its laying while also surrounding organic growth. The stone arrangement in the park creates a comfortable introspection and congregation space without unnatural interference. The Haemophilia Memorial is a separate space commemorating how the victims of an already Terminal disease were unknowingly subjects to HIV and AIDS due to sheer negligence. The idea is to provide a memorial for the terrible phenomena while creating another circle and viewing point.

Figure 6-10 The Haemophilia Memorial

Figure 6-11 Stone Memorials, Benches, Boulders

The Grove currently runs an Annual Program of patronship where donors are provided installations with messages as shown above. Relatives and friends of victims of HIV can get names incorporated in to the circle of friends. This enables newer installations without any construction of intrusion while keeping the donations acknowledged and used for more relevant purposes.

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Figure 6-12 The Seating Spaces

Figure 6-13 The Grove

The Takeaways from the NAMG 

The formal and informal use of stone in memorials and installation is extensive and granite has been a preferred material of choice.



Extensive use and retention of the original vegetation of the area.



The challenge of creating the Grove as a place of Hope rather than a Graveyard of grieving was difficult to achieve but has been tackled simply through subtle design techniques of open spaces, seemingly inconspicuous but collectively

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significant features, emphasis on natural elements and avoiding of imposing structures. 

The usage patterns encourage subtle gestures that benefit the entire ambience. For example, flowers upon a name in the Circle of Friends illicit hope and into the surrounding as opposed to grief upon a grave.



The Grove’s designers have also been unsure about avoiding of a central attraction or defined pathway within the park.



The Public Access has also been debated. The idea however remains that the memorial is entitled to the public access and recognition. Similarly letting out of spaces for funerals free of cost ensures the original aim of sensitizing people to the cause. The commercial letting out for occasions for members within and beyond the community may be seen as a part of contributing to the surrounding neighbourhood for their support and also a reminder to the regular visitors and users of the overall joyous nature of life. The groves spaced far apart also ensure calm spaces and corners for visitors wanting quiet.

The grove essentially places nature and landscape above human interventions and grand memorials and encourages small individual human gestures over massive ritualistic obligations. 6.2.2

Dora Efthim Healing Garden The garden, near Boston, is based on the Native American concept of the medicine

wheel. The garden is divided into four quadrants, or rooms, each associated with a direction, a season and a character trait. At its centre is a Rain Catcher sculpture and ancestor stones, symbolizing wisdom. It is open to the public (Faurest, 2020). “She and Cynthia Mayher, the Executive Director of Parmenter VNA & Community Care, for whom the garden was to be built, were firm in their resolve that the sculpture not be representational. I found it to be liberating. It had been stimulating experience finding a natural bolder for the base. The challenge of saying something about healing and wholeness, in the midst of nature, without using the human figure literally, my thoughts turned naturally to the beautiful stones I had been studying for the past two years at the quarry in Rockport. Among the stones that held my interest were the cut and split remnants of the quarrymen's work. The three stones of Rain Catcher made themselves known to me. The stances of the individual stones and their gestures relative to each other seemed crucial to me and the slightest changes in the angles would make the stones look all wrong. I began to think of the stones as figurative. In this way I called them the Ancestors, hoping that the name would be evocative rather than defining. Sparsh Hospice, Hyderabad

Similarly, the words Illumination, Wisdom, Introspection, and Innocence carved in low raised letters on the granite edges of the pool are meant to be secondary discoveries to the garden experience rather than defining road signs to a single or limited interpretation.” -Morgan Faulds Pike (Pike, 2020)

Figure 6-14 Layout of Garden

Figure 6-15 Dora Efthim Garden Centre

The centrepiece of the garden in Granite surrounded by pathways, benches and symbolic elements is a classic example of an abstract memorial. The case study allows understanding the artistic value of stone and its importance in traditional systems. The idea remains to commemorate through comfort.

Sparsh Hospice, Hyderabad

6.3 DERIVATION OF MAJOR ELEMENTS & DESIGN PRINCIPLES From the Above Case Studies, an attempt has been made to understand the significant elements and design principles surrounding the typology of a healing garden acting as a Memorial. 6.3.1

Design Elements

The following elements may be namely identified1. A distinct entrance or gateway- Even if symbolic or minimal, a distinct entrance has a psychological impact. Existing iconic feature such as tree or Rock may be used or an interesting artwork may be created for the same.

