OMKAR S JADHAV 16SA14

TOPIC: HOSPICE AND PALLIATIVE CARE CENTRE

1. INTRODUCTION
1.1 DESCRIPTION OF THE TOPIC
1.1.1 Hospice
The word "Hospice" comes from the Latin "hospitium" meaning
guesthouse. It was originally described a place of shelter for weary and
sick travellers returning from religious pilgrimages.Hospice care focuses
on caring rather than curing. Hospice care is a philosophy of care
focused on comfort, quality of life, and assisting those nearing the end of
life. It is a system of care oriented towards treating pain and other
symptoms without curing the illness. Hospice care focuses on the quality
of life rather than its length.

The hospice care team is a multidisciplinary team made up of doctors,

nurses, social workers, trained volunteers, and spiritual advisors.
Hospice care can be provided in the home or in a facility such as a
hospital, nursing home, or a dedicated hospice care facility. Patients
entering hospice care understand that their illness or disease is not
responding to medical treatment. By entering hospice, attempts to cure
the patient’s illness are stopped. Stopping curative treatment does not
mean discontinuing all treatment. For example, if a patient is being
treated for high blood pressure with medication, he or she will continue
receiving those treatments in addition to the treatments they are
receiving to manage the symptoms of their terminal illness. Patients can
elect to leave hospice care at any time if he or she decides that they want
to resume curative treatments. Patients may also leave hospice care if
their condition improves.

