SHANTHAM – INTEGRATED CURO PALLIATIVE
CARE CENTRE
THESIS REPORT
Submitted by
SRUTHY SASHIKUMAR
(17136010)
Under the guidance of
Ms. MARY JOHN
in partial fulfillment for the award of the degree
of
B. ARCH (Bachelor of Architecture)
SCHOOL OF PLANNING ARCHITECTURE AND
DESIGN EXCELLENCE
MAY 2022
SHANTHAM – INTEGRATED CURO PALLIATIVE
CARE CENTRE
THESIS REPORT
Submitted by
SRUTHY SASHIKUMAR
(17136010)
Under the guidance of
Ms. MARY JOHN
in partial fulfillment for the award of the degree
of
B. ARCH (Bachelor of Architecture)
SCHOOL OF PLANNING ARCHITECTURE AND
DESIGN EXCELLENCE
MAY 2022
BONAFIDE CERTIFICATE
Certified that the Thesis titled “SHANTHAM – INTEGRATED CURO
PALLIATIVE CARE CENTRE” is the bonafide work of Ms.SRUTHY
SASHIKUMAR (17136010) who carried out the Thesis work under my
supervision. Certified further, that to the best of my knowledge the work reported
herein does not form part of any other thesis on the basis of which a degree or
award was conferred on an earlier occasion on this or any other UG student.
Dean Head of the Department Ar. MARY JOHN
(SPADE) (Architecture and Design) Design Chair
(SPADE)
INTERNAL EXAMINER EXTERNAL EXAMINER
Name:________________________ Name:________________________
Designation: ___________________ Designation: ___________________
Date of Viva voce:
Table of contents
Chapter No Title Page no
ABSTRACT i
LIST OF TABLES ii
LIST OF FIGURES iii
1. INTRODUCTION OF THESIS
1.1 INTRODUCTION
1.2 AIM
1.3 OBJECTIVES
1.4 SCOPE
2. LITERATURE STUDY
2.1 FRAME WORK
2.2 DATA COLLECTION
3. CASE STUDY
3.1 NET CASE STUDY
3.2 LIVE CASE STUDY
4. ANALYSIS
4.1 SITE DETAILS
4.2 SITE ANALYSIS
4.3 SITE SURROUNDING ANALYSIS
4.4 CLIMATE ANALYSIS
5. DESIGN DEVELOPMENT & PROPOSALS
5.1 REQUIREMENT
5.2 CONCEPT
5.3 ZONING
5.4 SITE PLAN
5.5 SCHEMATIC DRAWINGS
5.6 MASSING
5.7 VIEWS
6. BIBLIOGRAPHY
ABSTRACT
As hospice and palliative care centres have started to be looked at as an institutional building with common
prototypes, it seems as though we are defining a “right” way to die, or experience the whole process. Although
there are no “right” ways to die, there are comfortable and familiar scenarios that makes a person with chronic/
terminal illness feel dignified. In layman terms, Hospice and Palliative care centres strive to domesticate death;
find similarities to natural spaces and spaces that are comfortable to be in.
This project tries to tackle the perceived problems of architecture’s unsatisfactory engagement with terminal
illness and end of life care treatment spaces and destigmatize the concepts of designing the same.
i
LIST OF TABLES
Serial TABLES Page no.
No.
1 Area Statement 18
ii
LIST OF FIGURES
Serial FIGURES Page No.
No.
1-8 Literature Study Data 2-5
9 - 11 Net Study 01 5-6
12 - 16 Net Study 02 8-9
17 - 21 Case Study 01 9 - 10
22 - 23 Case Study 02 11
24 - 30 Analysis Drawings 12 - 17
31 - 42 Design Drawings 18 - 26
iii
Chapter 1
INTRODUCTION
1.1 Overview
Health care is provided in three major categories - Curative, Palliative and Bereavement Care. Curative care is
when there is hope for recovery. Palliative care is pain management and End of Life Care. Bereavement Care
is providing support services to the family before and after the death of the patient to assist the family in
coping with issues related to grief, loss, and adjustment. Curative care is any hospital or clinic that provides
patients with treatment. Palliative care therapy is providing the patients with painkillers and sedatives to aid
pain management. This varies from using external pain relief patches, to injection of morphine as a legal
sedative for cancer patients. These services are critical and are hence carried out in the supervision of trained
clinical staffs and not at home. Hence, there is a spatial requirement for the same, which is not met in the
country till now.
