STUDY FOR UNDERSTANDING THE ROLE OF

ARCHITECTURE IN HOSPICES

SEVENTH & EIGHTH SEMESTERS

B. ARCH DISSERTATION

Submitted by
JESLINE JOSE
14055017

MANGALAM SCHOOL OF ARCHITECTURE AND PLANNING

PARAMPUZHA, PERUMBAIKKAD P.O.
Kottayam – 686028

JUNE 2018
 STUDY FOR UNDERSTANDING THE ROLE OF
ARCHITECTURE IN HOSPICES

SEVENTH & EIGHTH SEMESTERS

B. ARCH DISSERTATION

Submitted in partial fulfillment of the requirement for the award of

Bachelor’s Degree in Architecture of Mahatma Gandhi University

Submitted by
JESLINE JOSE
14055017

Guided by
Ar. SNEHA ANN PHILIP

MANGALAM SCHOOL OF ARCHITECTURE AND PLANNING

PARAMPUZHA, PERUMBAIKKAD P.O.
Kottayam – 686028

JUNE 2018
 JUNE 2018

MANGALAM SCHOOL OF ARCHITECTURE AND PLANNING

PARAMPUZHA, PERUMBAIKKAD P.O.
Kottayam – 686028

CERTIFICATE

This is to certify that this dissertation titled ‘Study for Understanding the Role of Architecture
in Hospices’ is a bonafide record of the study presented by Jesline Jose, under our guidance
towards partial fulfillment of the requirement for the award of Bachelor’s Degree in Architecture
of Mahatma Gandhi University, during the year 2018.

GUIDE PRINCIPAL
Ar. Sneha Ann Philip, Ar.K.Narayanan
Asst. Professor, Professor,
Mangalam School of Architecture and Planning, Mangalam School of Architecture and Planning,
Kottayam Kottayam

EXAMINERS
DISSERTATION
 CO-ORDINATOR
 Ar. Sharon Joseph
Asso. Professor,
 Mangalam School of Architecture and Planning,
Kottayam

1
 DECLARATION
I hereby declare that the dissertation titled ‘Study for Understanding the Role of Architecture
in Hospices’ was carried out by me during 2017-18 in partial fulfillment of the requirement for
the award of Bachelor’s Degree in Architecture of Mahatma Gandhi University. This
dissertation is my own effort and has not been submitted to any other University.

Kottayam, (Signature)
June 2018 Jesline Jose

2
 ACKNOWLEDGEMENT

I take this opportunity to thank all those who have helped me in carrying this study. First of all, I
thank my friends with whom I explored the most; Ar. Sneha Ann Philip, who has been there to
guide me right from the beginning; Prof. KM Joseph, Dr.RajaGopal, Sr.Anamma Mathew,
Chacko Homes, Signature & Paradise Hospices and various good-willed people for spending
their precious time with me and helping me to gain much for this study throughout the project.
Above all I am indebted to my family, especially my grandmother, who inspired me to take this
topic.

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 ABSTRACT

Architecture is a powerful tool for mental & physical therapy. Architecture could be a balm for
healing, altering our attitudes, reforming our lifestyle, so on. Almost all buildings contribute to
Emotional Architecture, but not all of them are successful enough in generating the right moods
needed for that building type. Health care units are one such category of buildings that fail to
cater and compose the right ambience for its occupants. Spaces that should treat and heal usually
leaves the occupant hopeless and stressed. Terminally-ill patients are the worst affected as their
surroundings sadly deteriorates their health and will-power.
Thus, this study is to guide designers for creating a better ‘last home’ for the terminally ill.

4
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION ................................................................................................. 11
CHAPTER 2: POWER of ARCHITECTURE ............................................................................. 12
CHAPTER 3: HEALING THROUGH ARCHITECTURE ......................................................... 13
3.1. SPATIAL PERCEPTION .................................................................................................. 13
3.1.1.Atmospheres in the arts ................................................................................................ 13
3.1.2.Recognition of place and space .................................................................................... 13
3.1.3.Atmospheric intelligence – a capacity of the right hemisphere.................................... 13
3.1.4.Space and imagination .................................................................................................. 14
3.1.5.‘Understanding’. The artistic image ............................................................................. 14
3.2. EMOTIONAL aspect of ARCHITECTURE ..................................................................... 15
3.2.1.Emotions& Architecture ............................................................................................... 15
3.2.2. Types of emotions ....................................................................................................... 15
3.2.3. Science behind emotions ............................................................................................. 16
3.3. FACTORS .......................................................................................................................... 17
3.3.1. HUMAN PSYCHOLOGY .......................................................................................... 17
3.3.2.Design influence on Emotions ...................................................................................... 17
CHAPTER 4. ALTERNATIVE MEDICINE ............................................................................... 20
4.1.Healing with Sounds and Frequencies ............................................................................... 20
4.1.1.Auditory Sound............................................................................................................. 20
4.1.2. Music ........................................................................................................................... 20
4.1.3. Solfreggio Frequencies ................................................................................................ 21
4.2. Fragrance ............................................................................................................................ 21
4.3. The Sacred Geometry ......................................................................................................... 22
4.4.The Effect of Light & Sight ................................................................................................ 22
4.4.1.Light.............................................................................................................................. 23
4.4.2.The Effect of Colour ..................................................................................................... 23
4.5. Touch Sense ....................................................................................................................... 24
4.5.1. Crystal Healing: ........................................................................................................... 24
4.6.The Future of Healing ......................................................................................................... 25
CHAPTER 5: HOSPICE............................................................................................................... 27

5
 5.1. HISTORY........................................................................................................................... 27
5.2. SCOPE ............................................................................................................................... 27
5.3. EMOTIONAL ASPECT OF HOSPICES .......................................................................... 28
5.3.1. EMOTIONS FACED IN HOSPICES ......................................................................... 28
Emotions as you near the end of life ..................................................................................... 28
Fear ........................................................................................................................................ 28
Anger ..................................................................................................................................... 28
Guilt and regret ...................................................................................................................... 28
Grief ....................................................................................................................................... 29
Anxiety and depression ......................................................................................................... 29
Feeling alone.......................................................................................................................... 29
Seeking meaning.................................................................................................................... 29
5.4. HOSPICE DESIGN............................................................................................................ 30
5.4.1.Natural Light................................................................................................................. 30
5.4.2.Building Facades .......................................................................................................... 30
5.4.3.Greener Areas ............................................................................................................... 30
5.4.5.Interiors ......................................................................................................................... 30
5.4.5.Treatment methodology................................................................................................ 30
5.5. GLOBAL EFFORTS ......................................................................................................... 31
CHAPTER 6: DESIGN TOOL KITS ........................................................................................... 32
6.1. UK King’s Fund ................................................................................................................. 32
6.1.1.Natural Environment .................................................................................................... 32
6.1.2.Natural materials........................................................................................................... 32
6.1.3.Legibility ...................................................................................................................... 32
6.1.4.Dignity .......................................................................................................................... 32
6.1.5.Comfort ......................................................................................................................... 32
6.1.6.Robustness and economy.............................................................................................. 32
6.1.7.Respecting time ............................................................................................................ 32
6.1.8.Beauty ........................................................................................................................... 32
6.1.9.Arts and crafts ............................................................................................................... 32
6.2. Hospice for Childcare, Dublin 2 .................................................................................... 32
6.2.1.General principles of design ......................................................................................... 32

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 6.3. The Hospitable Hospice Handbook.................................................................................... 33
6.3.1. The Open Hospice ....................................................................................................... 33
6.3.2.Care Hub ....................................................................................................................... 33
6.3.3.Launching a Palliapp .................................................................................................... 33
6.3.4.Giving freedom of Speech & Act ................................................................................. 33
6.4. END-OF-LIFE ARCHITECTURE, Works, Thesis, Case studies ..................................... 33
CHAPTER 7: LITERATURE CASE STUDIES .......................................................................... 34
7.1.St.Michael’s Hospice [2017 RIBA West Midlands Regional Award Winner]................... 34
7.2. Rwanda Hospital by Michael Murphy ............................................................................... 37
7.3. Hospice CareCenters,USA ................................................................................................. 38
7.4. CONCLUSION .................................................................................................................. 39
CHAPTER 8: HOSPICE in INDIA ............................................................................................. 40
8.1. KARUNASHRAYA- Bangalore Hospice Trust ................................................................ 40
8.2. BHAKTIVEDANTA HOSPICE ........................................................................................ 44
CHAPTER 9: LIVE CASE STUDIES: HOSPICE IN KERALA ................................................ 46
9.1.Institution with care for terminally ill ................................................................................. 47
9.1.1Chacko Homes, Aluva – Senior Residents .................................................................... 47
9.1.2.Signature Hospice ......................................................................................................... 49
9.1.3.Paradise Hospice........................................................................................................... 51
9.2. Home Care door-to-door service ........................................................................................ 53
9.2.1.A day with Palliative care Karunya .............................................................................. 53
9.2.3.Karunya Palliative Care ................................................................................................ 54
9.3. Interviews and Talks .......................................................................................................... 54
9.3.1.Dr.RajaGopal ................................................................................................................ 54
9.3.2. SrAnnamma Mathew .............................................................................................. 55
CHAPTER 10: Inferences – Hospice Design Recommendations ................................................ 56
CHAPTER 11: Design Recommendations for Hospices in Kerala ............................................. 58
11.1.Tactile: Overall Spatial Requirements: ............................................................................. 58
11.1.1.Home-like setting ....................................................................................................... 58
11.1.2.Rooms ......................................................................................................................... 58
11.1.3.Miscellaneous: ............................................................................................................ 60
11.2.Non-Tactile: Spatial Perception by each of our Senses .................................................... 61

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 11.2.1.Sight ............................................................................................................................ 61
11.2.2.Smell ........................................................................................................................... 63
11.2.3.Ears ............................................................................................................................. 64
11.2.4.Touch .......................................................................................................................... 64
11.2.5.Space and Form .......................................................................................................... 64
11.2.6. Summary.................................................................................................................... 65
ANNEXURE I: SYNOPSIS ......................................................................................................... 66
ANNEXURE II: Study Strategy ................................................................................................... 67
ANNEXURE III: QUESTIONNAIRE ......................................................................................... 68
REFERENCES ............................................................................................................................. 69
BIBLIOGRAPHY ......................................................................................................................... 70

LIST OF TABLES
TABLE 1. CHACKO HOMES INFERENCES 48
TABLE 2. SIGNATURE HOSPICE INFERENCES 50
TABLE 3. PARADISE HOSPICE INFERENCES 52
TABLE 4. DOOR-TO-DOOR CARE 55
TABLE 5. METHODOLOGY 67

