Hospice Home

STATUS:  We are actively seeking the financial help of our community through our Capital Campaign to enable us to purchase property in Ottawa West to create a 9 bed residential hospice in a quiet, tranquil setting that is ideal for our immediate and long term needs. The acquisition of a site will allow our team of staff and volunteers to expand and consolidate the key community support programs, including in-home support, day away hospices, transportation, caregiver and bereavement support, and training and education permitting greater reach to those who need support while living and coping with a life threatening illness, and ultimately for those who are no longer able to receive or give care in their own homes.

Mid-way through our Capital Campaign, a concerted and exciting endeavour to coordinate hospice services throughout the community came underway.  This bodes well for hospice care but also necessitates our patience while this comprehensive plan is fully finalized.

• In August 2010 the Hospice at May Court, the Friends of Hospice Ottawa and Bruyere Continuing Care established the Ottawa Hospice Services Committee to pursue consolidation and expansion of hospice services in Ottawa and develop an integrated service provider.  They developed and submitted a proposal that was approved by the LHIN in January 2011
• The Local Health Integration Network (LHIN) appointed a Transition Committee to move forward with a detailed plan and business case
• The plan will include targets for growth in community based Hospice beds in the Ottawa area based on provincial and international benchmarks
• The goal is to build on excellent programs that currently exist and plan for the future
• Ottawa currently has a significant shortage of Hospice beds with nine (9) currently operating at the Hospice at May Court, sixteen (16) sub-acute (Hospice like) beds at Bruyere Continuing Care; benchmarking suggests that Ottawa needs sixty to eighty (60-80) beds to get to universally endorsed bench marks
• This process is not simply about beds, it is also about building on the tremendous community outreach and day programming that is currently led by Friends of Hospice Ottawa and the Hospice at May Court these services make a difference in the lives of 100s of families who need outreach, respite and support in their homes, we need to strengthen this capacity as well
• The process is about building a system, a continuum of end of life care that is responsive, compassionate and builds on the excellence that currently exists in our region, partnerships are key to our collective success
• In the past, the community has paid for the lion share of Hospice care in the Ottawa area, despite the significant commitment, ownership and generosity of the community, increasing Hospice services and even maintaining what already exists is unsustainable without additional support from the Ministry of Health and Long Term Care and the Local Health Integration Network
• The LHIN provided funding to conduct the detailed planning and hire a Project Manager to move the process along:
• We have made tremendous progress since April, a Project Manager is now in place and the process is moving forward with a goal to have a draft report ready for Transition Committee review by the end of June
• A number of working groups have been struck including those focused on:
• Building a Service and Supports Model including the important role of Volunteers
• Building an Operating Planning and Budget
• The report will outline:
• A Governance and organizational Structure
• Their Services and Supports Model including the important role of volunteers
• An Operating Plan and Budget
• Once approved by the Transition Committee, the plan will be presented to the Boards of:
• The Hospice at May Court
• Friends of Hospice Ottawa
• Bruyere Continuing Care
• The plan would then be presented to each organization according to their internal approval process
• If approved it would then be submitted to the Champlain Hospice Palliative Care Program Council and then to the LHIN for review of the detailed business plan that will delineate the funding that will be required from the LHIN to make this a reality
• The Ottawa Hospice Transition Committee will move forward with a transition process and quickly establish a new organization to meet the growing needs of our community
• Your support, commitment and participation is key and we are committed to keeping you up to date as the process unfolds.

OVERVIEW FOR AN ARCHITECT

Residential hospices grow out of the needs of people living with a life-threatening illness who can no longer be cared for in their own homes, yet do not require the expensive and highly technical care of an acute hospital. Hospices are designed to meet the needs of a patient and his/her loved ones when a curative approach is no longer achievable.

Friends of Hospice Ottawa, along with its community partners, has identified such a need in the west end of Ottawa, including the rural west. We are at the stage now when a design plan for such a hospice facility is needed.