1.1.2 Palliative care

Palliative care is an approach that improves the quality of life of patients
and their families facing the problem associated with life-threatening
illness, through the prevention and relief of suffering by means of early
identification, treatment of pain and other problems, physical,
psychosocial and spiritual. Unlike hospice, palliative care can be
performed for non-terminal patients. It is in fact to help people live
longer, happier lives. Palliative care team is a multidisciplinary team of
doctors, nurses and other specialists who work together with a patient’s
other doctors to provide an extra layer of support. In palliative care, you
do not have to give up treatment that might cure a serious illness.
Palliative care can be provided along with curative treatment and may
begin at the time of diagnosis. Palliative care does not replace primary
treatment; it works together with the treatment, providing an extra layer
of support for physical, emotional, spiritual, and practical needs.
Treatment will involve medicines, therapies, and any other support that
specialist teams believe will help their patients. Someone can receive
palliative care at any stage of an illness, whereas hospice care is only
appropriate at an end-of-life stage.
Palliative care:
1. Provides relief from pain and other distressing symptoms;
2. Affirms life and regards dying as a normal process;
3. Intends neither to hasten or postpone death;
4. Integrates the psychological and spiritual aspects of patient care;
5. Offers a support system to help patients live as actively as possible
until death;
6. Offers a support system to help the family cope during the patient’s
illness and in their own bereavement;
7. Uses a team approach to address the needs of patients and their
families, including bereavement counselling;
8. Will enhance quality of life and may also positively influence the
course of illness.
1.2 DIFFERENCE BETWEEN HOSPICE CARE AND
PALLIATIVE CARE
Hospice care and palliative care are very similar when it comes to the
most important issue: “CARE”. Palliative care is for anyone with a
serious illness. Anyone can have it at any age and any stage of an illness
and can have it along with curative treatment. It is not dependent on
prognosis. Hospice is an important Medicare benefit that provides
palliative care for terminally ill patients who may have less than 6
months to live. People who receive hospice are also no longer receiving
curative treatment for their underlying disease.
1.3 AIM
The aim is to design a centre where fusion between the living space,
physical surroundings and the user’s need are created using an
integrated design solution and to identify what factors can actually
trigger recovery for patients in a healthcare environment.
1.4 OBJECTIVE-
• To avoid an institutional appearance and atmosphere.
• To create a warm, comfortable, home like environment to serve as a
prototype for other hospice centres in India.
• To plan and design a centre where care is given to the patient.
• To create outdoor spaces for wellness and integrate outdoor spaces
with built environment.
• To establish the need for an architectural design in healthcare
environment.
• To provide positive distraction for patient.
• Role of healing gardens and healing spaces.
• To create energy efficient building.
• To study the model centres. (case studies)
1.5 SCOPE OF STUDY-
The area of study includes creating a hospice and palliative care facility
which is suitable for a place like Nashik,maharashtra with a  hot, rainy
and cold weather seasons, to cater a psychological and social needs of the
users.
1.6 JUSTIFICATION OF THE TOPIC
In present Indian society, death is often viewed as an inappropriate and
unacceptable phenomenon. Despite its inevitability and universal
nature, fatality has strangely become an “unspoken topic” among us
being ultimately concealed within hospital walls. The institutionalised
setting present in today’s hospitals, sadly neglects the emotional needs of
patients and their loved ones when dealing with the fear and stress
related to death and a terminal disease. Hospitals around the world
continue to hide their dying patients away from their activity centres,
transfer them to rooms at the far end of long depressing corridors. This
situation has ultimately detached the person from their families and has
relegated them to an institutionalized setting where the ill have to die
alone and with fear. So those with a short period of time to live are in
dire need to make the best out of the remaining time and find their real
purpose in life. They have been places of mourning for the end of life
rather the celebration of life. The topic has been selected to change the
stereotypical hospital environment and give patient a healthy
surrounding with help of architecture and landscape that can connect to
nature and positive distraction can take the patient’s mind off the
situation.
1.6.1 STATISTICS
Hospices are very rare in India and only 16 of India’s 29 states and 7
union territories (less than 45%) have any palliative care service at all.
Every human being has a right to die with dignity and minimal distress.
In India, patients are not able to achieve this. The concept of hospice is
well known in the West but in India, where palliative care is so
desperately needed, it is almost unheard of.
McDermott et al. identified 138 organizations currently providing
hospice and palliative care services in 16 states or union territories.
These services are usually concentrated in large cities and regional
cancer centers, with the exception of Kerala, where services are more
widespread.
The Kerala network has more than 60 units covering a population of
greater than 12 million and is one of the largest networks in the world.
In April 2008, Kerala became the first state in India to announce a
palliative care policy. 
Cancer and other Non Communicable Diseases have emerged as major
public health problems in India. The National Cancer Control Program
of the Government of India is a laudable initiative and constitutes one of
the very few such models in the world. Cancer control needs a
multidisciplinary approach and palliative care is an important
component of this approach. Despite its limited coverage, palliative care
has been present in India for about 20 years. The past two decades have
seen palpable changes in the mindset of healthcare providers and policy
makers with respect to the urgency of providing palliative care. Every
hour more than 60 patients die in India from cancer and in pain.
Moreover, with a population of over a billion, spread over a vast geo-
political mosaic, the reach of palliative care may appear insurmountable.
It is estimated that in India the total number who need palliative care is
likely to be 6 million people a year. These figures are likely to grow
because of the increasing life span and a shift from acute to chronic
illnesses. It is estimated that 60% of the people dying annually will suffer
from prolonged advanced illnesses. This means there will be a sizeable
population of the aged who will have several spells of hospitalization
interspersed with long periods of being confined to their beds at home.
In addition to the challenges posed by illnesses, many of the patients in
India are extremely poor and do not have access to clean water, food, or
even shelter. When chronic or life-threatening illnesses strike, it is a
crippling blow for them and their families. There is therefore a crucial
need for a system of care at home that can best be built by a community-
based palliative care movement.
Palliative care was born in India as the Shanti Avedna Sadan in Mumbai,
a hospice, in 1986 .Over the next five years, it established two more
branches, one in Delhi and one in Goa; but patients outside these
institutions had no access to palliative care. Two major developments
occurred in the 1990s. One was the formation of the Pain and Palliative
Care Society (PPCS) in Calicut in the South Indian state of Kerala in
1993. The other was the formation of the Indian Association of Palliative
Care in 1994.
Over the next few years, in the latter part of 1990s, several new palliative
care initiatives were started such as the Guwahati Pain and Palliative
Care Society in Assam, the Jivodaya Hospice in Chennai, Cansupport in
Delhi, the Lakshmi Palliative Care Trust in Chennai and the Karunasraya
Hospice in Bangalore.  Some regional cancer centres like Trivandrum,
Bangalore and Delhi which already had pain management programmes,
also included palliative care in their service. Though every year a few
centres were added, the growth was limited considering the enormity of
Indian population.
Table 1. Palliative Care Provision in India by State/Union Territory

State/Union Services;  Ratio of Service Inpatient Outpatient

Territory n to Population Services; n Services; n
1:000s
Hospice Hospital Home Day
Care Care/Clinic
Andhra Pradesh 3 25403 1 2
Assam 5 5331 4 5
Chandigarh 3/4 225 2 1 1 1
 State/Union Services;  Ratio of Service Inpatient Outpatient
Territory n to Population Services; n Services; n
1:000s
Hospice Hospital Home Day
Care Care/Clinic
Goa 1 1347 1
Gujarat 3 16890 1 1 2
Karnataka 5 10570 2 2 2 4
Kerala (by district)
 Alappuzha 2 1 1 1
 Calicut 15 1 13 13
 Ernakulam 5 2 3 3 5
 Idukki 3 1 2 2
 Kannur 4 1 3 4
 Kollam 1 1
 Kottayam 3 2 1 2
 Malappuram 20 20 20
 Palakkad 5 4 5
 Thrissur 5 5 5
 Trivandrum 9 3 1 2 5
 Wynad 11 11 8
Total 83 384 9 6 65 71
Madhya Pradesh 6 10064 3 3 6
Maharashtra 5 19376 4 1 4 4
New Delhi 3 4617 1 2 2
Orissa 1 36805 1 1 1
Punjab 1 24358 1
Rajasthan 5 11301 1 2 4
Tamil Nadu 12 5200 4 5 6 7
Uttar Pradesh 1 166198 1
West Bengal 1 80176 1 1
Total 139 24 22 89 112
 Table 2. Home Care Services by State/Union Territory
State/Union Territory No. of Organizations Providing Home Care Services
Assam 4
Chandigarh 1
Karnataka 2
Kerala 63
Madhya Pradesh 1
Maharashtra 4
New Delhi 2
Orissa 1
Tamil Nadu 6
West Bengal 1
Total 88