1.2 Introduction
According to WHO, 14% of the senior citizen category population need palliative/ hospice/ life support care.
In India, only 1% of the population that require palliative support acquire it. Even then, the spaces are just
claustrophobic IMCU rooms in the rear service end of the hospital block, without any interaction with the
outdoors. Family members are not allowed to visit the patient frequently, and hence, both the patient and the
family members go through a tough mental time. While dealing with spaces like this architecturally, the
intangible elements of human emotions come into play. This has to be dealt with very sensitively and the
spaces must be humane and accommodative of various activities. Palliative care centres are rarely found in
India in this scale, and the existing ones are almost close to non-functional. India having majority of its
population under the senior citizen and working-class category, spaces like this are of utmost importance.
1.3 Aim
To design with sensitive humane understanding, the spaces required for functioning of palliative and hospice
care facilities and generate prototypes for certain spaces that can be retrofitted into existing hospitals. users
1.4 Objectives
1. Understand emotional and sensory perception of spaces in Palliative Care by all end users (not just
doctors and patients).
2. Understand functioning of Palliative Care Spaces.
3. Explore the idea of trauma recovery and grieving help centres as plug ins.
4. Create an inclusive and accessible master plan.
1.5 Scope and Limitations
1. The prototypes generated can be altered with basic parameters and can be adapted all across the
industry and retrofitted into existing buildings.
2. One-of-a-kind scale for palliative care spaces in India.
1
Chapter 2
LITERATURE REVIEW
1.2FRAMEWORK FOR RESEARCH
Certain questions were to be answered before proceeding with the design phase and certain topics to be
looked into. Such statements which make the periphery of the thesis work and will lead the research as
follows:
2. What is end of life care?
3. What are the non-conventional spaces required for sustaining the campus?
4. Understand the demographics and user category.
5. Sensory understanding of spaces associated to health care.
6. Explore bereavement care spaces.
2.2 DATA COLLECTION
To begin with the understanding of the project, there has to be a detailed study of the existing literature.
The collected data will help in framing the project.
2.2.1 UNDERSTANDING OF SPACES
Fig.01 Openable Windows in wards Fig.02 Accessibility of bed by all age group
Fig.03 Doors providing view to outside Fig.04 Access to outdoor landscape
2
Fig.05 Ample Space for Discussion Fig.06 Personalization of spaces
2.2.2 INFERENCE:
a. Access to open natural spaces enhances quality of space. These spaces must be accessible by ramps to
allow movement of wheel chairs and stretchers.
b. Big windows that can be opened and closed based on requirements must be provided near the bed.
The window must look into a landscaped open space.
c. Doors must be designed and located in a way that it can open into common spaces to create a sense of
connect with people if need be. Doors must also be wide and tall enough to accommodate the
movement of stretchers and other equipment for support.
d. Enough space must be provided for accommodation of a family member to stay overnight. This must
be located adjacent to the bed, with ample space for people to stand in between the beds.
e. Ample space must be provided for private conversations between doctors and family members, and
between the patient and the family member as well.
f. Personalization of furnishings must be allowed and no permanent decorative pieces is of necessity, as
patients can keep what they like.
AREA OF WARD:
Area of each ward must be a minimum of 15% more than that of a normal hospital ward. This would
approximate to around 15sqm only for the utility of patients. Apart from that, for care taker, storage of
medical equipment etc., the room area would approximate to around 20 – 23 sqm.
SITE SELECTION:
The site must be in close proximity to an acute health centre, or there must be a health centre in the same
grounds as the palliative care. Site must have good accessibility, and must be within 10km radius from a
speciality hospital.
3
Fig.07 Space requirement for Ward
Fig.08 Site Selection Requirements
4
Chapter 3
CASE STUDIES
3.1. NOAH’S ARK CHILDREN HOSPICE, NORTH LONDON
Fig.09 Lower Ground Floor Plan
Fig.09 Lower Floor Plan
5
DESIGN INFERENCE:
Noah’s Ark Children’s Hospice in Barnet, north London, is where terminally ill children go to die.