Hospice design should meet the physical, emotional, and social needs of its residents, and creates a place where people can die with dignity in a well-supported, sustaining physical environment. The Hospice movement, in Canada and abroad, is a young movement with coherence, passion and focus that works to fulfill what many of us wish for in our last days – if we cannot die in our homes, to die in a home-like setting, free of pain, surrounded by the people we love. We see hospice as an extension of home.

A hospice is a community of both the dying and the living. It is the place of last repose for the dying, but also the context of last memories for many caregivers and family members. Although it is only home for a few hours, days, weeks or, at most, months of life, it is one of the most intense, difficult and emotionally charged times we face as human beings.

The architectural challenge of hospice design is to create a warm, home-like environment in which the dying can live their last days with humanity and dignity. We expect that the Friends of Hospice Ottawa residential hospice in the west end of the Ottawa region will be a product of the community and meld with both the natural environment and the community organizations that surround it.
At a symbolic level, the hospice is a home. At a functional level, it is a home, a care facility, and a workplace. It is also a community meeting place, a place of celebration of lives lived, a place of sharing knowledge and stories.
General principles for hospice design include:
- Creation of a home-like setting
- Focus on quality of life and a positive experience for patients and their loved ones (including design features and environments that are conducive to positive memories)
- Symbiosis with nearby community groups, services and facilities where appropriate
- Sustainable design (building orientation, energy efficiency, non-toxic and recycled materials, innovative sustainable features such as living walls, interior gardens, green electrical and mechanical features)
- Accessibility (e.g. wheelchair, hospital bed, internet)
- Creation of a place where people like to work, whether as volunteers or as paid professionals
The hospice should have as many characteristics of “home” as possible. Defining “home” is different for everyone, and will involve many partners. Here are a few suggestions that come from the Hospice Association of Ontario Residential Hospice Manual:
Home should avoid the use of institutional materials, hardware, and arrangements. For instance, wherever possible, materials should be warm and natural. (Also choosing materials that require little finishing makes the building more environmentally sustainable, and lower maintenance). The detailing of things such as operable windows should emphasize ease of personal control. Floors should be rich woods, warm carpets not cold tiles. Institutional building features such as long corridors should be broken down and all hallways end in natural light as a way of making the building more pleasant. Rather than the harsh fluorescent fixtures so typical of hospital environments, lighting should take a softer form using more residential lighting choices.
Home means that the massing and size of the building should be broken down as much as possible.
Home means an open and inviting kitchen that draws people in any time for snacks or tasty meals, its architecture designed to accentuate the pleasures of smell, taste, and community.
Home means familiar features like fireplaces, porches, patios, gardens, generous rooms where a combination of privacy and visiting are possible, with flexibility so that if residents want to surround themselves with familiar objects, they can. Or if the bed needs to be oriented in a certain direction, say for religious reasons, it can be.
Home means appreciating that different people, at different times of their living and dying, will want different degrees of activity and social interaction. The social diagram of the building plan should address the needs of the residents for both very social and highly private environments, as well as the functional needs of the people who work there.
Home is a vessel of memory. Memory will play an important role in the design of the building: patients’ rooms will be designed to house objects – e.g. photos and artifacts – that make the past immediate, and will take the form of niches, shelves, nooks and crannies. For many patients, whose entire world becomes their room, their own room becomes a “family room” where children play, people talk, relatives sleep, and basic medical care and symptom management is undertaken. Each room ideally should be generously scaled as flexible space is especially important.

THE RELATIONSHIP BETWEEN THE HOSPICE BUILDING AND ITS SITE:

Another of the architectural opportunities will be to look at ways of optimizing and enhancing the inside-outside connections that the building creates with its environment. A comfortable, even intimate, relationship with the building site can be established so that nature and the outdoors add a sense of well-being and the passage of time and the cycles of our natural world are made more tangible. Skylights, big windows, a patio outside each room accessible by wheelchair or hospital bed are all ideas we have had to enable more connection with the natural world outside the hospice.