This review of hospice and palliative care development in India uncovers

a contradictory progress. On the one hand, the barriers to improving
hospice and palliative care provision in India are multiple, complex, and
entrenched; on the other, these challenges have been tackled over the
last two decades, and although not always overcome, successful
indigenous approaches are gradually emerging.
1.7 ARCHITECTURE INTERVENTIONS
The avoidance of an institutional appearance and atmosphere is
considered to be particularly important in relation to the need to take
account of the complex emotions and perceptions of those being
admitted to a hospice, as well as their families and friends.
Orientation and views should provide interest and stimulation, and
enhance the environmental character and quality of the unit. The public,
semi private and private areas should be well segregated. circulation
patterns, vehicular and pedestrian, (e.g. staff access, patient transport,
visitors, delivery of supplies, ambulance, kitchen etc) need to be taken
into account. Adopt universal access for those with disabilities.
The creation of a ‘domestic’ character in particular areas, especially for
the in-patient unit. This should be achieved by careful attention to such
considerations as quality of light, exploiting views, use of colour,
selection of furniture, material and finishes, and so on. In addition to
being domestic in character, the physical accommodation for patients
should have a relaxed atmosphere and consistent with the requirements
of nursing care. A key consideration in the creation of an appropriate
‘atmosphere’ in a unit will be clarity of circulation. Avoid
overcomplicated or confusing circulation routes, especially in the areas
used by patients and visitors. A clear, legible and ‘user-friendly’ signage
system (both internal and external) should be incorporated in the design
at an early stage. The environment should offer privacy to patients and
their families when required.
Careful consideration should be given to ensuring a quiet environment,
with a higher than normal level of sound containment and acoustic
privacy, for patients and their families. The effects of noise can be
reduced by planning measures, such as locating noise generating rooms
away from those requiring quietness, by isolating sound sources with
sound containing partitions and doors, by absorbing sound with acoustic
materials and generally by the incorporation of floor coverings, curtains,
and other materials that do not reflect sound.
In view of the possibility of unpleasant odours in bedrooms, bathrooms,
WC’s, and day areas, together with the sensitivity of some patients to
smells and odours, the level of ventilation provided should be of a high
standard. While recognising this need for mechanical ventilation in
particular areas, it is desirable that natural ventilation should be used
wherever possible, and every effort should be made to avoid draughts.
The environment should offer privacy to patients and their families
when required. Complementary therapy rooms should be provided for
positive distraction of patients. Complementary therapies can include
aromatherapy, acupuncture, music therapy, art and others.
Open Spaces are merged with whole composition. Outdoor spaces, green
spaces and water bodies should be integrate in and around the unit for
the enjoyment of patients, staff, and visitors and to assist orientation.
The green spaces can act as a transition space between built and unbuilt.
water body can be used to capture the feelings of tranquility and a sense
of calmness, peace, as most of the patients are in the advance stages of
disease and are subjected to excruciating pain. The playground
structures for children can capture the spirit of adventure while being
friendly, fun, exciting and importantly accessible to both mobile and
wheelchair-dependent patients. Key factors to consider in space for
wellness
1. Sight/Mind
Visual distraction and connection to nature. Not just through sight but
also through the five senses to promote the human experience with
nature by integrating natural textures, forms, and patterns.
2. Light
Natural light, dynamic and diffused light. The goal is to connect as much
as possible to natural light via windows or skylights to reinforce the
natural rhythms of day and night.
3. Sound
Ambience in the audio environment, sound privacy and again connection
to nature and natural sounds where possible to improve well being.
4. Temperature
Thermal comfort and a sense of control over your environment to
provide warmth and cooling as and when needed
5. Water
Proximity to water and views of water are proven to have many wellbeing
benefits including reduced stress, lower heart rate and blood pressure,
increased feelings of tranquility, positive emotional responsiveness,
improved concentration and perception, and memory restoration.
Innovative architectural design of a Hospice and Palliative Care centre
will able to motivate the government bodies and the stakeholders to
provide funding and other aid to construct many more such centres,
which is the need of the society.