Innovations in Hospice Architecture

Stephen Verderber, Ben J. Refuerzo

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000733389
• Edition: 2
• Topic: Architecture
• Subtopic: Architecture General

This fully revised, new edition of Innovations in Hospice Architecture responds to the need for an up-to-date, theoretically based reference book summarizing key historical and recent developments with respect to this rapidly evolving building type. This Second Edition presents:

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• an overview of the historical origins of the contemporary hospice

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• the diverse variations on the basic premise of hospice care

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• a review of the scant architectural literature published on this subject to date

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• a broad series of case studies of exemplary hospices around the world

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• planning and design concepts for palliative care environments.

Case study projects are from Japan, Canada, Europe, Africa, Australia, Indonesia, China, the United States and South America. Thirty-six case studies are individually presented and comparatively analysed, and prognostications for the future of hospice architecture are examined. Each case includes floor plans, technical drawings and beautiful, full colour illustrations. Through an in-depth discussion of the inner profundities of hospice architecture, the book presents this type as a humane, genuine expression of the spiritual, physical and psychosocial dimensions of the contemporary death and dying movement. Written with a broad audience in mind, the book provides both technical and conceptual information, blending narrative, images and diagrammation so that the audience may understand and articulate the complexities of this specialized building type in professional practice contexts.

PART 1

A history of hospice

CHAPTER 1

An architectural history of hospice

The old idea of one hospital to satisfy all needs is a thing of the past . . . we need a series of institutions . . . in the terminal situation, the family is as necessary as any other form of care. But we exclude families from intensive care units . . . we’ll need [care settings] where humanity won’t have to overcome the technical apparatus.

John D. Thompson (1975)¹

Medical technologies of the twenty-first century dazzle our imagination. They shield us, or so it seems, against deformity, disease, even death. A patient can be kept alive for years even if their brain has ceased to function. Such a patient is light years removed from the dying patient in a medieval monastic ward hospital. The more cures we discover, the worse death appears as an option. Western culture, in particular, remains, for the most part, unable to be reconciled with death or its inevitability. We tend to blame death on some failure of medical science. In institutions where the dying were once housed in the not so distant past, avoidance was the norm, so much so that people would cross a road in order to walk on the far side, altogether avoiding the place for death as if it were a leper colony. Even within the contemporary hospital milieu, this denial reigns. Hospitals around the world continue to hide their dying patients away from their activity centers, relegating them to rooms at the far end of long, bleak corridors. The culture of denial is highly choreographed.²

From the earliest Neolithic settlements in Mesopotamia, as long ago as 50,000 years, cave dwellers set aside ‘nests’ reserved for the care of their sick and dying. Neolithic cave paintings attest to the need to grieve the dead and for their proper burial. For centuries, scholars considered death and dying off limits, as if to do otherwise would acknowledge Satan. Death was associated with the devil, witchcraft, and darkness. By the fourteenth century the Catholic Church had outlawed all exorcisms and forms of witchcraft on pain of being burned at the stake. This form of death was a means of ensuring that the condemned would be consigned to an eternity in Hell. In the painting The Triumph of Death (c. 1562), by Pieter Brueghel the Elder (c. 1520–69), the ‘fumes’ ultimately overcome all (Figure 1.1). By contrast, in ancient Egypt the dead were provided with all the accoutrements they would need for a comfortable afterlife. In Egyptian culture the afterlife was considered far better than life on earth.

1.1 The Triumph of Death (1562) portrays the timelessness of the struggle between life and death

By the eighteenth century, gradual developments in religious and medical protocols had transformed Western traditions surrounding death, dying, and grieving. For centuries, Christian ­tradition preordained the primary role of family members, with their responsibility for nursing their dying relative and gathering around the deathbed to seek reconciliation. After the person’s death, a church funeral, a parish burial, and a period of public mourning aided in tempering the inevitable pangs of loss and grief. Hospitals and commercial undertakers, by contrast, are much more recent innovations of the nineteenth and twentieth centuries.³

The word hospice stems from the Latin word ‘hospitum’, meaning guesthouse. Its earliest uses describe places of shelter – waystations – for sick and weary travelers returning from religious pilgrimages and other lengthy, arduous journeys throughout Europe and lands beyond. Hospice quarters were available at many of the monastic hospitals operated by various religious orders during the Middle Ages. Provisions often consisted of private rooms, for those who could afford to pay or barter in return for shelter and respite, or those simply too sick and infirm to travel any farther. In a seventeenth-century Batavia painting, part of a collection on Chinese medicine, a Chinese doctor is depicted taking the pulse of a terminally ill man (Figure 1.2). Gradually, evolving religious doctrine increasingly separated grief from public ritual. The act of mourning shifted more and more to the private realm, becoming the primary responsibility of the family. Christian tradition had held that the dead must await Judgment Day before being transported into Heaven (or elsewhere). Nineteenth-century popular sentiment, by contrast, favored the image of the dying being immediately rapt into Heaven; the belief was that as other family members died, they would immediately rejoin their beloved deceased. The family was, as a consequence, obliged to tend to the memory of its dead, to erect marked graves, to visit cemeteries for moments of recollection and meditation, and to vigilantly preserve and enhance the belief that the family would one day be reunited in Heaven.⁴

1.2 A Chinese doctor taking the pulse of a sick man in the man’s home. Home has been the preferred setting for dying for most of recorded civilization