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LIST OF FIGURES
FIGURE.1FORM AND SHAPE-CURVES MEANING WARMTH ........................................................................................15
FIGURE 2COLOUR, LIGHT & SHADOW, RHYTHM, BALANCE AND SYMMETRY ............................................................15
FIGURE.3WELL-LIT SPACES WITH GOOD VENTILATION AND INDOOR PLANTS; SOCIAL..............................................19
FIGURE.4NATURAL ELEMENTS ....................................................................................................................................19
FIGURE5MANAGING SPACE AND AMBIENCE ..............................................................................................................19
FIGURE.6SOCIALIZING/COMMUNAL SPACES ..............................................................................................................19
FIGURE.7ST.MICHAEL'SHOSPICE,UK ............................................................................................................................34
FIGURE.8IMAGE OF A SOCIAL CLUSTER SPACE ACTING AS A BUFFER BETWEEN PUBLIC STREET, CORRIDOR AND
PATIENT BEDROOMS. THE SPACE OFFERS OPPORTUNITY FOR ALL TO INTERACT AND SOCIALISE AND GIVES
RELATIVES A MOMENTARY ‘BREATHING’ SPACE AWAY FROM SOME INTENSELY EMOTIONAL S(NICKY WEST,
CEO, ST. MICHAEL'S HOSPICE) ...........................................................................................................................35
FIGURE.9BRICK CLADDING...........................................................................................................................................35
FIGURE.10CENTRAL DOUBLE HEIGHT CIRCULATION PACE..........................................................................................35
FIGURE.11SEMI-PRIVATE GARDEN ..............................................................................................................................35
FIGURE.12EXTERNAL STREET VERANDAH ...................................................................................................................36
FIGURE.13WELL-DESIGNED WELCOMING ENTRYWAY ................................................................................................36
FIGURE.14PLAN ...........................................................................................................................................................36
FIGURE.16.1. WARDS WITH VIEWS..............................................................................................................................37
FIGURE15THE LO-FAB WALL- EFFORT BY THE COMMUNITY .......................................................................................37
FIGURE.18OUTDOOR VERANDAHS .............................................................................................................................. 37
FIGURE.17DOCTORS QUARTERS ..................................................................................................................................37
FIGURE.19WAUD HEALING GARDEN ........................................................................................................................... 38
FIGURE.20COSY HOME-LIKE ROOMS ........................................................................................................................... 38
FIGURE.21NATURE EMBEDDED GARDEN ....................................................................................................................38
FIGURE.22KARUNASHRAYA HOSPICE .......................................................................................................................... 40
FIGURE.23STONE EXTERIOR ........................................................................................................................................41
FIGURE.24AERIAL VIEW ...............................................................................................................................................41
FIGURE.25WARDS FRONTED BY POOLS .......................................................................................................................41
FIGURE.26BUFFER SPACES...........................................................................................................................................41
FIGURE 27BEAUTIFUL POOL VIEWS .............................................................................................................................43
FIGURE.28NATURAL MATERIALS, SEMI-OPEN VERANDAHS........................................................................................43
FIGURE.29POOLS AND COURTYARDS .......................................................................................................................... 43
FIGURE.30SHADOW PLAY IN THE HOSPICE PATHWAYS ..............................................................................................43
FIGURE.31BHAKTI VEDANTA HOSPICE COUNSELLING.................................................................................................44
FIGURE.32A.HOSPICEBUILDING ; B. WELL-LIT AND SPACIOUSTYPICAL ROOM ...........................................................44
FIGURE.33COMMUNAL SPACE IN ROOMS ..................................................................................................................45
FIGURE.34ENTERTAINMENT BY COMMUNIT ..............................................................................................................45
FIGURE.35WARDS ........................................................................................................................................................45
FIGURE.36DURING CELEBRATIONS-BHAKTIVEDANTA .................................................................................................45
FIGURE.37CHACKO HOMES .........................................................................................................................................47
FIGURE.38EXTERNAL VERANDA WITH OPENINGS .......................................................................................................47
FIGURE.39STAIR LANDING HAS SPACES FOR SOCIALIZING..........................................................................................47
FIGURE.40CENTRAL COURTYARD ................................................................................................................................47
FIGURE.41PLAN TYPICAL .............................................................................................................................................48
FIGURE.42SINGLE UNIT................................................................................................................................................48
FIGURE.43SIGNATURE HOSPICE ..................................................................................................................................49
FIGURE.44SINGLE UNIT TYPICAL ..................................................................................................................................50
FIGURE.45PARADISE HOSPICE TYPICAL FLOOR 3D ......................................................................................................50
FIGURE.46PARADISE HOSPICE .....................................................................................................................................51

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FIGURE.47TYPICAL FLOOR LAYOUT-SINGLE ROOM .....................................................................................................52
FIGURE.48COUNSELLING, SOCIALIZING....................................................................................................................... 53
FIGURE.49TREATMENT AND CHECKUP .......................................................................................................................53
FIGURE.50NATURALLY-LIT AND VIEW ......................................................................................................................... 58
FIGURE.51DEFINED PATHWAYS...................................................................................................................................58
FIGURE.52SPACE FOR FAMILY TO CONGREGATE IN SINGLE ROOM FACILITY .............................................................59
FIGURE.53SPACE FOR FAMILY .....................................................................................................................................59
FIGURE.54BEAR COTTAGE CHILDREN’S HOSPICE, .......................................................................................................59
FIGURE.55HOSPICE OF THE CENTRAL COAST, .............................................................................................................59
FIGURE.56ST CHRISTOPHER’S HOSPICE, LONDON GARDEN ........................................................................................60
FIGURE.57ST CHRISTOPHER’S HOSPICE, LONDON ......................................................................................................60
FIGURE 58BEREAVEMENT SUITES, ST JAMES’S HOSPITAL ...........................................................................................60
FIGURE.59BEREAVEMENT SUITE COMMUNAL ROOM ................................................................................................60
FIGURE.60MEDITATION AND WORSHIP ......................................................................................................................61
FIGURE..61MARIE CURIE CANCER CARE:RESTORATIVE LANDSCAPES INCLUDE PATHS, SEATING, GARDENS, AND
CLOSEPROXIMITY TO THE MAIN HOSPICE .........................................................................................................61
FIGURE.62EACH INPATIENT BEDROOM AT THE AHI HOSPICE, AICHI PREFECTURE, JAPAN, WAS CONCEPTUALIZED AS
A FLEXIBLE, ADAPTABLE SPACE, INVITING PERSONALIZATION ON THE PART OF THE PATIENTS AND THEIR
FAMILY MEMBERS. .............................................................................................................................................62
FIGURE.63SERENITY SUITE SANDWELL & WEST BIRMINGHAM HOSPITALS NHS TRUST*...........................................63
FIGURE.64ST.MICHAEL'S HOSPICE RUSTIC FINIS .........................................................................................................63
FIGURE.65WAUD HEALING GARDEN, USA ..................................................................................................................63
FIGURE.66WAUD HEALING GARDEN ........................................................................................................................... 63

10
Study for Understanding the Role of
Architecture in Hospices
 CHAPTER 1: INTRODUCTION

Architecture has the ability to influence moods and behaviours. We know by experience that
spaces which are green, open, free seem to be more happier, calming than those that are
congested, noisy, has foul odour, lacks cleanliness, ventilation and lighting. Best example for the
former would be gardens & parks while for the latter would be poorly designed Hospitals.
It’s appalling to believe that we go to such a place to get cured. Lack of timely care and access
forces many to spend their last days at a hospital. They often wish to runaway but only death could
help them escape; for them it’s their last home which sadly, recedes their health, forcing them to
accept death painfully. This is why Hospice Care is relevant; and so is its Architecture.
The aim of this study is to understand and guide in the designing of Hospice Care in Kerala.
For this, extensive study has been done on identifying the role of spaces on people’s emotions;
tactile/non-tactile factors responsible for human health improvement; importance of ‘space’ in
healing through behavior analysis; Healing through Architecture and alternative methods
However, the study has been limited to Kerala due to lack of time. Its impractical to develop a
universal design tool for all because of unique preferences that differs from man to man. However,
this study ensures a few key design factors that can make life for the terminally ill living in a
hospice beautiful and easier.

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 CHAPTER 2: POWER of ARCHITECTURE
Architecture, the Mother of Arts, not only beautifies space, but also touches both the occupant
and the perceiver in many ways. Architecture is the backdrop of every incident-built or unbuilt.
From books to paintings Architecture is important in one way or the other for mood setting,
aesthetics, and much more.Architecture is capable of influencing and being a part of culture,
affect mood, give soul to a place, control behaviour, guide people, etc.
Architecture best affects our thoughts and emotions through space, colour, form, light, air and
sound.Architecture most importantly, could change people’s behaviour.1 For instance, here are a
few examples of architects who believed in this architectural concept;
• Leon Battista Alberti, an Italian Renaissance-era architect, claimed in the 1400s that
balanced classical forms would compel aggressive invaders to become civilians.
• Frank Lloyd Wright, the US architect who designed one of the most famous buildings
in America, Falling water, similarly believed appropriate architecture would save the
US from corruption and turn people back to wholesome endeavours. [Japanese
Architecture]
• British author and thinker Ebenezer Howard believed companies would be more
efficient if their people lived in village-like garden communities.
• In his book, Happy City: Transforming Our Lives Through Urban Design, US author
Charles Montgomery points out that some environments predictably affect our
moods.
In 2008, researchers in the UK found that a ten-minute walk down a South London main street
increased psychotic symptoms significantly. Although, the psychological effects of architecture
are difficult to prove, but difficulty doesn’t dilute the value of a building that hits the right notes
and creates a sense of awe. Each building type has different functions, and for each there’s an
imperative to use the building to help create an optimal mood, desire or sense of coherence,
security or meaning.
As useful as in generating goodness, Architecture could be aggressive in many ways. Eye sore
buildings unyielding to its surroundings, Buildings like Pruitt Igoe, failed Urban Concepts like le
Corbusier’s Villa Contemporaine, etc. Demolition would be the only option for any such
building, which is more expensive than constructing it in one go.
Pruitt Igoe, was designed by architects George Hellmuth, Minoru Yamasaki and Joseph
Leinweber to provide “community gathering spaces and safe, enclosed play yards.” By the
1960s, however, it was seen as a hotspot for crime and poverty and demolished in the 1970s.The
loss of faith in architecture’s power has been regrettable, ever since.
Fortunately, there’s a resurgence of belief that buildings can change behaviour, led by a few
architectural journals: World Health Design, Environment Behavior and HERD. Most of
thesefocus on health care design, because that’s where behavioural changes have life and death
consequences.

1
rmt@cdps.umcs.maine.edu

12
 CHAPTER 3: HEALING THROUGH ARCHITECTURE

3.1. SPATIAL PERCEPTION2

The quality of a space or place is not merely a visual perceptual quality as it is usually assumed.
The judgement of environmental character is a complex multi-sensory fusion of countless factors
which are immediately and synthetically grasped as an overall atmosphere,ambience, feeling or
mood.
“I enter a building, see a room, and – in the fraction of a second – have this feeling about it”
Peter Zumthor, one of the architects who have acknowledged the importance of architectural
atmospheres, confesses. In his book The experience of place, Tony Hiss uses the notion
“simultaneous perception – the system we use to experience our surroundings” . This is,
however, also the way we normally observe, with all the senses at once.
As Merleau-Ponty notes “My perception is […] not a sum of visual, tactile, and audible givens. I
perceive in a total way with my whole being”
An atmospheric perception also involves judgements beyond the five Aristotelian senses, such as
sensations of orientation, gravity, balance, stability, motion, duration, continuity, scale and
illumination. In addition to environmental atmospheres, there are cultural, social, work place,
family, etc. interpersonal atmospheres. The atmosphere of a social situation can be supportive or
discouraging, liberating or stifling, inspiring or dull.
3.1.1.Atmospheres in the arts
Atmosphere seems to be a more conscious objective in literary, cinematic and theatrical thinking
than in architecture. Even the imagery of a painting is integrated by an overall atmosphere or
feeling;
Architecture likewise can heal people. We find well-lit and ventilated spaces that promote
harmony of mind, body and soul to be serene.
3.1.2.Recognition of place and space
The instant recognition of the inherent nature of a place is akin to the automatic reading of the
creature-like identities and essences in the biological world. We become attached to certain
settings and remain alienated in other kinds of settings, and both intuitive choices are equally
difficult to analyse verbally or alter as experiential realities.
3.1.3.Atmospheric intelligence – a capacity of the right hemisphere
Recent studies on the differentiation of the human brain hemispheres have established that,
regardless of their essential interaction, the hemispheres have different functions; Space and
imagination Our innate capacity to grasp comprehensive atmospheres and moods is akin to our

2
Space, Place and Atmosphere.Emotion and Peripheral Perception in Architectural Experience.

13
capacity of imaginatively projecting the emotively suggestive settings of an entire novel, as we
read it.
3.1.4.Space and imagination
Our innate capacity to grasp comprehensive atmospheres and moods is akin to our capacity of
imaginatively projecting the emotively suggestive settings of an entire novel, as we read it.
Remarkably, we do not experience these imaginary spaces as pictures, but in their full spatiality
and atmosphere.