Figure 6-16 Gilchrist Center for Hospice Care, Baltimore, Maryland.

2. Outdoor meditation spaces which are almost isolated and surrounded by natural elements.

Figure 6-17 Houston Hospice restorative Garden integrating all kinds of spaces. Added Gazebo for mediation and small gathering spaces accompanied by the children’s park and naturally shaded pathways.

Sparsh Hospice, Hyderabad

3. Nursery for early stages of plants and for engagement of the residents in the gardening and growth process. Essential for utilization of Horticulture Therapy.

Figure 6-18 Dedicated nursery at Sun Health Hospice, Scottsdale, Arizona

4. Water Bodies, flowing or otherwise have a significant impact on the pace at which the mind works. Water bodies have a soothing effect on the senses and are a sure way of livening the environment.

Figure 6-19 Waterscape adjoining Rooms in AHI Hospice, Japan

5. Semi-Private Spaces form the basis for Hospice Gardens. As opposed to public parks and monuments, they encourage conversation, but enhance the quality of personal dialogue over public discourse.

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Figure 6-20 LaGrange Hospice providing courtyard and a variety of landscape spaces for residents

6. Children’s Play Area, ideally separated but, visually connected. This is for the patients in the pediatric ward as well as a lively focal point for other observers. This area is to be specially designed to be more engaging, artful, movement centric and designed to a more flexible scale.

Figure 6-21 Children's Play Area at George Mark Children’s Hospice, San Leandro, California

7. Art installations can be a mood enhancer. It should however be ensured that the artwork is not too abstract or complicated to cause confusion or distress.

Sparsh Hospice, Hyderabad

Figure 6-22 Stainless Steel Tree in North London Hospice

8. Integration of fauna may also be considered and provision for birdhouses, kennels or simply fish and harmless wildlife is highly encouraged. 6.3.2

Design Principles

1. Use of multitude of textures for not just accessibility but to enhance the choice of usability and accommodate various tastes and fluctuating moods. Grass, pavers, soil, pebbles and other such textures can make a limited space capable of a wider range of sensations. In case of land constraints, the most fulfilling materials need to be identified and utilized.

Sparsh Hospice, Hyderabad

Figure 6-23 Seirei-Mikatagahara Hospital Hospice, Shizuoka Prefecture, Japan

2. Visibility from living spaces through windows, balconies, courtyards etc.

Figure 6-24 Bear Cottage Children’s Hospice, New South Wales, Australia demonstates low contact but high visual connection to nature

3. Maintain the original landscape of the context as far as possible to avoid artificial look or mount unnecessary expenditure. Therefore, minimized hardscaping should be the norm.

Sparsh Hospice, Hyderabad

Figure 6-25 Sun Health Hospice, Scottsdale, Arizona maintains natural desert landscape

4. Enhanced feeling of belongingness and control should be encouraged. Users should be aware that there is a garden, easy access and use. Patients should feel free to choose between the various and the different areas. Healing gardens should be designed with special areas that cannot be seen from the windows to achieve privacy and a sense of isolation for those who want to. In the construction of the greenhouse, all or any of the five senses can be selected as focal stimuli that enhance cognitive efficiency and boost control feelings. (Vapaa, 2002) 5. Emphasis on the soft landscape promotes the sense of well-being of patients, so that green materials should also dominate the design of the garden, reducing the hardscape to the lowest level so that trees, shrubs and flowers form around 70 per cent of the garden, with 30 per cent in the corridors and squares. (Franklin, 2012) 6. Well defined pathways encouraging movement and transition helps in absorbing variety and refreshment. The designs should provide easy access and a sense of independence, as well as alleviate the feeling of stress by providing patients with structural elements such as walking trails to encourage exercise and play areas for children. (Severtsten, 2006) 7. Care is to be taken in providing seating and meeting spaces of sufficient size and comfort for Contact in the garden with other patients and family members. This strengthens the patient's mental environment (Ulrich, 1999)The design of a healing garden that encourages conversations and social networks between groups of patients and visitors can facilitate social support. (Momtaz, 2017) 8. The urban intrusions should be minimized or blocked out efficiently to prevent negative distractions. Noise, harsh lights, smoke, and pollution need to be blocked out as far as possible.