A hospice for the dying was opened in Lyon, France, in 1842, by Mme Jeanne Garnier, but the use of the term ‘hospice’ was applied in this case as but one interpretation of a general French term. Our Lady’s Hospice at Harold’s Cross, Dublin, was opened in 1879 by the Irish Sisters of Charity, and in all likelihood represents, according to Grace Goldin, the first use of the term in the modern sense in the English language. It was not a hospital, by any means, for in their description:

No one comes here expecting to be cured, nor is it a home for incurables, as the patients do not look forward to spending years in the place. It is simply a ‘hospice’ where those are received who have very soon to die, and who know not where to lay their weary heads.⁵

At the same time, religious sentiment was evolving in rapidly urbanizing industrial societies, as more and more people were now living in new surroundings, remote from the village of their birth. Families emigrated from their homeland to new nations, from rural communities to cities, migrating from enclave to enclave within the Industrial Age city and, decades later, to its burgeoning suburbs. No longer was the immediate community able to be either held responsible for or even directly knowledgeable of its deceased members. Notable exceptions to this were local community leaders, religious clergy, and politicians. As a consequence, the local undertaker, and a new building type, the funeral home, i.e. a home-like building, and its main room, the parlor, appeared on the scene. In the homes of families of means, the main parlor was where the body was placed for public viewing prior to burial. The funeral parlor would supplant the former centrality of the family and the family residence as the place where death, dying, grieving, and reconciliation occurred. The funeral ‘home’ sought to replicate as closely as possible the ambiance, dignity, and status once occupied by the family home. The undertaker would henceforth function as the ‘manager’ of death by offering families a menu of prepackaged rituals from which to choose. For persons without family or those families without means, almshouses for the aged had been established, predating the Industrial Age city by more than 300 years. These residences would evolve over time into an autonomous building type of their own. The residents, referred to as pensioners, lived independently for as long as possible. Many almshouses operated in the U.K. and elsewhere in Europe by the end of the nineteenth century. Some decades later, in the aftermath of the Second World War, the almshouse would succumb to the International Style modernist nursing ‘home’.

The conditions at Harold’s Cross in the 1880s were in stark contrast to the conditions of the typical hospital at the time, as hospitals continued to be described as ‘cold and impersonal’. This hospice, perhaps the first nonprofit hospice in the contemporary sense, was supported from donations, and even minuscule sums donated by the poor, who might hope to reside there ‘before the earth receives them’.⁶ Twelve years after the founding of Harold’s Cross, in 1891, Trinity Hospice was founded in London. Trinity is the oldest full-fledged hospice in England. The first appeal letter by Colonel William Hoare appeared in The Times of London on Christmas Day in that year. Having raised the 2,000 pounds needed, this successful appeal enabled the Anglican Order of St James’s Servants of the Poor to open a hospice, which became known as the Free Home for the Dying, at 80 and 82 The Chase, Clapham, in London. Royalty supported Trinity Hospice from its beginnings: Queen Alexandra became the hospice’s first patron while still Princess of Wales. Two beds were named in her honor in 1902, and she saw to it that thereafter this hospice would receive funding from collections on Alexandra Day each year.

On the death of the Queen in 1926, the Duchess of York took on the role of patron, which, as Queen Mother, she occupied until her death in 2002. Trinity grew in stature if not in physical size in the intervening decades: in 2000, it operated three wards for inpatient care, housing a total of thirty beds. St Michael’s is the largest of the wards, with thirteen beds, and is situated on the ground floor. All the bedrooms look onto a beautiful restorative garden, to which there is direct access for the patient. St Margaret’s Ward is on the second level in one of the Georgian buildings. It houses seven beds and rooms overlooking gardens, trees, and the lawns of the adjoining Clapham Common. A mechanical lift was installed some decades ago to provide for physical access. Here, most patients share semi-private rooms, each with three beds, although some single rooms are available. There is a dayroom on each ward for patients’ and visitors’ use, as well as a small private consultation room. Elizabeth Clark Ward has ten beds and is located upstairs in another of the Georgian buildings. Its configuration is nearly identical to that of St Margaret’s Ward.⁷

By the time St Joseph’s Hospice, shown here in a photo taken in 1907, was founded in London, in 1905, hospice, as a specialized building type, was becoming somewhat known in London society (Figure 1.3). In 1900 a Jesuit priest had implored the Irish Sisters of Charity to come to London to care for the sick and poor in the East End. Five of them responded, who:

1.3 St Joseph’s Hospice, London, U.K. This was among the earliest institutions to provide care for the dying in London, and has since served as an architectural precursor to the contemporary hospice movement

Went down daily into the cellar-like compartments of the destitute . . . there was no mistaking the heartfelt relief and gratitude of the bedridden . . . as they felt their face and limbs being sponged, their hair cleansed of lice, fragrant night attire put on them, their pallet given an aspect of tidy wholesomeness, with the odd flower to add its quota of happiness.⁸

Trinity Hospice and St Joseph’s Hospice would function as two important precursors to St Christopher’s Hospice (see below). Another important precursor was St Luke’s Home for the Dying Poor, founded in 1893 by Dr Howard Barrett. Unbelievably, this hospice had been in the planning for twenty-seven years. Three qualifications had to be met for admittance to St Luke’s: the applican...