3.1.5.‘Understanding’. The artistic image

Materials, colour, rhythm and illumination are strongly atmospheric. In architectural education
we are usually advised to develop our designs from elementary aspects towards larger entities,
but, our perceptions and experiential judgements seem to advance in the reverse manner, from
the entity down to details. Vernacular settings and traditional towns are examples of pleasant
atmospheres

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 3.2. EMOTIONAL aspect of ARCHITECTURE

3.2.1.Emotions& Architecture
According to the architect, Peter Zumthor, emotions turn into memory. Right from perceiving a
space to emoting and understanding the space makes it a memory. That moment may be
unforgettable and/or different to many. Emotive designs can evoke the right emotions according
to the space for which its intended.
For instance, Daniel Libeskind’s Jewish Museum makes the occupant feel as they were living in
the memories of the Jewish victims. Right from the entry one experiences fear, uncertainty,
victimized. Many were moved to tears by the time they reached the exit. Therein lies the power
of Architecture in influencing our thought, moods, and emotions.
Colours, light, form, space, sound – all that are sensed by our 5 senses individually or
collectively influences our minds.

Figure 2Colour, light & shadow, rhythm, balance and symmetry Figure.1Form and shape-Curves meaning warmth

3.2.2. Types of emotions3

Every space evokes emotions, and later a memory. So its basically important to realize the types
and potent of the emotions generatedbyspaces.
The ancient sources of Rasadhyaya of the Natyasastra [3rd century AD] delineates the 9 basic
emotions- sthayibhava. This school recognizes emotions with respect to the moral context of
emotional function in religion, culture, etc – suggesting that particular emotions are
systematically related to the ethics of a cultural community.

The 9 Sthayibhavas
1.Love ; 2.Humour; 3.Sorrow; 4.Anger ; 6.Fear; 6.Perseverance; 7.Disgust ; 8.Amusement;
9.Serenity

3
Ortony and Turner (1990)

15
Aristotle’s Rhetoric based on opposites of a reaction
Anger vs. Calmness; Friendship vs. enemity ; . Fear vs. Courage ; Shame vs. Confidence ;
Kindness vs. Cruelty ; Pity vs. Disgust ; Indignation ; Envy ; Love
Meanwhile Darwin through his book, “The expression of the emotions in man & animals”
considered the most effective study as being the only book that features emotions through
photographs of different emotions which basically categorizes them as follows

Darwin’s Classification
Suffering; Low spirits; High Spirits; Reflection; Hatred & anger; Disdain; Surprise; Self-
attention
According to Darwin, emotions are behavioural traits which evolved and that our face adapts to
show these emotions through facial muscles that aren’t possible in other animals.
Whereas according to Robert Plutchik’s theory with reference to the ‘Wheel of Emotions’
identifies 8 basic emotions

Robert Plutchik’s theory

Fear; Anger; Sadness; Joy; Disgust; Surprise; Trust; Anticipation;
Thus it can be inferred that study of emotions is a vast topic that differs from place to place.
However they can be universally understood by different people but the process of understanding
the consciousness of others can be deceptive. Emotions just like people are the same core
understanding elements which are perceived differently from person to person.
3.2.3. Science behind emotions4
There are various definitions for emotions. However the most basic one is that Emotions are
subjective responses that are generated from a core of pleasure or pain. This core is embedded in
the outcome of appraisal/ the awareness of a situational meaning. Emotions can be defined in
terms of action/action readiness/ action tendency / even the lack of it.Emotions involve the
following characteristics
1. Change in action readiness [readiness to go at it/ away from it]
2. In sheer excitement [ready to act but unaware of which action]
3. Being stopped in one’s action/in loss of interest
According to Darwin, as stated earlier, emotions are action patterns that include facial changes.
These emotional states are basically inferred constructs that occur without our perception. We
may not always be aware of slipping into these emotional states.Emotions are caused by change
in idea or physiological state of the organism. They are either triggered by an external [non-
social influences like noise, light] or by an internal stimulus [such as separation from a loved
one].They are adaptive responses to specific events, for instance sadness as a result of loss; fear
due to uncertainty, so on.

4
Oatley, K., & Johnson-Laird, P. N. (1987). Towards a cognitive theory of emotions. Cognition & Emotion, 1, 29-
50.

16
3.3. FACTORS

3.3.1. HUMAN PSYCHOLOGY

According to physiological theorists, they are bodily responses to an event; neurological theorists
propose that activity within the brain leads to emotional responses; Whereas Cognitive theorists
argue that thoughts and mental activity play an essential role in forming emotions.
They are also shaped by our cultural social environments. Because for a the developing brain,
emotions aren’t solely affected by its genetic blueprint but also by the surrounding environment
to grow and reveal its complexity, plasticity in dynamic interpersonal exchanges with people and
contexts.
Efforts for the classification of emotions began well before. Many prominent scholars have
developed theories to identify the basic human emotions.
3.3.2.Design influence on Emotions

1. Colour5
Red: symbolizes intense emotions-passion, romance, couragewrath, rage, malice, energy,
increases human metabolism, respiration rate, BP; high visibility;high physical activity;
quick decision
Green: Colour of nature, growth, harmony, freshness, safety; Ambition, sickness, emotional
healing, peace;
Blue: Depth & stability; confidence,piety, cleanliness, power, healing
Yellow: Joy,energy, cheerful, decay, intellect;
Black: Power, elegance, mystery, evil, death, contrasting
White:light, goodness, purity, innocence, faith

2. Light & Shadow6

Natural lighting best for our bodies, maker of material
Attached,Shading and Cast shadow: mystery evoking silence and awe.
Spaces can be dramatic with proper use of light and shadows. Eg. Salk Institute brings to
mind the dark silence of cloisters; Monotone 3D volumes revealed by shade.Use of deep
intrados in IIM, Bangalore.

5
Two Create. ”Architectural Healing: How the Built form changes lives”.11.06.15
6
Thomas Schielke.”Light Matters:Louis Kahn and the Power of Shadow”23 Apr 2013.Archdaily.2.06.18

17
3. Form7
Well-lit and ventilated spaces that promote harmony of mind, body and soul to be Healing.
Quieter hospitals reduce stress and improve sleep outcomes; stress reducing views; natural
lighting , all can heal although not cure.
Forms that are balanced and symmetric make people feel disciplined, organized; jagged edges
make us feel cautious; curves seem to lack threat, safer; Rectangular look formal, elite; so on
4. Sound8
Ambient sound has always been proved to have a calming, soothing effect on the listener.
Noise proof spaces are needed or else it’d increase our stress levels by large.
5. Air
Clean, and fresh air with fragrances that are not disturbing.
6. Ventilation
Well-lit/open space with beautiful outdoor views of nature
7. Texture
It adds dimension and a unique charater to the space. Hardwood flooring, carpets, accent
walls, fixtures and fabrics make a room polished.
8. Temperature
Climatically designed spaces that are in tune to its site. Use of appropriate materials and
colours too for ambient temperature.
9. Spatial
Flexibility of Design, space management; Natural cover; Socially interactive; Dispble
friendly, etc
Now how are the ways Architecture can affect our emotions? The following are some of the
various approaches taken to ease moods/emotional states.
1.Flexibility of Design
This enables the users to explore and experience rather than define spaces specifically for a
particular allocated purpose alone. The user must feel as though he/she is capable of controlling
his/her surroundings rather than the other way around.

2.Manage ‘space’
Space must be in balance with the form. This may not always be practically implemented as
architects create in 3D models to the farthest extent which may not may be in the case when the
actual building comes up.
3.Greener Areas
Has less effect of depression and soothes the mind.Populary the colour green is known for its
ambient and healing properties.

7
Eric Jaffe.”Why Our Brain like Curvy Architecture”.CO.Design by Evidence.13.10.17

18
 4.Socially interactive
Social interactions for mental health unavailable in cities. Social isolation is a risk for many
illnesses. Successful design is not how our buildings shape us after all, but how it makes people
feel that they are in control of their surrounding. (images).9

Figure.4Natural elements Figure.3Well-lit spaces with good ventilation and indoor

plants; social

Figure.6Socializing/communal spaces
Figure5Managing space and ambience

9
Innovations in Hospice Architecture. Stephen Verderber& Ben.J.Refuero.2005

19
 CHAPTER 4. ALTERNATIVE MEDICINE

Apart from Architecture, there are various other factors that can evoke emotions, alter moods,
differ human behaviour and perception of the space. They are the details that make up the whole.
The following explains them based on our 4 of our 5senses- ears, eyes, nose, skin

4.1.Healing with Sounds and Frequencies 10

4.1.1.Auditory Sound

Sound work is “creating a frequency and vibration for someone that’s conducive for him or her
to heal,” says Joshua Leeds, the author of The Power of Sound and an expert in the field of
psychoacoustics, the study of the effects of sound on the human nervous system. “Sound healing
is trending up. It’s like where yoga was 15 years ago. People are realizing that sound is a viable
medium to address distress, enhance learning, even work with an autistic child.”
“When the brain is in synchronicity, there’s more focus,” says Carol Moore, marketing director
of Monroe Products, which makes Hemi-Sync verbal meditations and music that contain
embedded binaural beats. For example, “Our sleep titles help drop you into the deep delta waves.
Electrical activity in the brain gets slowed down.”
Application of ultrasound has been shown to speed broken bone regeneration by one third, and
even restore memory to mice with Alzheimer’s. The team of researchers also found that the use
of ultrasound could reverse the migration issues of fibroblasts from human venous leg ulcer
patients, which showed that this approach is applicable to humans as well as mice.
Now, a growing body of research suggests that when used in a directed way, sound can also help
us reduce stress, create a deep sense of well-being and even promote healing. From playing Bach
in the nursery to yogic chanting in the oncologist’s office, sound therapy is gaining popularity as
both a preventative medicine and as a complement to more-traditional treatments. Good for both
the mind and the body, it has been shown to help lift depression, clear sinuses and help cancer
patients recover more quickly from chemotherapy.

4.1.2. Music
Now, a growing body of research suggests that when used in a directed way, sound can also help
us reduce stress, create a deep sense of well-being and even promote healing. From playing Bach
in the nursery to yogic chanting in the oncologist’s office, sound therapy is gaining popularity as
both a preventative medicine and as a complement to more-traditional treatments. Good for both
the mind and the body, it has been shown to help lift depression, clear sinuses and help cancer
patients recover more quickly from chemotherapy.

10
The Science Behind Healing with Sound by Kathryn Drury Wagner – December 16, 2013
Previously published as "A Wave of Relief" in Spirituality & Health's Practice issue.

20
4.1.3. Solfreggio Frequencies

By listening to Solfeggio, 432 and 528 Hz music you can release yourself from stress; raise your
energy; expand creativity and consciousness; improve memory; unlock your potential
Fritjof Capra says, “The processes that create sound into harmonious music are the same
processes that govern all associating vibrations throughout the universe.” We are a vital part of
the process. Hans Jenny and his Cymatic phenomena clearly demonstrate that how we see things
is always a result of more subtle, invisible vibrations. Change the vibration, and you change the
manifestation.
How it cleaned polluted water in the Gulf of Mexico
In 2010, John Hutchinson, an electromagnetic energy expert from Vancouver, B.C., Canada,
helped purify poisoned water off the Gulf of Mexico following the BP oil spill. He and his
research partner, Nancy Hutchinson (formerly Nancy Lazaryan), used the 528 Hz frequency and
other Solfeggio tones to reduce the oil and grease in polluted waters.
The polluted area was treated with the frequencies for four hours the first day, and by the next
morning, the waters were cleared. They also did four more hours of RF frequency to complete
the test. The frequency device was situated about 25 feet up the beach from the water.
Their results were certified by Dr. Robert Naman, President of Analytical Chemical Testing
Laboratory, Inc. of Mobile, Alabama. Dr. Naman, an analytical chemist with almost 30 years in
the field, tested the samples and confirmed the complete removal of oil and grease from the after
treatment sample source tested.

A recipe for the Planet

528Hz is the bioenergy of health and longevity. It is the harmonic vibration that lifts your heart
and divine voice in harmony with heaven.
Conclusion: Sound, music and frequencies could be used to soothe and forget pain instantly. It
may differ from person-to-person, however. Acoustically designed spaces that dissolve noises
are to needed for a serene setting. Time to time playing of frequencies even at a lower volume
can be done. Sometimes even nature voices have been proved powerful in calming a person.
Therefore a nature-friendly design that brings in chirping birds, flowing water, etc could be used.