Sparsh Hospice, Hyderabad

9. Special focus on complete accessibility to cater to all patients. 10. Flexibility in terms of garden arrangement to accommodate any future changes that may be necessary.

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6.4 RELEVANT LANDSCAPE FEATURES IN STONE

Figure 6-26 Landscape of Stone

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7. CONCEPT DEVELOPMENT

Figure 7-1 Component of Palliative Care

Palliative Architecture happens to be the Architecture of compassion. As learnt from above, it has been established that the aim remains to provide a homely space for a peaceful and loving experience.

Figure 7-2 Palliative Architecture as Architecture of Compassion - A concept

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The aims to be achieved through this are-

Figure 7-3 Design Aims of the Project

The above figure and chart here explain how design principles will be followed in designing a space that fulfils the criteria laid down. With abundance of choice of movement, view and arrangement and pathways, the patients are given freedom to choose what comforts them the most, physically and mentally. The emphasis on Landscape and its integration is essential and there is an attempt to merge it with the concept of Remembrance.

Figure 7-4 Stone, Landscape and Remembrance - A concept

This highlights how Nature is integrated within the interiors through the material of the surroundings and the indoor is oriented towards the outdoor. Remembrance also utilises long lasting element of stone and while occupying usable spaces. The enhancement of this concept and the derived principles into a coherent space is the aim of the design.

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7.1 BUBBLE DIAGRAM

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8. DESIGN PROPOSAL The design has been developed keeping in mind the above principles and ideas. 

All building footprint avoids existing vegetation.



Water bodies have been provided in relatively flat or low lying areas so that they enhance the microclimate of the space.



The Stack effect has been used through roof openings and high roof.



The scale is kept human centric and the form outdoor oriented.



Every external corridor is abutted by a nursery to keep patients engaged and busy.



Every nook is accessible through ramp.



The contours have necessitated the formation of 3 distinct level. The first level houses the commercial areas, the offices, the staff residence, Public Park, parking etc.



The second level proceeds to accommodate the administration, spa and AV room, open gardens on one end and the services such as store, laundry, waste disposal etc in the other wing.



The third level is an exclusive Patient space with flexible ward layouts, corridors with seating, gardens and water bodies.



A built- up of 92000 square metres has been achieved.

8.1 THE SITE

Figure 8-1 Site Plan

For a detailed Site plan, refer to Annexure I.

Sparsh Hospice, Hyderabad

Figure 8-2 Site Section

8.1.1

Service Layouts

Figure 8-3 Service Layouts

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8.1.2

Site Sectons

Figure 8-4 Site Sections

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8.2 LEVEL 1 DESIGN

Figure 8-5 LEVEL 1 GROUND PLAN (Plinth at +450mm)

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Figure 8-6 LEVEL 1 - 2ND FLOOR PLAN (FFL at +3950)

Figure 8-7 WAITING, OPD and Day-care Plan

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Figure 8-8 Section XX'

Figure 8-9 COMMERCIAL AND ADMIN BLOCK PLAN

Figure 8-10 Section XX' (COMM. BLOCK)

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Figure 8-11 Staff Residence Plans

Figure 8-12 Staff residence Section XX'

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8.3 LEVEL 2 DESIGN

Figure 8-13 LEVEL 2 GROUND PLAN

Sparsh Hospice, Hyderabad

Figure 8-15 LEVEL2 West Wing Plan

Figure 8-14 LEVEL 2 East Wing Plan

Figure 8-16 LEVEL2 Section YY'

Figure 8-17 LEVEL2 Section YY'

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8.4 LEVEL 3 DESIGN

Figure 8-18 LEVEL 3 GROUND PLAN

Sparsh Hospice, Hyderabad

Figure 8-19 Section XX'

Figure 8-20 Variable Ward Layout

Figure 8-21 The Rememberance Garden

Sparsh Hospice, Hyderabad

BIBLIOGRAPHY Abel, J. (1986). The hospice movement: institutionalising innovation. International Journal of Health Services 16, 71-85. Chatto, B. (2106). Drought Resistant Palnting : Lessons from Beth Chatto's Gravel Garden. London: Frances Lincoln. Davis, A. E. (2002). The telling and knowing of dying: philosophical bases for hospice care in Japan,. International Council of Nurses. Nagano,Japan. Faurest,

(2020,

April

25).

www.levego.hu.

