The Importance of Optimal Architectural Design for Palliative Care

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As palliative care models evolve, new facility designs must adapt to enhance the quality of life and ensure privacy

Palliative care is one of the fastest growing trends in healthcare. This growth has occurred primarily in response to the rapidly aging population, the increasing number of Americans living with serious and chronic illnesses, and the beginning of a shift in the cultural approach to dying. According to the National Hospice and Palliative Care Organization, hospice use has surged, with 1.5 million Americans receiving hospice care in 2013, compared with only 246,000 in 1994.

The benefits of palliative care have been shown to include improved quality of life, increased patient and provider satisfaction, improved symptom control, fewer and less intensive hospital admissions in the last month of life, reduced anxiety and depression for both patients, family and caregivers, and overall cost savings.

Economics

Around 5% of patients accounted for an estimated 60% of healthcare costs in 2011, according to the Center to Advance Palliative Care. About 27% percent of Medicare dollars are spent on patients in their last year of life and roughly 25% to 32% of patients die in hospitals.

As payment models shift away from fee-for-service and toward global budget and population management strategies, it is economically advantageous for hospitals to find alternatives for end of life patients. Consistent with the goals of a majority of patients and their families, palliative care patients spend less time in intensive care, and are less likely to die in intensive care units. Palliative care is associated with higher quality of life and lower costs through fewer and shorter hospital stays and less intensive treatments, and is thereby a compelling option in the context of healthcare reform.

Education and Training

While the number of palliative care programs has grown dramatically over the past decade, there is a significant shortfall in the number of trained physicians to provide care, and to mentor and teach the next generation of physicians, and other caregivers. According to the American Academy of Hospice and Palliative Medicine, there are 5,150 hospice programs and 1,635 hospital palliative care teams in the U.S. which translates to only one specialist for every 20,000 older adults living with a severe chronic illness. Hospice and Palliative medicine was officially recognized as a subspecialty only recently in 2006, by the American Board of Medical Specialties and American Osteopathic Association. A twelve-month fellowship is required, and there are only 176 fellowships in the country.

The palliative care treatment approach emphasizes the importance of training many types of caregivers within robust interdisciplinary teams in order to deliver the best possible evidence-based care, including the most advanced pain and symptom management.  This includes physicians and medical students, as well as nurses, nurse practitioners, health aides, administrators, chaplains, social workers, physical and occupational therapists, healing arts practitioners, lay caregivers, and volunteers.

Successful palliative care and hospice treatment best occurs within facilities that are innovatively designed to provide a homelike, serene setting, assuring maximum privacy, while seamlessly supporting these interdisciplinary care teams, and providing the most sophisticated medical treatments. It is also ideal for these spaces to be designed to support ongoing, critically-needed education and training.

Design Considerations

As palliative care models evolve, new and innovative facility designs will adapt to enhance the quality of life, ensure privacy, facilitate ease and coordination of interdisciplinary care, and promote healing for both patients and their families. Since the central premise of palliative care is respect for the values and interests of the patient, designs must be based on their extensive input. To obtain this, the design team must spend time talking and listening to the caregivers who are in regular and intimate contact with patients and families. The design response in turn becomes a creative adaptation to achieve the most homelike and serene environment possible, enhancing a patient’s sense of calm and control, while ensuring maximum privacy, facilitating care coordination, and enabling immediate access to highly specialized care.

Single-occupancy patient bedrooms are essential to ensure privacy, and to accommodate family members who wish to stay. Since a central premise in palliative care and hospice is to recognize dying as a part of life, space is designed to accommodate community participation in the process, such as in art and music therapy, massage and including a large team of volunteers. Additional spaces to support the full range of living activities are important, such as an onsite commercial kitchen for staff to prepare patient meals, as well as separate kitchen and dining rooms for families to prepare and share meals.

A variety of specialty spaces to support both patients and their families are essential to this mission. These include rooms or places for meditation and reflection, a spa, library and reading nooks, exercise room, a play area for small children and a teen media room. Access to nature is fundamental to support the grieving process, as are plentiful windows, natural lighting and materials, such as wood and stone, which can enhance comfort and nurture patients, families, staff, and volunteers.

Multi-disciplinary workspaces and respite areas for staff are essential to facilitate collaboration and resiliency among the many different professionals interacting with patients and families. Space should also be designed to accommodate increasing levels of privacy between caregivers and patients as required.

A palliative care and hospice center provides caregivers with an unparalleled degree of immersion in acute symptoms management, and extensive experience with end of life care. Because of this, it can be an ideal environment for education and training. It should thereby be designed to have ample space for onsite learning opportunities, such as rotations, consultations, and simulation-based training. Tele-health video conferencing capabilities can provide critical access for timely consultations between staff and community-based clinicians, as well as a variety of educational sessions delivered conveniently over distances to professionals, lay caregivers, and patients.

The physical environment of a palliative care and hospice center sets the stage for the quality of life for patients and families and effective holistic treatment. It can also make a palpable difference in supporting caregivers of all types, sharing best practices, and expanding the capacity of caregivers in the future.

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About Author

Charles Rizza, AIA, MorrisSwitzer Environments for Health
Charles Rizza, AIA, MorrisSwitzer Environments for Health

Charles Rizza, AIA, is an associate partner with MorrisSwitzer Environments for Health. As director of the Portland, Maine, Office, Charlie has focused the last 15 years of his more than 30 years in healthcare planning and design in Maine. Charlie speaks regionally in the areas of master planning and excels at conducting live user group planning sessions using interactive software. His interests include fishing Maine waters, restoring his 200-year-old home and repurposing things.

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