4.2. Fragrance11

Although it is not considered one of the higher senses like the visual and the auditory senses,
“smell is one of the most primitive and most important of the senses.” Differing from other
senses, smell has a direct route to the brain. Not only, by the visual sense, can people identify
their personal spaces, but also by the smell that is related to their spaces they can define them.
These smell qualities of any space provide it with special characteristics that differentiate it from

11
[Sloan Kettering Memorial Hospital. Aromatic Consultant John Steele.Ruga, 1997.] Does Design Affect Our
Senses? By WALID ABDEL MONEIM ABDEL KADER,PHD. Architect, Lecturer, Architectural Department,
Faculty of Engineering, Cairo University.

21
all other spaces. Lawrence found that “a space physically defined by partitions to assure privacy,
for example, may be perceived more communal when penetrated by unwanted sounds and
smells.”
Aromatic consultant John Steele highlighted the therapeutic benefits of environmental fragrance.
He said: “Perhaps the most notable example of stress reduction using fragrance in medical
setting is at the Sloan Kettering Memorial Hospital, the world’s largest private institution
devoted to cancer research.” Steele discussed more benefits of using fragrance on the
psychological status of the patient. This is also the case for the normal person.
Nice smells in any environment, provides a pleasant atmosphere and an encouraging
environment to work and thus increase productivity. While, bad smells create an expelling
environment and force the user to leave, which causes critical influences on productivity and
efficiency.
Conclusion: Aromatherapies, flower blooming plants in landscape design, fragrance sticks, etc.
However it must not be overdone; must be limited to specific rooms like yoga /meditation rooms,
etc.

4.3. The Sacred Geometry12

Simply described, the Sacred Geometry arises out of the set of numbers from the Fibonacci
series or the “golden ratio.”; Through the years since ancient times, it has been significantly used
in the planning and construction of religious structures (churches, temples, mosques, tabernacles,
altars and monuments), as well as sacred spaces (like holy wells and sacred groves), and the
creation of religious art.
Fibonacci numbers, ratios and shapes have been used to explain creation, growth and harmony –
from a number of petals on a flower and grandiose architecture, to a spiraling galaxy. And to
music lovers, it’s one beautiful harmony of musical scale that pleases the ear and ultimately the
spirit.
Conclusion: Simple and minimalistic design that follows the basic principles of design such as
balance, proportion, symmetry, etc

4.4.The Effect of Light & Sight13

Although it is important for architects to understand how eye functions when perceiving light,
the main interest to them is the analysis of light from an ecological and psychological
perspective. Light has two basic types, radiant (direct light) and ambient (indirect light). The
radiant light passes

12
Bradley, P. Great Mysteries. New Holland (2010).
Calter, P. Polygons, Tilings, & Sacred Geometry. Dartmouth. Accessed September 22, 2011.
13
[ Torrice, 1988. Elyacoubi, 1999. Gappell, 1991. Elyacoubi, 1999. Riley, 1995].Does Design Affect Our
Senses? By WalidABM Kader

22
through the different media with varying degrees of interference, while the ambient light consists
of the light reflected from the surfaces around us. Also, there is another classification which is of
great significance of the designers that is the natural light and the artificial light.
Natural light from the sun is considered to be the best source of light for the human health
physiologically and psychologically. Antonio F. Torrice clarifies that “when we are surrounded
by natural outdoor light, there’s an equal balance of each of the colours of the spectrum in our
bodies.” The human system evolved under the influence of the sun - light spectrum to which
particular light-sensitive and light-modulated organ systems are specifically adapted.

4.4.1.Light

“It has been proved scientifically that the cases of depressions are much more (about 200%)
during the autumn and winter season than during the spring and summer season. After several
researches, psychologists found that light is the main reason behind that.” It also enhances the
visual perception in the environment for both form and colour, and provides a pleasant feeling.
In the same time, designers can overcome the negative effect of glare and heat through different
architectural treatments externally and internally.
Light does not only have a psychological effect on humans but also has a physiological effect.
“Full-spectrum light provides prophylactic control of viral and staph infections and produces
significant improvements in physical working capacity by decreasing heart and pulse rate,
lowering systolic blood pressure, and increasing oxygen uptake.” Therefore, designers have to
respect light and its effect in their designs. It became not only a source for visual functioning in
the environment, but also a stimulus for the senses physically, mentally and emotionally.
So, for architects light adds dynamic qualities to their architecture, extends patterns, forms and
designs into the dimensions of time. In addition to that, the mixture between light and shade
generate contrasts, helps distinguishing between different planes and creates texture to surfaces.
Conclusion: Apart from proper lighting which is legible and bright enough, proper ventilation,
beautiful sights and views must be enhanced for a better ambience. Inclusion of a disable-
friendly garden, artworks, right use of colours, etc.
4.4.2.The Effect of Colour

Colours are essential in our lives. Without it we cannot discriminate the surrounding
environment and perceive its dimension and components. “The colour is not important in itself.
What is vastly more important is the response to it.” However, without our ability of perceiving
colours we lose our capability of realizing the difference of forms, surfaces and components of
any space. Therefore, colour is one of the major design elements that affects functional,
physiological, and psychological aspects.

23
4.5. Touch Sense14

When the architect designs a space, he/she must put into consideration the climatic conditions of
this space. Researches have proved that the human behavior in any space can be affected by the
abnormal levels of heat, cold and wind. “Traditionally, touch was thought to be a single sense.
Today, it is considered to include three distinct skin senses, one responding to pressure, another
to temperature, and the third to pain.”
Many studies had shown that there is a strong relation between the ambient temperature of any
space and the behavior of the user inside this space. Any activity is going to be enhanced at first
when the temperature is being raised and then it gets worse. Also there is strong evidence that
there is a relation between heat and aggression.
Temperature, barometric pressure, altitude affects the human behaviour. Some studies found that
therapeutic massage has great effect on the physiological and psychological status of the person.
It improves appetite, enhances well-being and mood, reduces stress and decreases pain.
For architects and interior designers the most related issue to the touch sense is the selection of
materials they use. Every material has a different touch and thus a different effect.
Therefore, the materials used in any space have a noticeable effect on the user, the differences
between the materials from the degree of hardness and softness, rigidity and flexibility, lightness
and heaviness, etc. All these various specifications influence the design decisions of the
architect. This fact was proven in a survey on the effect of the finishing materials used in the
psychiatric healthcare buildings in Egypt on the mental health of the psychiatric patients.
Conclusion: Designing with respect to the site, climatic conditions are equally important. Choice
of rightcolours for ambience-warmer tones for rooms seem to be hotter than those with cool
colours (this however is quite difficult to please many). Use proper materials with appropriate
textures that are not only aesthetic but are safe to use.
4.5.1. Crystal Healing:15

Crystal healing is an alternative medical technique in which crystals and other stones are used to
cure ailments and protect against disease. Proponents of this technique believe that crystals act as
conduits for healing — allowing positive, healing energy to flow into the body as negative,
disease-causing energy flows out.
While there are no scientific studies on the efficacy of crystal healing, there is a study that
suggests that crystal healing may induce a placebo effect in a patient who receives this type of
treatment. Placebo effects are effects that accompany a treatment that are not directly due to the

14
[Atkinson, 1996. See Bell, 1996 for more information. PP. 202-206.] Does Design Affect Our Senses? By Walid
ABM Kader
15
British Psychological Society Centenary Annual Conference in Glasgow. Christopher French,University of
London. 2001.

24
treatment itself acting on the disease of the patient, according to Christopher French, head of the
anomalistic psychology research unit at the University of London.
In other words, a person may feel better after undergoing crystal healing treatment, but there is
no scientific proof that this result has anything to do with the crystals being used during the
treatment.
In 2001, French and his colleagues at Goldsmiths College at the University of London presented
a paper at the British Psychological Society Centenary Annual Conference in Glasgow, in which
they outlined their study of the efficacy of crystal healing. For the study, 80 participants were
asked to meditate for five minutes while holding either a real quartz crystal or a fake crystal that
they believed was real. Before meditating, half of the participants were primed to notice any
effects that the crystals might have on them, like tingling in the body or warmth in the hand
holding the crystal.
After meditating, participants answered questions about whether they felt any effects from the
crystal healing session. The researchers found that the effects reported by those who held fake
crystals while meditating were no different than the effects reported by those who held real
crystals during the study
Call it a placebo effect or a way of dealing with a difficult situation. Scientists may never give
these stones the time of day, but healing crystals may help you mentally feel more mindful and
resilient.

4.6.The Future of Healing16

Sound therapy, many experts say, is at the cutting edge of healing. And soon, they insist, like
yoga and meditation, it will enter the mainstream.
Classical Music. Classical music has been show to increase the rate of development of synaptic
connections in young children's minds. It also helps fuel creativity and enhance joy in adults.
Classical music can even help address physical ailments like high blood pressure and muscle
tension.
Humming: According to a study conducted by Swedish researcher, and published in the
American Journal of Respiratory and Critical Care Medicine, humming may actually help keep
your sinuses clear and healthy.
Singing Bowls: Whether metal or quartz crystal, along with rhythms produced by striking the
edge of the bowl, the vibrations and tones slow down breathing, brain waves and heart rates,
producing a deep sense of calm and well-being.
Tuning Forks. Sound therapists use the vibrations of tuning forks to increase the amount of
energy in parts of the body they are trying to heal or energize. These good vibes can support
relaxation, balance our nervous systems and increase physical energy.

16
The Healing Power of Sound, BY KAREN OLSON | NOVEMBER 2006
https://experiencelife.com/article/the-healing-power-of-sound/

25
Yogic Chanting and "Om"ing. Chanting, the first step to meditation, is also a means of
maintaining health and well-being. Research shows that chanting can stabilize heart rate, lower
blood pressure, improve circulation, produce endorphins and aid the process of metabolism.
Attuned Vibrations provides high-quality healing music to align you with the rhythms and
tones that form the basis of the Universe. By exposing yourself to the healing frequencies, you
can easily achieve a greater sense of balance and higher consciousness.

26
 CHAPTER 5: HOSPICE

5.1. HISTORY17

The modern hospice movement grows out of a complex history of building types associated with
the root etymology of the Latin word hospitium – hospital, hostel, hotel and hospitality. All are
places where visitors, guests, pilgrims or those in physical or spiritual need are welcomed and
cared for.
In 1967, Dame Cicely Sauders founded St. Christopher’s, the first modern day hospice. Here she
developed care programs linking expert pain and symptom control, compassionate care, teaching
and clinical research. She had recognized the inadequacy of the care of the dying in hospitals,
and understood that a dying person is more than a patient with symptoms to be controlled.18
A hospice is not just a building but a place where the philosophy of what it is to be a mortal
human is tested to the fullest.
A hospice is a place for the care of the terminally ill. Where a hospital is designed to cure, a
hospice is designed to comfort. Hospice care involves not only helping patients but also
supporting their families which has become an integral part of palliative care.”
People live until they die and it is the job of the hospice to support and enable each patient to live
their life as fully as possible. It is a place for reflection and a place to search for meaning and
purpose. For many, it is perhaps the first time that they have seriously addressed the fundamental
issues of life and death. The hospice building must be sympathetic to, and supportive of, our best
efforts. The building must be planned to the finest of detail, because we cannot afford to get is
wrong.”