That is the stark essence of the brief taken on by its architect, Squire & Partners. A 38-page booklet
produced by the architect expands on this somewhat: the hospice client sought “an inspiring space
for palliative care, relaxation and adventure within a ‘home from home’ environment”.
a. Spatial planning of spaces according to the site conditions is noted. The in-patients’ wards are moved
away from the common user traffic.
b. The noise pollution from the close by fly over is considered and the adjacent block is restricted to
lower number of floors.
c. Balconies of the wards face the courtyard.
d. Play area for children provided in the roof top, which is in close proximity to the children’s ward.
e. Site is located in the prime area of the city and is in close proximity to multiple recreational and
spiritual public
spaces.
f. The spatial planning observed is very clean and the internal circulation is linear and not confusing.
g. One major corridor with rooms opening out to it has an out ward looking floor plan with each room
directly opening out to an open space through a partially covered open corridor.
h. Garden and play area at the rear end act as a gathering space for activities.
i. Natural materials like timber and exposed stone masonry are used to increase the domesticity of the
design.
j. Double height spaces and wide doors are provided to accommodate the movement of stretches and
other equipment, and also to facilitate natural lighting and ventilation.
k. Interactive corridors are provided and doctors use these spaces for casual consultations and talks with
families of children.
l. Extra-wide doors allow direct access for treatment beds to the gardens and terraces outside, and fitted
furniture is adjustable and specifically designed for children with mobility issues. Inevitably, there is
some evidence that this is a medical facility. Bedrooms are equipped with a hoist and ceiling-track
system that allows a child to be transferred directly from their bed to a bath, and more subtly, all
surfaces are specified to be anti-bacterial and/or easily cleanable to minimize the chances of infection.
Fig.10 and 11 Design Elements
6
3.2 ASSISI HOSPICE, SINGAPORE
DESIGN INFERENCE:
a. 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 pediatric 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.
b. Currently the biggest hospice in Singapore, the six-story building is expected to serve more than 2000
patients yearly, double the 1000 patients before.
c. 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.
d. 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.
e. The wards were the key driver of the design, the 2 ward-fingers house 4 wards, which are North-
South facing to maximize 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.
f. 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, is West facing.
g. 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 institutionalized. Whilst the balconies
provide a view, there are invisible grills to ensure safety and prevent suicide.
h. 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.
i. At the pediatric 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 span across the different levels.
j. 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.
7
Fig.12 to 15 Design Elements
Fig.16 Section 01
8
Fig.17 Section 02
3.3 KARUNASHRYA PALLIATIVE CARE CENTRE, BANGALORE
DESIGN INFERENCE:
a. Karunashraya offer patients the flexibility of alternating between the hospice and their home, they
help patients live without pain and in dignity and peace till their journey’s end. They have been
offering in-patient care since 1999 and home care since 1995.
b. The building is made of stone masonry and the patients can experience the view of greenery on one
side and water on the other side of their ward.
c. Recreational activities include indoor games, TV, Newspaper etc.
d. A 100-seat auditorium is provided with full-fledged modern technology to accommodate learning and
training.
e. The entrance is shaded with flowering trees and the way towards the main entrance has parking
spaces which can accommodate 10 cars under shelter and multiple open bike parking.
f. The south entrance has a large front courtyard with parking spaces for staff.
Fig.17 Karunashrya Plan
9
Fig.18 to 21 Karunashrya Design Elements
3.3 INSTITUTE OF PALLIATIVE MEDICINE, CALICUT
DESIGN INFERENCE:
a. The Institute of Palliative Medicine is an education, training and research center for palliative care
located in Kozhikode, India.
b. The institute trains health care professionals in palliative care and related medical disciplines.
Through its connection with Calicut Medical College and other clinics in the state of Kerala, the
institute supports between 4,500 and 5,000 patients per week.
c. Special care is taken to ensure that the patients don’t spend their days staring at the blank ceiling, by
providing colorful walls with windows which open into the lively courtyards filled with plants and
people.
d. Designed with many courtyards and verandahs with seats, the building is unlike any typical hospital.
e. Ramps are provided within the hospital to ensure wheelchair accessibility and the bathrooms are
spacious so the caretakers can provide assistance to the infirm. The roof structure, tiered in response
to design of structure to accommodate patient wing in a single story and institutional block in two
stores, makes the elevation interesting from inside and outside.