Accessibility and compactness are important features: a one-storey building is preferable as it will enable easy wheelchair access, enable beds to be moved, for example, to an outside porch or patio. The design of a compact, efficient floor plate will ensure that the hospice meets the functional needs of the professionals who work in the building. Also in the category of accessibility are the entrances and ease of getting from the parking area to them, the exit through which funeral homes leave, the delivery point for supplies, medications, equipment.

OUR WISH LIST for SPACE: overall, we anticipate a total floor space of 8,000 to 10,000 square feet.

NINE PRIVATE ROOMS, estimated at 12’ by 16’ each. Each room would become the space which one patient would call his or her own, so to speak, for the time spent at the hospice. This space would include that for a private bathroom (accessible sink and toilet), enough space to enable the re-orientation of the hospital bed and other furniture to suit the patient and family. Extra equipment might be oxygen cylinders (we intend to use the portable variety rather than have oxygen piped in as a larger facility might have), suction equipment, at least one easy chair, at least one space to allow a fold out bed or cot to be set up. We would also like wide enough doors to wheel chairs and beds through, garden access from each room (via bed or chair), moveable closets, light and bright rooms, with large windows that are ‘user friendly’ to open and with good window coverings for those who prefer dark. TVs, cable and internet access need to be part of each room.

We would like to have one of these nine rooms designated as a ‘special’ room where there would be extra room for special circumstances: e.g. ventilated patients, a child with family, a bariatric bed, and we are sure to think of others, or be presented with unusual requests in the future. Approximate size 14' by 14'.

FAMILY ROOM: We would like to see one room designed for a family to spend the night or a weekend, for example, with a full bathroom, and say, one double bed and 2 pull-out beds. Or perhaps with all beds that pack up in wall units that can allow for other uses of the room when not needed for a family.

WELCOMING ENTRANCE: Warm, inviting, with enough space to allow reception of visitors, at times several at once, space for a reception desk, handy place for coats and boots. It would also have to be the entry point for a new patient, often brought in by stretcher or wheelchair.

STORAGE SPACE: Full basement or other options. We are placing this item near the top of our list to stress the importance of plenty of storage space. Large equipment e.g. chairs, mattresses, even lifts, as well as small equipment like suction devices, oxygen units, as well as storage space for all the nursing supplies, linens, office supplies for the running of the hospice will be needed. If basement storage area for equipment is planned, then elevator access is essential.

A CENTRAL AREA FOR THE STORAGE AND ORGANIZATION OF MEDICATION: It will need good lighting, surfaces to prepare meds, and need to be safe and secure, probably in the staff charting area to make it accessible and secure.

BATHING AREA WITH SPECIAL TUBS

MAIN FLOOR LAUNDRY, near bathing area and nurses and meds.

JANITORIAL AREA AND DIRTY UTILITY ROOM (with swinging doors on dirty utility)

KITCHEN/DINING AREA: meets standards, friendly, warm, large enough to accommodate family groups, could double as meeting/social event space.

GARDEN ROOM/could double as another MEETING ROOM. In fact, we anticipate that several small private and large meeting spaces will be multipurpose.
For example, we are considering running some, not necessarily all, of our day hospice programs (up to 16 patients) out of the residential hospice. Also, we may have bereavement groups (say, up to 8-10 people) or even some of our volunteer education sessions out of the residential hospice building. We would often need meeting space for family or team meetings as part of our every day work at the hospice. Our Friends of Hospice Ottawa Board meetings could be held at the hospice (up to 15 people). We see ourselves as networking and collaborating with other community groups, and would want to host meetings at the hospice. These would not all be running at the same time, but we might need 3 or 4 spaces of various sizes to accommodate different groups.

OFFICE SPACE: While the hospice activity will mainly serve patients who are in need of care, and we wish the service end to be the largest, we also have to provide a comfortable work setting for the volunteers, nurses, doctors, administrators, social workers, physiotherapists, occupational therapists, complementary therapists, etc. As such we will need some office space, again often multipurpose, internet access, private telephone spaces.

CHILDREN PLAY SPACES

MUSIC and noise factors need to be considered.

This is just the framework of our wish list, upon which we hope that a basic “footprint” of our hospice can be built.