5.2. SCOPE18

Architecture is the art of spaces that is capable of evoking emotions, generating moods and
creating ambience. Being a powerful tool for mental & physical therapy, Architecture could be a
balm for healing, altering our attitudes, reforming our lifestyle, so on. Almost all buildings
contribute to Emotional Architecture, but not all of them are successful enough in generating the
right moods needed for that building type.
Health care units are one such category of buildings that fail to cater and compose the right
ambience for its occupants. Almost all patients, today,; prefer to run away from hospitals. There
are people who wouldn’t even get treatment because of their fear for hospitals. This may be
partly by the pain caused by the treatment that a patient has to undergo or perhaps the

17
Wikipedia.org
18
Talks, Ar Allison Killing: Spaces that Heal (ted tx)

27
hopelessness of being normal again, especially in the case of patients who fall under palliative
care. But if their surroundings seem cold and unsupportive, it adds up to their misery.
According to Allison Killing, an American architect who researches in Empathy Architecture,
the modern hospital architecture is erratic in providing comfort and mental support to patients.
They are cold and unwelcoming causing fear and anxiety. She points out at Brunelleschi’s
amazing work of a hospital at Italy where the architect has defined a unique method of redefining
Healing Spaces.
However, it has been noted that, architecture can contribute to healing and even recovering.
Ambient well-designed, emotionally controlled and empathic hospices/palliative care units could
reassure the patients unlike most of our huge monstrous hospital blocks that look life-threatening
even at sight.
There is a need for designing healthcare units that can treat a person. The intention of this study
is to realize the different emotions and feelings suppressed in these blocks and to formulate a
means to relieve the harshness caused by them on its occupants. Penned specially to help patients
with incurable ailments to recover/ exempt their stress, this article aims to find a general criterion
to design healthcare units- a unit which actually is the treatment

5.3. EMOTIONAL ASPECT OF HOSPICES

5.3.1. EMOTIONS FACED IN HOSPICES

Emotions as you near the end of life19

Knowing that death is coming soon takes an emotional toll on the person with a deadly disease
and their loved ones. This is an emotional time, and though it’s hard to talk about them, these
issues must be addressed. Knowing these feelings are normal and may help you cope with what’s
happening. Some of the emotions you can expect to have include:
Fear
People are often afraid to die, but pinpointing what part of death they’re afraid of can be helpful.
Anger
Anger is sometimes hard to identify. Very few people actually feel ready to die. It’s perfectly
normal to feel angry about one’s life ending – maybe earlier than you expected, which seems
totally unfair.
Engage them in their interests, spaces for painting.
Guilt and regret
In the last few months of life, a person might regret or feel guilty about many things. But how
does it help anyone if you hold onto guilt or regret? Worrying endlessly about these things won’t
make you feel better about them. Sociable spaces

19
The American Cancer Society medical and editorial content team
Last Medical Review: April 29, 2016 Last Revised: June 8, 2016

28
Grief
It’s natural to feel intense grief during the last months of your life. You’re grieving the loss of
the life you planned and expected. You can no longer look ahead to a seemingly “endless”
future.
Anxiety and depression
Anxiety has been described as having a nervous stomach, a shaky feeling all over, being short-
tempered, a sense of dread or worry, or a fear of the unknown. It can be quite unpleasant.
Some anxiety is expected, but if it’s severe it may need to be treated through counseling or with
medicine. Depression is more than just feeling sad. Depression includes feeling hopeless or
helpless, feeling useless, feeling sad for weeks at a time, and having no joy in any activity. These
feelings are not normal, not even when life is ending.
Spaces for spending quality time, independently move-around
Feeling alone
When someone knows for sure they’re facing their last months of life, there can be a loneliness
that’s different from any other. It’s a loneliness of the heart, even when you have people around
you. Homesickness
Spaces for communicating, socializing, open plan yet has privacy; community centric.
Seeking meaning
Almost everyone wants to feel their life had purpose – that there was some reason for their being
on earth. Some people find meaning in their work. Others find that raising a family has brought
them the greatest sense of joy and accomplishment.
Spaces for meditation, prayer, Rooms with family & friends

29
5.4. HOSPICE DESIGN

Recovery of a patient depends on his surroundings too, apart from the mode of treatment.
However, hospices and palliative care units today are cold and unnerved structures that boo a
person rather than soothe them. Thus, the patient &/or the occupant has to submit to the
environment as it is, willy-nilly. Many people live their last days and die in places that they don’t
even like-spaces that are concrete, and stressful. This tortures the occupants even more and in
most cases, plunge them into depressions and bleak out their chances of survival.
5.4.1.Natural Light20
Natural light creates a physiological impact on people. Biologically, they regulate human body to
produce hormone melanonin to regulate our body clock and produces the serotonin that reduces
depression.
5.4.2.Building Facades
If complex and interesting the facades contribute to positive feelings whereas simple and
monotonous facades makes one more negative.
5.4.3.Greener Areas
Has less effect of depression and soothes the mind.Populary the colour green is known for its
ambient and healing properties.

5.4.5.Interiors
Simple, well-lit interiors with proper signage and disable friendly design. Materials that aren’t
sharp or phobia-generating to be chosen for the interiors. Colour, size and shape too has a role in
evoking emotions and thus, has to be wisely picked.
5.4.5.Treatment methodology
Treatment methods may usually be non-surgical for hospices unlike those in a palliative care
unit. However there are chances of complete recovery in either cases through self-confidence,
reports many.
Hospices are models for quality compassionate care for people facing a life limiting illness.Thus
their therapy mainly includes
1. pain management, support and care
2. Belief that each of patient deserves a pain-free dignified death and that their families
receive the dental support to allows them to do so
Palliative Care Units provide specialized care for people with serious illness. Their care is based
on the following concerns
1. Focuses on giving relief from symptoms and stress
2. To improve the quality of life-serious illnesses

20
2. The Architecture of Happiness, Alain de Botton;issuu journal on Hospice & Empathy Architecture

30
Many architects engage nature into the hospice environs to free the nausea. Because places that
were lush and green were more reminiscent of home rather than cubicle congested building
blocks, some that are even gigantic.
Music has been found to have healing properties and thus has a scope in Hospice Architecture. It
reduces depression, stress and anxiety argue music therapists. Music has an ability to link people
with positivity and thereby impact on their mental health.
Another perspective of better ambience can be created by the right choice of materials, finishes
and lighting for the interiors. Also the flexibility to transform a space as and when one prefers
giving him the freedom to control it makes one feel safer, and lighter.
Many countries around the Globe have their own policies and design tool kits for proper
Hospice/ Pallitive Care Design.
The following shows the Design Brief developed in countries like UK, Ireland, USA.

5.5. GLOBAL EFFORTS21

Each year an estimated 40 million people worldwide require palliative care, including 2.1 million
children. Various conditions can warrant palliative care including HIV/AIDS, cardiovascular
diseases, cancer, and dementia. According to WHO, less than 14% of those needing hospice care
at the end of life currently receive it.WHO is working with governments to expand the palliative
care services they provide.
“Palliative care must be available to all people, of all ages, with all diseases,” says Dr Belinda
Loring, from WHO’s Department for Management of Non-communicable Diseases, Disability,
Violence and Injury Prevention. There are real health gains for health systems – and especially
patients – through ensuring the delivery of appropriate palliative care.
The challenges of life-threatening illnesses go beyond patients, extending to their families and
support networks. WHO acknowledges that families are an important part of the network
providing care, and also require services such as social support and bereavement counseling.
Policy action needed
Despite a handful of cases, many people with incurable illnesses fail to receive the health care
they need, and this is often because of a lack of government policies and laws to address the
issue of palliative care, according to Dr Emmanuel Luyirika, the Executive Director of the
African Palliative Care Association.
Progress is being made in Malawi, Mozambique, Rwanda, Swaziland, United Republic of
Tanzania, and Zimbabwe, says DrLuyirika, where health authorities are improving patient access
to pain medication and improved training on palliative care for health and social workers.

21
(October 2015; http://www.who.int/features/2015/south-africa-palliative-care/en/)

31
 CHAPTER 6: DESIGN TOOL KITS

6.1. UK King’s Fund22

6.1.1.Natural Environment
The natural environment should touch every part of the building from the informal garden to the
more arranged aspects of landscape through to internal planting.
6.1.2.Natural materials
The building should use simple, robust and non-toxic materials that are from the ground or
grown.

6.1.3.Legibility
It is important that the building and its associated landscape are very carefully organised into
compatible uses that are public, semi-public, semi-private and private.
6.1.4.Dignity
The building should itself be dignified and be designed to allow for patient dignity.
6.1.5.Comfort
The building, its materials, fixtures and fittings should be comfortable for people to interact with
or use.
6.1.6.Robustness and economy
The building should be flexible and capable of being gradually adapted over time.
6.1.7.Respecting time
The perception of time differs greatly according to circumstance.
6.1.8.Beauty
The building and its relationship with nature must be beautiful
6.1.9.Arts and crafts
It is important in a place of caring that the building elements and details demonstrate love and
caring in the making.

6.2. Hospice for Childcare, Dublin 223

6.2.1.General principles of design

 The avoidance of an institutional appearance

 The creation of a ‘domestic’ character in particular areas

22
Environmental Design Audit Tool Principles for the Design of Residential and Day Care Homes and Hospices
23
DEPARTMENT of HEALTH & CHILDREN, Hawkins House Dublin

32
  A key consideration in the creation of an appropriate ‘atmosphere’ in a unit will be clarity
of circulation
 It is essential to have simple routes. A clear, legible and ‘user-friendly’ signage system.
 The environment should offer privacy to patients and their families when required.
 Sheltered outdoor spaces should be created in and around the unit for the enjoyment of
patients, staff, and visitors, and to assist orientation
 Patients should be provided with a sunny aspect and a good view
 Careful consideration should be given to ensuring a quiet environment
 High level ventilation of high standard – mechanical, if needed
 Design with regard to, the latest thinking on palliative care facilities and settings when
designing new buildings or extending existing units for hospice purposes.
 Low maintenance fittings and finished
The visual (but not necessarily physical) integration of artworks is considered important, and this
should be considered at an early stage in the design process. It is equally important

6.3. The Hospitable Hospice Handbook24

Commissioned by Lien Foundation, a Singapore based philanthropy and the Ang Chin Moh;
Foundation, a funeral service foundation, fuelfor came up with a handful of strategies to improve
the way hospice care is run, generally.

6.3.1. The Open Hospice

It encourages the community involvement to help raise awareness of care in the facility’s
surrounding neighbourhood, improving public perception of end=-of-life care.
6.3.2.Care Hub
Intermix of care, freedom, and privacy through natural cover and hotspots for socializing.
6.3.3.Launching a Palliapp
Which would be helpful to increase communication across disciplins and locations.

6.3.4.Giving freedom of Speech & Act

Giving the patients enough space and flexibility, allowing them to control their preferences/
environments.

6.4. END-OF-LIFE ARCHITECTURE, Works, Thesis, Case studies25

Patient and family first; The traditional biomedical model of care begins with a diagnosis, moves
on to a treatment plan and only then considers the individual wants and needs of the patient, says
Twaddle. Palliative care upends this model by focusing on the patient and family first.
Reduced walking distances, easy wayfinding, organized clinical space for caregivers are among
the other design features health care professionals note as critical to delivering effective
palliative care. Homelike environments rather than institutional appearance.

24
ShaunacyFerro,Brooklyn ,August 2014
25
Written by Olivia Kirk, Director, KKE Architects Ltd, for the Housing Learning and Improvement Network;
September 2015

33
 CHAPTER 7: LITERATURE CASE STUDIES
7.1.St.Michael’s Hospice [2017 RIBA West Midlands Regional Award Winner]26

Figure.7St.Michael'sHospice,UK

Despite being a clinical building, St.Michaels Hospice feels warm and friendly because of its Cedar
shingles Oak and Douglas fir cladding on the outside. The old Hospice was renovated by Architype Design
Firm for a better design with the following specified requirements:
1. A welcoming entrance zone, including the café, retail, children’s area and chapel.
2. New in-patient wing for 20 single en-suite bedrooms in five 4-bed social clusters, including bariatric
care
3. Sensitive treatment of Bereavement suite
4. Expanded Day Hospice and inpatient facilities
5. New range of integrated services, inc. quiet rooms, meeting rooms, therapy areas,etc
6. Staaff recreation room
7. Extended facility for research, specialist in-house and external training
Concept enables balance between activity/interaction, dignity/privacy, convenience/practicalities.
Compliant to the Design Guidelines and close working with the staff, Landscape Architects, the design
departs from the common clinical appearance to a warmer homely atmosphere without compromising
infection control.