10
Fig.19 to 23 IPM Design Elements
11
Chapter 4
ANALYSIS
4.1 SITE DETAILS:
Fig.24 Site Geographical data
LOCATION: MUTTUKADU, EAST COAST ROAD
SITE AREA: 85,000 sqm
APPROACH ROAD WIDTH: 24m
REASONING:
a. Site is selected in ECR to accommodate for close proximity to important amenities, but at the same
time, stay away from the traffic, noise and hustle of the city.
b. The site is serene and is abutting ECR near the Muttukadu Backwaters. This gives a set of vast
options to explore with views and vistas.
c. The site being in close proximity to many recreational and religious spaces also adds on to the
strengths of the site.
d. The site is 1.2km away from the shore. There is a single lane pathway, that connects from the junction
till the shore.
e. There is a setback of 205m provided from the edge of the water body till the edge of the site.
f. There is extremely good connectivity with minimum to zero traffic, which makes it easy for
Ambulances and cases of emergency.
12
4.2 SITE SURROUNDING ANALYSIS:
Fig.25 Micro Site Surrounding Context
INFERENCE:
a. Majority of buildings are restaurants, cafes, resorts, villas and hotels. These will serve as a good
recreation space for the family / visitors of the patients, to get out of the institute for refreshment.
b. Majority of the spiritual buildings are located in very close proximity, again for family/ visitors to
visit and rest their mind for a bit.
13
Fig.26 Macro Site Surrounding Context
INFERENCE:
a. Accessibility is solid. The East Coast Road is always traffic jam free. Cars, bikes and ambulances can
reach the site with ease. A bus stop is situated within 400m from the site.
b. Major Hospitals of the city (with diagnostic and curative care) accessible within 20 mins (all within
10km radius).
14
Fig.27 Site Surrounding Context
INFERENCE:
a. Natural vegetation: Trees with various canopy sizes and heights are found on site. Shaded towards the
West end of the site where the site edge is the Backwaters.
b. Site edge with Muttukadu Backwaters adds on to advantages of views and an open space for the users
to interact with.
c. Site elevation: Site is elevated 2m above sea level on an average, and is almost flat and not contoured.
d. The sea is within the 1km radius and visitors can easily take a walk along the shore.
15
Fig.28 Climate Analysis
INFERENCE:
a. The prevailing wind direction along with the phenomenon of sea and land breeze, makes the site have
the strength of a great amount of wind through the day. Aligning courtyards along the direction of the
wind and trying to not create wind shadow region will help in passive cooling and other sustainable
factors.
b. The site is in such a way that the shorter side receives the rising and setting sun. Hence it naturally
helps in reducing surface heat gain by buildings.
c. Since the adjacent buildings do not have heavy architectural style and the buildings are all low rise,
there is no evident shadow cast on the site due to buildings.
d. There is a decent amount of usable vegetation on site. There are over grown shrubs and other
unnecessary plants that have to be cleared off before construction.
e. The climate of the area is accommodative of using passing cooling methodologies, and hence that
must be capitalized.
16
Fig.29 Sensory Analysis
Fig.30 SWOT Analysis
17
Chapter 5
DESIGN DEVELOPMENT & PROPOSALS
5.1 ARCHITECTURAL PROGRAM:
Area Requirements are mentioned below in table 01:
Table 01. Area Program
6.2 ZONING:
Fig.31 Zoning
18
6.3 CONCEPT:
19
Fig.32 Concepts
20
Fig.33 Concepts
21
6.4 THRUST AREA
Fig.34 Thrust Area
22
5.5 SITE PLAN
Fig.35 Site Plan
5.6 SCHEMATIC DRAWINGS
Fig.36 Schematic Drawings
23
Fig.37 Schematic Drawings
Fig.38 Schematic Drawings
24
5.7 MASSING
Fig.39 Massing
Fig.40 Massing
25
5.7 VIEWS
Fig.41 Views
Fig.42 Views
26
BIBLIOGRAPHY:
https://www.bdcnetwork.com/blog/evidence-based-design-practices-palliative-care-
environment
https://www.archdaily.com/616654/the-architecture-of-
death?ad_source=search&ad_medium=projects_tab&ad_source=search&ad_medium=search
_result_all
https://architecturetoday.co.uk/noahs-ark-hospice/
https://www.liebertpub.com/doi/10.1089/jpm.2019.0314
https://www.nhmagazine.com/caring-for-the-dying/
https://www.slideshare.net/jeff-sarang/karunashraya-hospice-case-study
27