Retrieved

from

www.levego.hu:

https://www.levego.hu/sites/default/files/kapcsolodo/healinglandscape-en.pdf Flood, C. T. (1984). The Evolution of Hospice. The American, Winter: 82–84. Franklin, D. (2012). How Hospital Gardens Help Patients Heal. Scientific American Magazine, 3. Johnsen, J. (2017). The Spirit of Stone. Pittsburgh: St. Lynn’s Press. Kaufman, S. (1997). Intensive Care, Old Age, and the Problem of Death in America. The Gerontologist, 715–725. M Mills, H. D. (1994). Care of dying patients in hospital. British Medical Journal 309, 583-586. Manning, M. (1984). The Hospice Alternative: Living and Dying. London: Souvenir Press. Mansfield, S. (2009). Japanese Stone Gardens. Tokyo: Tuttle Publishing. Momtaz, R. I. (2017). Healing Gardens- A Review of Design Guidelines. International Journal of Current Engineering and Technology. Nolan M., G. G. (1995). Busy doing nothing: activity and interaction levels amongst differing populations of elderly patients. Journal of Advanced Nursing 22, 528-538. Pike,

(2020,

May

26).

http://morganfauldspike.com.

Retrieved

from

http://morganfauldspike.com: http://morganfauldspike.com/rain-catcher/index.html Rajagopal, M. (2015). The Current Status Of Palliative Care In India. Cancer Mangement, 5761. Rajagopal, M., & Joranson, D. (2007). India: opioid availability – an update. Pain Symptom Manage, 615-622.

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Rasmussen, B. S. (1997). How patients spend their time in a hospice and in an oncological unit. Journal of Advanced Nursing, 28(4),, 818-828. Severtsten, B. (2006). Major Foundation. Retrieved from www.majorfoundation.org: http://www.majorfoundation.org/campaign-for-the-beautiful.htm Shibley, R., Axelrod, E., & Farbstein, J. (2000). National Aids Memorial Grove. In R. Shibley, E. Axelrod, & J. Farbstein, Commitment to Place : Urban Excellence and Community (pp. 68-96). Charlestown: Bruner Foundation. Thompson, & Goldin. (1975). Ulrich, R. (1999). Effects of gardens on health outcomes: Theory and research. In InC. V.Mor. (1987). Hospice Care Systems: Structure, Process, Costs and Outcome. New York: Springer. Vapaa, A. (2002). What are defining characteristics that make a healing garden? A thesis for Master’s of Landscape Architecture. College of Architecture and Urban Studies. Virginia Polytechnic Institute and State University,. Verderber, S., & Refuerzo, B. (2006). Innovations in Hospice Archiecture. Abingdon, Oxon: Taylor & Francis. Yamazaki, F. (1990). Dying in a Japanese Hospital. Tokyo: The Japan Times.

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ANNEXURE 1

The following are the presentation handouts and drawings-

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Figure 0-1Site Plan

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Figure 0-2 Level 1 plan

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Figure 0-3 Level 2 plan

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Figure 0-4 Level 3 Plan

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Sparsh Hospice Design - Architectural Thesis

Articles inside

Figure 5-10 Sun Health Hospice, Scottsdale, Arizona maintains natural desert landscape

Figure 5-7 Stainless Steel Tree in North London Hospice

Figure 6-19 A Rock Waterfall at George Mark Children’s Hospice, San Leandro, California

Figure 4-17 Nursery and Backyard Garden at Karunasharay

Figure 4-8 Layout of Garden

Figure 1-6 Rock deposits on proposed Site

Figure 4-7The Grove

Figure 4-1Stone Marking the Entrance

Figure 1-4 Christopher House, Austin, Texas resonates remembrance through a wall mural with casts of hands of former patients

Figure 1-3Marie Curie Cancer Care, Bradford, U.K

Figure 1-1Painting Depicting hospital conditions in the Middle ages Figure 1-2 Restorative garden at the Essa Flory Hospice Centre, Lancaster, Pennsylvania, allows for respite

and contemplation along paths and semi-private areas

Figure 1-5Granite Boulder Deposits on Site