The Assisi Hospice is a patient-centric palliative care facility, with a capacity of 85 beds, of which 80 are located in the adult ward alongside a paediatric ward with 5 beds. It is the first new generation hospice in Singapore, with its backdrop being the development of the National Strategy for Palliative Care. Currently the biggest hospice in Singapore, the six-storey building is expected to serve more than 2000 patients yearly, double the 1000 patients before.
We have designed the building in close collaboration with the users through a co-creation process that greatly influenced the final design. User group meetings and dialogue-based processes created synergy between the designers and the users. The result is a hospice that is a peaceful, calm and safe abode for patients, family members and healthcare staff. It is a life-affirming place where patients live and pass on with dignity. Architecture
The underlying notion is to make a sad place like a hospice feel more natural. The initial intention was to provide patients the sense of ‘grounded-ness’ so that they feel safe. A low courtyard scheme was thus appointed. The 11,000sqm building accommodates 85 patients in a tri-partite plan around a central courtyard. The 3 blocks have a link bridge connecting the wards at the roof garden. The block nearer to the highway is deliberately designed shorter to prevent noise disruption from the highway.
The wards were the key driver of the design, the 2 ward-fingers house 4 wards, which are North-South facing to maximise natural ventilation. The paediatric ward is located at the top level so that it opens out to the kids’ playground where the children can escape to.This location creates secure separation for children, avoids overlooking and allows for safe play. At the roof opposite, lies the chapel. It offers a sacred space for one to retreat into oneself and private conversations, as well as for grieving, healing and letting go. The admin block, which accommodates the physiology centre, training centre, therapy rooms etc,iswest-facing.
Making an environment feel as non-clinical as possible is an important aspect of palliative care. Balconies are added to every room so the hospice feels less institutionalised. Whilst the balconies provide a view, there are invisible grills to ensure safety and prevent suicide. The facade’s varying composition of quality rich materials gives the hospice a warm and tactile look. The East-West facing sides are fitted with thick laminated glass to prevent noise and vibration disturbance from the highway.Sliding screens are in place to allow ventilation, while the over-riding terrace serves as shades for the levels beneath. At the paediatric ward, it is more flexible. Windows are openable, but shades are allowed to remain closed. At night, the illuminated staircase becomes a beautiful lantern feature with the lighting shining out from the full-length glass cover that spans across the different levels.
The new generation hospice has transformed into a placeless like a hospital, but a space where perhaps the perception of death is not as forbidding.Within the ward, there are no nurses’ stations. Instead, you will find cosy and communal spaces for patients and family members, like a large living area. Family rooms are available for visitors to accompany patients overnight. It is homely and welcoming, its success evident as children do their homework in the large communal dining areas and pantries on each floor, while visiting families stay the entire day with the patients, which was uncommon. The space encourages family support, and closeness, allowing patients to make new memories even during their final journey.
The Landscape Courtyard provides a venue to hold performances. Inclusivity is apparent here as all patients, even those bedridden,are able to see the courtyard from their balconies.For those who are unable to move even to the balcony, technology connects them. Data cables transmit the live feed to their rooms’ TV screens.
The overall form and concept were heavily influenced by a number of constraints on the existing site, including topography and underground tunnels. However, it offered an opportunity for us to develop a ‘caring pavilion in the garden’ where the building is surrounded and penetrated by a richly landscaped environment.
Greenery and Gardens &Access to Nature – ‘A Caring Pavilion in the Garden’
The garden is oftentimes a form of therapy for patients, visitors, volunteers and staff. Where a patient is too ill to go to the garden, nature has to come to him in other ways. The layout allows all individual bed spaces a view of nature and for those who are able, the ability to move through the courtyard and surrounding gardens. This allows the patients to develop an immediate connection between the internal and external spaces - a prominentfeature throughout.The sensory garden features plants of different textures, which were specifically chosen to stimulate the patients’ senses.
