The role of the built environment in experiences of hospice care: challenges for hospice design

The term ‘hospice’ refers to both a philosophy of end-of-life care and a building type, dedicated to offering this care. Hospice care strives to offer dignity, personal choice, peace, calm, and freedom from pain. Hospice care is anchored in space and spatial practices; however this relation is understudied. It is a rather new building type, for which architects have few historical references, post-occupancy evaluations, or direct experiences available. The prospect of replacing a Belgian hospice offered an opportunity for a case study. We aim to understand how the built environment of a hospice affects experiences of care, and discuss design considerations derived from that. Our qualitative research approach was based on principles of Grounded Theory and combined observations with semi-structured interviews with six staff members, six volunteers, three relatives and eight patients. Our analysis shows that the built environment contributes to hospice care by the balance it affords between privacy and social interaction, by the discrete ways in which it affords offering high-level care, and by its human scale and relation to the natural environment. Insights gained challenge hospice designers to consider how meaningful encounters are often spontaneously triggered by daily activities; guests’ lifeworld changes in size; a delicate balance is required between proximity and seclusion; the built environment can support the ethos of staff and volunteers; aspects of environmental support (e.g. accessibility) are intertwined with aspects of emotional comfort (e.g. hominess); high-level care can be offered in discrete ways.