26
Architype / St. Michael's Hospice / The UK's Leading Passivhaus, Sustainable Architects

34
By injecting their sustainable expertise into the overall plan, Architype have made our new Hospice into
what we believe will be a ‘landmark design’ for future Healthcare environments. Clear communication,
creative design, partnership delivery: that’s what sets Architype apart.

Figure.8Image of a social cluster space acting as a buffer

between public street, corridor and patient bedrooms. The
space offers opportunity for all to interact and socialise Figure.9Brick Cladding
and gives relatives a momentary ‘breathing’ space away
from some intensely emotional s(Nicky West, CEO, St.
Michael's Hospice)

Figure.11Semi-private Garden

Figure.10Central double height circulation pace

Right from the entrance a beautiful landscape-a prominent feature throughout the building- greets the
visitor. The multifunctional street- central double height circulation space lit by glazed roof with discreet
seating areas, breakout areas and conveniently positioned nurses’ stations.Social cluster areas act as a

35
transition space towards the 4 bedrooms, offering a real communal feel with patients and family able to
congregate, eat, relax, and socialize in a vibrant, bright atmosphere. Flexible bedroom and cluster spaces
with blinds, doors, curtains.
Landscaped Gardens fronted by bedrooms, Channelized rain-water streams and rills for therapeutic water
features, to help soothe and calm. Native plantsflowering blooming plants too are a part of the Garden.

Figure.12External street verandah Figure.13Well-designed welcoming entryway

Predicted to use approximately 60% less energy than if designed to UK Building Regulation standards

Figure.14PLAN

36
7.2. Rwanda Hospital by Michael Murphy27

Figure.18Outdoor verandahs
Figure.16.1. Wards with views

Figure15The Lo-Fab wall- effort by the community Figure.17Doctors Quarters

Lo-Fab Technique Invest in dignity of the practices you serve

• Local people to be hired • Design acc. to disease
• Source regionally • View for every bed
• Train where you can • Site-specific design

27
Architecture that Heals:TED tx by Michael Murphy

37
7.3. Hospice CareCenters,USA28

Figure.20Cosy home-like rooms

Figure.19Waud Healing Garden

Figure.21Nature embedded Garden Figure 0.3.Family Room

The Hospice CareCenter at Northwest Community Hospital features eight private patient rooms
for hospice patients as well as other amenities to support patients and their families. The
CareCenter is located at 800 Central Road, Arlington Heights, Illinois in Northwest Community
Hospital on the 9E level of the hospital’s campus.
WAUD HEALING GARDEN
• They even have a Family Healing Garden
• Variety of flowering plants
• A manmade cascading waterfall in stone
• A botanical garden adjoining a 50 acre nature preserve
• Open to patients, families & the community

28
Multi-sensory Garden Hospice: Hospices in USA/googleweblight.com/

38
7.4. CONCLUSION
Architecture plays a key role in Treating a patient Our system of Care needs to be upgraded and
safe guarded by norms and principles This can be done at various levels, identified as follows;
Primary level Basic emotional variations with surroundings achieved through various elements
of Space; Secondary Level Materials, Surroundings, Form, Acoustics, Colour, Unbuilt form
Tertiary Level Response of every occupant to each above

• Use of natural materials, natural environment

• Serene atmosphere, site chosen as such
• Beautiful views for every room
• Easily accessed outdoor-gardens, etc
• Family room
• Includes close relatives and friends, even community to participate in treatment and care
• Proper ventilation and air circulation through spatial planning
• Materials and finishes
• Use of greens
• Homely environment
• Sociable Spaces
• Therapeutic Garden, Therapies by water, sound, etc
• Legible and understandable suroundings

39
 CHAPTER 8: HOSPICE in INDIA29

In a country like India, where the birth rate is growing rapidly every hour, Healthcare is least
bothered mainly due to lack of knowledge, unaffordable expense and superstition.
With a population of 14 million, 22% of people live below the poverty line (BPL); which equates
to Rs 27 per day or 27p per day. A large proportion of the population do not have the means to
access even basic health care. With only a handful of outpatient palliative care clinics even fewer
are lucky enough to access essential pain medication and palliative care services.
It is estimated that one million new cases of cancer occur each year in India, with over 80%
presenting at the point at which the disease is incurable and/or has spread throughout the body,
known as metastatic cancer. Around sixty percent will already be in significant pain and just
under half will be experiencing excruciating, unbearable pain. The need for palliative care in
India is huge.
The number of Hospices in India are as less as 10, much of these resemble hospitals and are not
designed.

8.1. KARUNASHRAYA- Bangalore Hospice Trust30

Designed by Ar. Sanjay Mohe

Figure.22Karunashraya Hospice

29
M.R. Rajagopal - International Association for Hospice & Palliative Care. (https://hospicecare.com/)
30
ReemaMoudgil. ‘Karunashraya:Dignity with Death’.26.11.2014

40
Figure.23Stone exterior Figure.24Aerial view

Figure.25Wards fronted by pools Figure.26Buffer spaces

41
31Located in Marathahalli, Bangalore, this Hospice lies in the midst of lush greenery, bird song
and peace in a densely populated city. Built in stone exterior, with simple planning Karunashraya
has been credited as”20th Century World Arcitecture – Phaidon Atlas Buildings Completed
between 1900 and 1999.
Apart from the well designed spaces blended with aesthetics, it promotes sustainable living by
harvesting and recharging water; generating solar power; surrounded by green pockets, water
bodies, semi-open corridors, etc.

There arecharity shops, voluteers to take care of the patients, kitchen and pantry where food is
prepared for over 55 patients and staff members; Mechanised laundry room; 100- seat well-
equipped auditorium; kids play area; a multi-faith place of worship; and even an ornamental
forest. All designed for healing.
People celebrate and engage in entertainment programmes and even have a recreation zone for
walking. Karunashraya offers ‘diversion therapy’ where volunteers come and play music to
refresh the senses of the inmates.
Focussed around a large expanse of water

31
Karunashraya.org/archnet.com

42
• An ‘Abode of Compassion’, this Organization is non-profitable charitable trust by the
Indian Cancer Society
• It offers patients the flexibility of a hospice and a home, enabling them to live without
pain and to die in dignity
• bed inpatient unit that works round the clock
• Stone Structure with composite masonry
• All rooms receive natural light & air
• Inclusion of recreational spaces
• Meditation rooms

Figure.30Shadow play in the Hospice Pathways Figure.29Pools and courtyards

Figure.28Natural materials, Semi-open verandahs Figure 27Beautiful Pool views

43
8.2. BHAKTIVEDANTA HOSPICE32

Bhaktivedanta Hospice is a project of Sri ChaitanyaSeva Trust. Its mission is to offer world class
Hospice & Palliative Care services to the poor & the needy sections of the society. It is located at
Vrindavan (Uttar Pradesh) and is comparable to the international standards.

Figure.31Bhakti Vedanta Hospice Counselling

Figure.32a.HospiceBuilding ; b. Well-lit and spaciousTypical room

Being a 3-storied building within a compound with recreated views of beautiful trees, this
Hospice offers help and cooperative support to its occupants not only clinically but by
involvingpeople from the community to entertain and socialize.

32
Bhaktivedanta official website

44
Figure.33Communal space in rooms Figure.34Entertainment by communit

Figure.35Wards Figure.36During Celebrations-Bhaktivedanta

Following are the services offered at the BhaktivedantaHospice:Nursing Care & Pain
Management; Symptom & Medical Management; Psychological Counseling; Bereavement Care;
Spiritual Care; Home Care; Care to the caregiver; Complementary Therapies like Relaxation
techniques, Music therapy, Herbal Therapy etc.; Personalized care at the time of dying;1 Post-
Mortem Services;1 Cremation Support;1 Memorial services to the grieving family

 Well designed & spacious room for patients

 Spiritual Ambience & Holistic Care
 Temple & Prayer Hall
 Kitchen, Cafeteria & Dining Hall
 Natural greenery & spacious garden
 Physiotherapy & Massage Facilities
 Laundry & Housekeeping Facility
 Staff Quarters For Medicos & Nurses
 Out-Patient Community Health Clinics
 Mortuary Support

45
 CHAPTER 9: LIVE CASE STUDIES: HOSPICE IN KERALA33

Kerala has the most experienced first-hand developed palliative care in the entire country. Dr.
RajaGopal is the director of Trivandrum Institute of Palliative Sciences and the flagship NGO
Pallium India. In April, the Kerala government announced a palliative care and pain policy; the
first state to do so in India.
Hospices in the state work charitably with the health and a decent ending of the sufferer in their
best interests. They work mainly in two ways- as an institution or as an on-wheel treatment
facility.
The first kind may be working individually and independently or even as a branch of a hospital
or any other existing institution. They involve daily normal activities and make it feel like home,
which is crucial for the occupants.
The second category mainly constitute of good will persons- like students, religious heads,
doctors, counsellors, people from different walks of life who provide their services by moving
from home to home of these physically/mentally ill people around them.
As you can see in both cases, they work with the community. One which is initiated by an
individual and then that engages the community for a normal life; and the other which is
volunteered by few members of the community. Thus, we see a much better hospice care in
Kerala. In fact, Gods own Country has been ranked first for a better place to die because of its
community - centric hospice care.

33
https://hospicecare.com/bio/mr-rajagopal/

46
 9.1.Institution with care for terminally ill
9.1.1Chacko Homes, Aluva – Senior Residents

Figure.37Chacko Homes

Figure.39Stair landing has spaces for socializing Figure.38External veranda with openings Figure.40Central Courtyard

The care focuses in providing quality care to retired persons who due to various reasons can’t
stay at the comfort of their own homes. The well planned layout and the homely feeling made
complete by the garden and playground satisfies the homely feeling that which the residents look
for.
The care is successful in running with about 30occupants all above years old, yet are able
enough to live by themselves, boasts that the lifestyle they practice clearly influenced by its
layout enables a community living just like home.
Supported by a cheerful, dedicated staff who works for the goodwill of the Home, this place is
indeed a community. Various programmes, debates and talks are hosted by them to keep the life
within smooth and functioning. The garden acts as a play area for the locality children, too.
Built as a Naalukettu, with open verandas and a nourishing Nadumuttom at its centre, the
residential unit resembles the Traditional housing of Kerala. The interlude space in between for
socializing.
The occupants here, come to spend their last days in dignity and freedom without worrying
themselves about their children, health issues (although they are required to hire a home-nurse
privately, fear of being alone –unlike in their own homes, where they are prone to neglect and
fear.

47
Common spaces are surrounded by greens and the dining hall is a double height space, which
adds volume to it.
All inmates are happy Thus the space requirements for a balcony/ exercising are important,
which is missing here. There are few space limitations too in the interiors.

Figure.41Plan Typical

Figure.42Single Unit

PROS CONS
1. Fronted Garden views open to Not every room gets a view
public
2. Central Courtyard, Ramp Ramp accessible only from A block
3. 3 storied Blocks [A,B,C] Quite farther from each other
4. Double height dining hall Nothing striking, lacks ambience
5. Outward verandahs Shut with grills and columns
6. Good room planning-each for Lacks space for families to stay along
two
7. Community Hall for gatherings Not individually reached to
and celebrations
8. Freedom to move about But might need support while going out
9. Small communal spaces between
rooms for socializing
10. Matt flooring, texture for grip
Table 1. Chacko Homes Inferences

48
9.1.2.Signature Hospice

Figure.43Signature Hospice

This 5 year old hospice located at Vennala, Ernakulam fosters care for terminally patients who
are too old to take of themselves. They are bed-ridden and rarely walk or communicate with the
staff.
Housing about 30 inmates with around 5-6 nurses working throughout evenings, the building is
basically an apartment that has been converted for this purpose. By design, large windows and
interlude balconies provide good ventilation and lighting.
Housed in a residential area, nearest to VijayalakshmiPvt Hospital [600m], Signature Care is
fronted by a good road, in a serene setting with a spacious parking area, front office at the ground
floor, administration and rooms in the following upper floors.
“Most of the inmates are bedridden, who do not actually make use of the ambience or views if
provided”.- Says Mr. Alex, founder of Signature Care. However, care is provided round the
clock with about.