Traditionally, hospices tend to be grounded, so we replicate this sentiment by having greenery all around in terms of planters, green platforms, gardens and terraces. Tall trees that grow up to 4 storeys high are planted at the perimeter. Pocket gardens are created by carving out little holes, creating opportunities to inject greenery.
Safety and Privacy
We optimise the benefits of segregating patient, public and facilities flows. For inpatients, this allows for a direct route from the ambulance drop-off to the wards, which avoids movement through public areas. The main public access is also distinct from the movement of goods and waste. Privacy is safeguarded as wards are located from the 2nd storey upwards, with a majority of beds located in single rooms. Within the single and double bedrooms, a privacy panel exists between spaces. In the quad rooms, beds are arrangedso that patients do not face each other. However, to combat isolation, there are semi-private seating areas outside the wards, so patients and visitors can benefit from small moments of interaction, and perhaps, a release of tension.
The bridge acts as a link but only at the roof level so patients do not lose privacy. The dementia ward opens out to the sensory garden through the bridge, and there is a need to contain patients without confining them. This is achieved by creating a pathway using the bridge andgarden, so that the patient is looped from the ward to the garden, and back to his ward thereafter. Extra measures are taken to ensure that wandering dementia patients can find their way back– the shade outside their ward is designed as a bus stop shelter, to remind them that the ‘bus-stop’ is right in front of their ‘house’.
There are also spaces for thought and emotions in the forms of private enclaves and sacred spaces, found in the chapeland pockets of spaces around the wards, and the viewing room - where family members can see the deceased before he is movedinto the mortuary. Private terraces are outside the wards for nurses’ briefing sessions during shift-changes. These terraces allow nurses views to the ward to ensure patients’ safety even when the nurses are outside of the wards. This space also serves as a break out area for the training rooms, which are equipped with smart technology and are intended to be a full-fledged training centre for MOH nursing staff.
Day care centre
Also housing the physiology centre, it is relocated to the ground floor for easy access as there would be a large number of vehicles sending patients to the centre. The day care centre peers out to the garden, which is ideal as the garden is often used for activities and therapy. The café is located opposite the day care centre for family members’ interaction.
Safety and Privacy
Privacy is ensured as wards are located from the 2nd storey upwards, with a majority of the beds located in the single bed rooms, as there is a growing trend for terminally ill patients to have private rooms. Within the single and double bed rooms, privacy panels exists in between spaces to maintain the patients’ privacy. In the quad bedded rooms, the beds are arranged in a manner where patients do not face each other, in order to give them and their families privacy. But to combat isolation, there exists semi private seating areas outside the wards, so that patients and visitors can benefit from small moments of interaction, as well as, perhaps, a release of tension.
Our paediatric ward is located at the topmost level (Level 4) and allows direct access to a dedicated rooftop garden and play area. This location creates secure separation for children, avoids overlooking and allows for safe play for patients, their siblings and other family members. The bridge acts as a link between the 2 ward blocks but it is only at the roof level so that patients do not lose their privacy. The dementia ward that is located at the top level opens out to the sensory garden, and there is a need to contain these patients without confining them. This is achieved by creating a pathway using the linkbridge and the roof garden, so that the patient is looped from the ward to the garden, and back to his ward thereafter. Extra measures are also taken to ensure that the dementia patients are able to find their way back to their bedrooms – the shade outside their ward is designed as a bus stop shelter, to remind them that the ‘bus-stop’ is just right in front of their ‘house’.
There are also spaces for thought and emotions in the forms of enclaves of private, sacred spaces for one to retreat into oneself and private conversations.These can be found in the chapel, as well as pockets of spaces around the wards, and the viewing room, where family members can see the deceased before he is moved into the mortuary.
Private terraces are located outside the wards for nurses’ briefing sessions during the change of shift. These terraces allows views to the ward from outside so that they can oversee the situation within, to ensure patients’ safety even when the nurses are outside of the wards. This space also serves as a break out area for the training rooms, which are equipped with smart technology and are intended to be a full-fledged training centre for MOH nursing staff.