49
 Figure.45Paradise Hospice Typical floor 3D
Figure.44Single Unit Typical

Pros and cons

PROS CONS
1. Manipulative use of apartment for 1. No ramp nor lift; access is quite
Healthcare of the elderly difficult
2. 3-storied with round checks and 2. No recreation space for the
nursing support round the clock nurses/staff
3. Central nurses’ station 3. Quite congested when its time for
watching TV
4. Balconies and proper ventilation 4. Inaccessible by the inmates due to
poor health
5. Beds laid out as in wards with 5. Lacks privacy
curtains, in the hall
6. Provision of reclining beds and other 6. Lacks freedom of movement
support material
7. Located in a residential area 7. No effort made in provision of good
views or inclusion of community
8. 8. Lacks bereavement room, spaces or
rooms for family members to
congregate – Lonely feeling
9. 9. Not much input into materials and
texture or ambience

Table 2. Signature Hospice Inferences

50
9.1.3.Paradise Hospice

Figure.46Paradise Hospice

Located in Tripunithura, this 3 year old hospice mainly looks after the old and terminally ill.
Housed in a rented apartment block, with minimal garden the site is located in a serene village.
Begun by two ex-NRI nurses; - Deepthi and Sheela, this organistion has grown to a charitable
trust aimed at helping people to have a dignified death.
The staff works in shifts, during the mornings, afternoons and evenings to serve the in-patients.
Paradise Hospice is equipped with ECG, pulse denominator, Suction Balls, Oxygen cylinders,
etc and in case of emergency the patient can be rushed to the nearest hospital, i.e, VKMHS or PS
Mission Hospital. However the location of the site being quite introverted is not dependable for
extreme cases.
The trust aspires to shift somewhere near a town, for easy access to health services at the earliest.
Spatially, the building is a rented -storeyed villa. “It is important to have a home-like setting…”
says Deepthi, “ because that’s when they are reminded of their home, their independent lives”.

51
Through this calm home-like appearance, she believes people could connect with their own older
self, since most of them are past years of age. A hospice is necessary, because it is happier,
peaceful and far less depressing than hospital care. The public involvement is far less, despite of
a school nearby.
To enhance a homely feel, the two sisters are even thinking of; raising pet animals and a
beautiful garden for small walks- the only exercise that is apt for people at this stage.
They use painkillers as placebos, to convince patients of a sure relief, to which they succumb
easily but come again. They spend their pastime chit-chatting, watching TV, etc.
When asked if they would use other placebo techniques for treatment, they were willing but
needed their clients’ guardian’s opinions as well. However, they would like the assistance of an
architect for designing their new building at Tripunithura. Majorly because of the lack of
knowledge of pain management, people still fear to use the forgotten healing remedies like
music, colours, plants, etc.

Figure.47Typical Floor Layout-single room

PROS
1. Manipulative use of rented house for
Healthcare of the elderly
2. Storage space of medicines in each
room
3. Balconies and proper ventilation
4. Beds laid out to ensure privacy
5. Nearest to town
6. Located in a residential area
7. Pet care to be initiated soon
8.
CONS
1. No ramp nor lift; access is quite
difficult
2. No nurses station
3. Inaccessible by the inmates due to
poor health
4. Takes up the common hall space
5. Lacks freedom of movement
6. No effort made in provision of good
views or inclusion of community
7. Not much space for landscaping
8. Not much input into materials and
texture or ambience

Table 3. Paradise Hospice Inferences

52
9.2. Home Care door-to-door service
9.2.1.A day with Palliative care Karunya

Figure.49Treatment and checkup Figure.48Counselling, socializing

Working with a group of people from a charitable Trust named Karunya, with a vision for the
betterment of the society by targeting the destitute and the bed-ridden patients who are incapable
of treating. The team comprises of a nurse, counsellors, a driver and/or doctors or students or
good willed people to undertake the task of assuring families, helping people to move on,
treating if required, so on. Partly charitable in in its deed, the study enhanced the true nature of
how gullible a patient could be to his surroundings in terms of health and also revealed the raw
life of mankind, left unattended.
Most of them are poor and in need of good care but due to lack of financials are forced to
discharge and stay at home. The advantage is, they return home rather than get stuck in places
that make us feel sicker than better. However, help may not always be accessible.
Almost all of them get along and move on their lives because they feel they ought to support
their families. Some of them risk their lives too.
“People need care and love more than anything else at this crucial point”…..Dr.Alex Paul-
Signature Hospice, Ernakulam
“….Yeah, but its evident that beautiful spaces can make people forget about their hardships for a
while, and in our case I guess Space does matter..”Ms.ShinuGopal, Assisstant Nurse.

53
9.2.3.Karunya Palliative Care
Karunya Palliative Care is a door-to door / free service palliative care service. Initiated in , this
charitable service will be ready to take in patients by August in their new premises at
Kadavanthara.
Every day nurses accompanied by a driver visits homes of people who are in need of medical
assistance, “..irrespective of caste, creed, age or wealth.”. They have access to Urine tubes,
cotton & cloth, water bed/air bed, medicines and most importantly Morphine- a sedative pain
killer, which is still not in use, widely.
One of them -Sr. Anamma Mathew-believes; that, “Hospices are better than hospitals, but is
never worth a home. This is one reason why every hospice needs to have a home-like setting.”.
The concept of hospice is irrelevant as long as people get good care in their own homes. Yet,
they are much better than hospitals.

9.3. Interviews and Talks

9.3.1.Dr.RajaGopal
Chairman: Dr. Rajagopal [Pallium India, TIPS]
Is Architecture promoting cure/relief in Hospital design?

 Not much*. Although they may be barrier free, it does not cope with the patient’s wants.
 Prevents independence
 Shuts people
 Terminally ill are the most affected
Do we have enough terminally ill care services in the country?

 Sadly, no. However Kerala is far better with community run Palliative Care centres.
 The country ranks among the top 100 for the worst place to die
 People are of great need of Hospice because there are instances of improper treatment at
home/ hospitals, quicker accessibility to hospitals and care.
Healing via Hospice Architecture: Our status?

 Unlike other countries, pain management has been included in Medicine only recently
 There are many who prefer to use non-medical treatments, placebo but fear of
experienting has stopped them
 We do not have a design guide for Hospice spaces, which decelerates healing. It would
be most welcome to have good designed hospices, for sure like Karunashraya in
Bangalore.
Suggestions:
Design resemblance close to home; no regimentation;Run by locality for sustenance;Assissted
living Facility;Barrier friendly;Encourages Personhood;Private yet secure rooms;Care-givers
recreational room

54
 9.3.2. SrAnnamma Mathew
What do people need the most at this period?
People at this time would need to be independent, they feel depressed with their own self,
wishing they were less of a pain to their near and dear ones. Apart from counselling, and
medicinal therapies and music/ any entertainment can be provided for elevating their moods and
helping them regain life back.
Placebo by music is known but not yet used intentionally on any of their patients. However,
some patients feel calmer while listening to their favourite kind of music; a few have confessed
receding pain; elevation of mood; even movements while unconscious, etc. Likewise they are
aware of healing through colour, too but do not exactly know how.
Unlike before, people are open to treatment, yet there are a many who resent the Palliative
Care’s services calling them as gypsies and their treatments a sham. It seems like Kerala has a
long way to go in eliminating strong superstitious beliefs.
Spatial Sugestions
Their new building is designed around a courtyard with a mango tree at its core. The rooms
overlooking the courtyard have no doors, just a half-wall with adjustable screen partitions. The
courtyard forces communication, and mingling. The bathrooms are capable for handicapped
patients, with sloping ramps at the door step.
Treatment, early detection, proper care and treatment can cure a terminally ill disease; it can
even be treated miraculously, or even psychologically through Art and Architecture. Palliative
care refers to pain management caused due to symptoms, finances, inabilities, etc. Each of them
are connected to our mental health, which has to be stabilized in these life-threatening diseases.
What Medicine cant do, should be completed by Architecture-built or unbuilt.
Pros and Cons

PROS CONS
Stay at home Might not get medical support at the right
time, perhaps
Socialize and communicate Embarassment and shutting off when such
people try to help
Freedom of Act & Speech Not all would get the desired treatment
Independent and Safer Might feel guilty and scared
Least likely to be lonely May have issues coping with illness by the
family and patient

Table 4. Door-to-Door Care

55
 CHAPTER 10: Inferences – Hospice Design Recommendations

Kerala’s community-generated palliative care and hospices are familiar to most people as they
are involved in these charitable works knowingly or unknowingly. This system of treatment by
the local community is important for patients to outgrow their fear and embarrassment through
counselling, small talks, some sort of entertainment, etc. In this kind of care, patients are taken
care of by not only their near and dear ones but also by the community.
However there are people who do not get the right amount of care and support from their
families due to distance, conflicting interests, etc. People are admitted to large hospitals- that are
cold, congested, sickening spaces - for further treatment and they grow weaker. In fact, their last
home distorts their hope to life and tortures them mentally, forcing them to die painfully. This is
where the need for housing terminally ill patients and their care is needed. Thus we need
hospices.
In a place like Kerala, most people prefer to work abroad leaving behind their families - usually
their old parents. The option of returning back for this cause may seem difficult. Some prefer
hospice care for younger patients as this could help them overcome the stigma they face. Many
other reasons pertain to this situation.
Thus hospices must be designed like home and should be open to the community, to some
degree. The design and interiors should be comforting rather than scary. Beautiful views,
ambient spaces that are barrier-free and safe are a must. Gathering spaces, open courtyards or
verandahs.

As an outcome of comparative study of foreign and Indian case studies, we conclude these
important remarks
• The natural environment is considered the main source of many human experiences
radiant and ambient light, temperature, sounds, odors, and mechanical contacts. The
way designers organize there built environment affects all these stimuli.
• It can be concluded, that what a user does and why, and the thoughts and feelings that
accompany those actions, are linked somehow to interactions with the designed
environment.
• Interactive building linking people’s behavior, thoughts and moods
• Our senses act as receivers and gateways to our minds and bodies. Surrounding
environment thus influence our minds and bosies, physically and mentally.
• We have to design by considering all the senses in every manner
• A visual environment with a variety of colours and shades is a good way of achieving
desirable interest and stimulation for a more pleasant and productive space.
• In combination with other stressors, noise and unwanted sounds have adverse effects
on physical and mental health. While nice fragrances have positive effects on
reducing stress.

56
 • Changes in air pressures associated with weather patterns can have harmful effect on
human beings. While therapeutic massage has positive affects on the physiological
and psychological status.
• Not many ordinary people get hospice care facilities. It must be economical yet
aesthetic. Not many housed in hospices are happy with their surroundings
• The materials used in any designed space have a considerable effect on the user’s
perception and feeling and thus, the user’s behavior.
• Architects should be in a contentious research and do more efforts to feed back their
knowledge about how the user of their designed environment reacts and behave..
• The benefits of these researches are plenty and varied such as employee productivity,
product marketability, and improving the responses of the users and their connected
behaviors.
With this in mind a typical Hospice Design Guide could be derived. The following chapter
describes this in detail.

57
 CHAPTER 11: Design Recommendations for Hospices in Kerala34

This Guide is prepared from two fundamental perspectives of a qualitative – Tactile:overall

spatial requirements and Non-Tactile: spatial perception by each of our senses.

11.1.Tactile: Overall Spatial Requirements:

11.1.1.Home-like setting
Avoid institutional-like appearance
Welcoming Entry right from the beginning beautiful views, gardens, clear defined paths are
needed.
Legible as in planning, proper signages, to avoid confusion and fear.
Barrier-friendly, ample space for moving about easily. Use of proper materials for flooring,
walls; provision of handrails
Materials and colours have to be chosen according to its properties to soothe and calm

Figure.51Defined Pathways Figure.50Naturally-lit and view

11.1.2.Rooms
• Rooms with beautiful views, well-lit and ventilated by natural lighting and air flow
[planning has to be done as such]
• Should have a living room, with TV where family can gather and congregate, space for
family members to stay. Kids play area, common could be indoor or outdoor, in case of a
single room.
• Interiors should be flexible enough for change as per the user
• Materials and finishes should prevent injury cause; Well designed beds and user friendly
accessories that enables them to move around without much help {Independence)
• Rooms need to be easily accessible by the caretakers, must enable privacy yet should be
observable by the staff 24x7.

34
(image credits: DESIGN & DIGNITY STYLE BOOK July 2014 Transforming End-of-Life Care in Hospitals One
Room at a Time. Irish Hospice Foundation. July 2014

58
• Courtyards at the centre act as breathing spaces, can have a special design feature like
pools or gardens in the centre
• For a common family room, near the ward must have ample space for 8-members, with
proper storage, refreshment ares, seating,kitchenette, should be private

Figure.53Space for family

Figure.52Space for family to congregate in single
room facility

Figure.54Bear Cottage Children’s Hospice, Figure.55Hospice of the Central Coast,

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11.1.3.Miscellaneous:

Figure.57St Christopher’s Hospice, London Figure.56St Christopher’s Hospice, London Garden

• Vegetable, multi-sensory Gardens where they could plant and cook from [can involve the
public]34
• Libraries, Arts Studio, Recreation Room for members to walk and exercise (Freedom to
do whatever they like to)
• Kitchen, Mess and pantry space with proper dining room for family [within rooms or
commonly]
• Staff Recreation room, changing rooms, cafes, pantry, locker room
• Auditorium, and pocket spaces for small gatherings and entertainment by community;
Open to community for performing (Socializing, Less lonely)
• Meditation room, Parks and Therapeutic Gardens for children as well (Treating guilt,
introspect)
• Bereavement Suites with seating, mortuary

Figure 58Bereavement Suites, St James’s Hospital Figure.59Bereavement Suite Communal room

34
As in Khoo Tech Phoo Hospital, Singapore

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11.2.Non-Tactile: Spatial Perception by each of our Senses
Based on how we see, touch, smell, hear and taste our surroundings. The following explains how
we can manipulate design in healing our senses collectively.

11.2.1.Sight
Natural Environment
Kerala is abundant in rainfall, natural cover, making it one beautiful place naturally. Hospices in
Kerala can be designed by manipulating this great asset of God’s own Country. Beautiful views
can be harnessed by proper site choice. Artificial streams can be recreated additionally. Seasonal
fragrant, flowering and fruit-bearing plants can be planted and maintained by the inmates and
even by volunteers from the community.
Each room, each bed should have an outdoor view; can have balconies as well. Indoor plants too
can be made use of.
Light and air

Figure..61Marie Curie Cancer Care:Restorative landscapes include paths, Figure.60Meditation and worship
seating, gardens, and closeproximity to the main hospice

Ambient lighting, play of light and shadow via design. Natural light from the sun is considered to
be the best source of light for the human health physiologically and psychologically.35Should not
be too bright in case of artificial lighting. Provide sunshades to beat glare and climate responsive
design to prevent excess heat accumulation
Courtyards and pocket spaces for natural air circulation and flow. Use of jaalis for effective
cooling (Stark effect) in enclosed spaces, semi-open verandahs fronted by sceneiic views. The
Big Ass Fan used in Rwanda Hospital rotates slowly but cools the skin surface gradually,
preventing coldness.36

35
Antonio F. Torrice cit.Elyacoubi, 1999.
36
TED tx by MASS Designs

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Flexible Spatial Planning:
This gives freedom to think, execute interests in their own way. People can arrange and decorate
their own rooms according to their will. Freedom of act and speech, where one’s opinions are
valued, even in life-stressing moments could help them cope with their personal issues.
They could even utilize their room for hobbies like, painting, playing music, etc. Spaces should
be calm and simple. Indoor plants can be used.

Figure.62Each inpatient bedroom at the AHI Hospice, Aichi Prefecture, Japan, was conceptualized as a flexible, adaptable
space, inviting personalization on the part of the patients and their family members.

Glass vision panel doors, artificial lighting with controls given inside appropriately.
Colour
Colour for rooms must not be too deep or bright. It should be warm and soothing. Warm color
seem to make a room hotter than cool colours, which means our eyes perceive warm colours and
subconsciously tells the body that the room is warm, although the temperature may be the same
in both rooms.Thus, the architect has to consider the psychological aspects of each color before
application.

62
 Figure.64St.Michael's Hospice rustic finis
Figure.63Serenity Suite Sandwell & West Birmingham
Hospitals NHS Trust*

Pieces of art, could be paintings or sculptures or even installations, that could lift up one’s spirits
must be installed. Research by Prof Roger Ulrich suggests
that nature art is more appropriate than
ambiguous, surreal, abstract art. Walls could be given a texture to stand out or columns could be
painted, so on. However the walls must not have poking textures, slippery floors, to avoid
accidents.
There should be handrails incase the occupant is blind; the walkways should be wider for two
people to communicate comfortably, in the case of a deaf/dumb person. Beds and in-patient
amenities have to be designed for free movement.

11.2.2.Smell
GardensFlower/fruit bearing scented plants can be planted. The interiors should have access to
supple fresh and clean air. Indoor plants and voluntary changing of flower vases from the garden
plants. Medicinal plants and some flowers like Tulsi, Jasmine, Rose, etc can be refreshing.

Figure.65Waud Healing Garden, USA Figure.66Waud Healing Garden

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Fragrances
Use of incense sticks or potpourri.
Buffer spaces in planning
11.2.3.Ears
Our ears can process sound even when its low. Therapeutic sound therapies, music, chanting,
ultrasound have been successful in healing a person. However, over usage may lead to internal
changes. Thus its wise to use classical music, Solfreggio frequencies while sleeping, etc.
Natural environment can enable the sounds of nature- birds chirping, therapeutic water therapy,
which has always been powerful in calming a person. Good visibility allows better hearing. So
meditation rooms can have neutral coloured interiors (with natural materials), or can be in these
gardens.
Acoustic flooring, carpet to reduce noise and disturbance. Double glazed windows and acoustic
ceilings, doors, etc for a serene quiet environment.
11.2.4.Touch
Natural materials, rustic and earthy are always high priority. Wooden flooring/finishes, Stone
walls, Bamboo walls, so on capture the perceiver’s soul and heart instantly. They feel settled and
better inclined with their surroundings.
Just as color could influence our sense of feeling, the Hospice has to be climate-responsive and
with ambient temperature. Therapeutic massage rooms.
Materials and Texture37
Seating should be soft, comfortable, durable and age-friendly; Tables and other furniture should
be of natural materials such as wood. Glass should be avoided; Accent features such as
individual art works, stained glass windows and decorative wall textiles should be considered;
Colour choices need to be carefully chosen. Ideally muted, warm, natural colours should be
considered; Natural effect flooring finishes should be considered
11.2.5.Space and Form
The overall picture of the entire Space is a collective symphony of all our senses. When our ears,
eyes, nose and skin are a stable, we find our taste buds work better. Similarly, when its dark, we
tend to concentrate less, if a space is too loud we feel stressed, so on. An emotively designed
space is achieved by focusing on the bigger picture and then shrinking down into the details.
Either way, it’s a paradoxical step: Whole to Part and Part to Whole.

37
Design Dignity Style. Irish Hospice Foundation.2014

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11.2.6. Summary
In 1966, a British planner called Maurice Broady came up with a new term for the architectural
Lexicon architectural determinism. This was to describe the practice of groundlessly asserting
that design solutions would change behavior in a predictable and positive way. However, It took
a long list of failures over the millennia to prove what could happen if we go wrong. The high-
point of this trend was over the demolition of the famously dangerous and dysfunctional Pruitt-
Igoe urban housing complex in St Louis in the US. The loss of faith in architecture’s power has
been regrettable, ever since. Spaces that are green, open, allowing freedom are considered to be
happier, fuller than those that are congested, noisy, has foul odor, and lacks cleanliness,
ventilation and lighting. Best example for the former would be gardens & parks while for the
latter would be poorly designed Hospitals. It’s appalling to believe that we go to such a place to
get cured. Lack of timely care and access forces many to spend their last days at a hospital.
Worldwide efforts are being taken for proper Hospice Care design, whereas India is lagging for
behind. Kerala, with its effective community-centric Palliative and Hospice Care, is
comparatively better. Hospices in Kerala is in its infant stages, and the pace of growth in need is
rapid. The design of a common Hospice at present in Kerala is not effective for healing. Current
practices, standards, and the future possibilities of hospice, in both the for-profit and the non-
profit sectors, are ripe for critical inquiry and debate. This report tends to direct the architect in
designing ambient spaces that is fit for health and healing. The guide is prepared under two
perspectives, spatial requirements and Sensory Analysis so as to rightly cater to the emotions
faced by the occupants in such spaces. Although this Guide has been derived from extensive
study, it’s still important to design according to the culture and desires of the staff and family as
importantly as the patient.

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 ANNEXURE I: SYNOPSIS

AIM
Recommendations for designing Hospices through Empathy Architecture in Kerala

The main goal of this study is to understand the design of Hospice and Palliative Care design
and recommend a few guidelines for those in Kerala. The study was done extensively by
collecting cases, visiting Palliative & Hospice Care Centers, meeting with patients, Doctors,
Nurses and other staff members.

OBJECTIVES
• Identify role of spaces on people’s emotions, generally Narrow down the study to
hospices
• What physical/mental/tactile/non-tactile factors are responsible for human health
improvement
• Importance of “space” in healing; Analysis through behaviour
• How architecture heals; Alternative treatment methods
• Understanding the need for Hospices in the country and the state
• Comparison of the design guidelines set by various other nations, their analysis
• Compilation of inferences and analysed data for design tool kit
SCOPE
• Hospice has often been considered a place for the dying. It symbolises a dark tunnel of
fear, uncertainty and hopelessness and a colourless world. But that is no more the case
today.
• Hospices are centres for giving people hope in coping with their greatest fear of death.
These institutions help in curing people of their insecurities and in a few cases their
diseases completely.
• It has been found that less than only 1% of the entire country’s population (1.2 billion+)
receives this care despite the rapid rise of people in need of this care. Many hospitals
reject people as incurable, or as invalids after they are found medically saturated to any
further treatments. This is why and where the need for hospices become important.
LIMITATION
• Its impractical to develop a universal design tool for all because of unique preferences
that differs from man to man. However, this study ensures a few key design factors that
can make life for the terminally ill living in a hospice beautiful and easier.
• The context of study has been limited to Kerala, wherein hospice and palliative care
are growing popular today.
METHODOLOGY
• Case Studies; appointment with doctors, palliative care experts, psychologists, etc
• Books, and issued papers of Psychology and Mental Health, Architectural
Subliminals ,Behavioural Architecture.
• TED talks, Interviews of Architects, Medical Persons, Scientists, etc

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 ANNEXURE II: Study Strategy

Architecture and Behavior Influences

Psychological changes Behavioural Changes

Spatial Perception
Physically Mentally

Factors affecting Emotions/ Moods

Science Architecture Alternate methods

Hospices
International Examples Design Guides

INDIA
Examples Design Strategies, if any

Kerala
Community centric Institutional bodies

INFERENCES
Design Guides Case Studies

Inferences – Hospice Design Recommendations

Literature references Intervies, Talkshows

Recommendations for Hospice Design in Kerala

TACTILE NON-TACTILE

Table 5. Methodology

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 ANNEXURE III: QUESTIONNAIRE

1. Brief about their Institution (Year, Staff, No. of Occupants, Treatment Methods)
2. Opinion on Hospices/ Palliative Care and Hospitals - which one is better?
3. Treatment Methods and Pain Management alternative measures taken by them
4. How important is space in such Care services
5. Kinds of spaces required; Staff requirements
6. Public involvement
7. Have you tried any therapeutic therapies?
8. If yes, howwas it? If no, why not and would they like to try some time later
9. Needs and emotions faced by Hospice Inmates
10. What do you do to cope with their feelings/illness
11. How do you support them? Any voluntary community involvement
12. If yes, how was it? If no, why not?

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