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A Home Away from Home

A Home Away from Home

A conversation about the design of the Jack Bryne Center for Palliative & Hospice Care

When designing a new building, Dartmouth-Hitchcock (D-H) has a long history of involving the building’s future users in the process. The Jack Byrne Center for Palliative & Hospice Care was no exception. “My job was to bring the right people to the table with the architect,” says Gail Dahlstrom, a senior health care consultant with HDR Architecture in Chicago. “One challenge was finding the right balance between the spaces for patients, families and staff.” 

Working with lead architect Charles Rizza Jr., and his team from E4H Architecture in Portland, Maine, they focused on ensuring that the facility was:

  • Home-like—a welcoming place to live and be with family
  • Personalized—making it feel like patients’ homes
  • Family-oriented—comfortable for daily living
  • Connected—to nature, family, other people and spirituality
  • Flexible—understanding that needs will change over time
  • Operational—for family caregivers, staff and volunteers

When completed later this year, the center will feature 12 spacious inpatient rooms; respite areas for families and staff; multidisciplinary staff workspaces; and areas to eat and prepare food, exercise, and enjoy art and music. D-H palliative care physician Ellen Bassett, MD, who has been the lead physician in the center’s development, says, “Our hope is that the building will be extraordinary and the people who use it will be able to get excellent care in a setting that makes this time less difficult.”

Imagine spoke with Dahlstrom, who is the former vice president of Facilities for D-H, and Rizza to learn more about their collaboration on this state-of-the-art facility, and how it was designed architecturally and programmatically to support patients, families and staff. 

Dahlstrom: One of Dartmouth-Hitchcock’s main objectives is caring for patients in the right place at the right time. For this patient population, it’s been hard to get them in the right place. They have either been at home or in a residential setting with caregivers who are often not able to handle the type of symptom management they need. Or they have received intensive care that was potentially unnecessary or unwanted in an acute or critical care bed in a hospital. What these patients really need is a whole different set of services. In some cases, they need technical clinical skills because their medications need to be managed well. And they may want a massage, or quiet or family time, or any number of things that can only be provided in a home-like environment and not in an institutional setting. So we worked on providing a place for the patient and his or her family to be cared for from a clinical and a holistic perspective that also provides significant clinical support.

Rizza: When a patient arrives, they will enter the facility through the front door and enter into the Great Room, a large living room that has comfortable furnishings, a fireplace and a lot of natural light. From that location, much like they may experience at home, they can see into the family kitchen and a small dining area, which can be closed off for privacy. This design immediately makes them feel welcome. 

Dahlstrom: When we toured other hospice centers, one of the things we loved and wanted to replicate here was a family kitchen, a place for the family to be together while they were going through this stressful time. We put the kitchen adjacent to the Great Room so that, as Dr. Ellen Bassett says, “We can have the smell of freshly baked cookies coming into the Great Room.” We also knew that we wanted to have a chapel for meditation and reflection after seeing a chapel in a Chicago-area hospice center that inspired an immediate sense of calm. There are also a couple of team stations, but the intent is when clinicians aren’t with patients most of their work will take place in a collaborative, clinical work room. It will accommodate everyone who needs to be there at any point in time, and bring together doctors, nurses, social workers, chaplains and bereavement counselors. In palliative and hospice care, the team is very interdisciplinary. 

Rizza: Another strength of this facility is that it’s on the Dartmouth-Hitchcock campus in a setting that’s quite stunning. Looking outdoors, you'll see either a beautiful garden or the woodlands, with hiking and walking trails. In designing the building, we recognized the solitude and natural landscape as important elements for clearing the mind. All 12 of the bedrooms look out onto that natural landscape. Each has room for family and a balcony—sort of a protected little patio—that looks out onto the natural environment.

Dahlstrom: The outdoor balconies can even accommodate a patient’s bed, which is going to be wonderful for people who want to connect with nature, either with their family or by themselves. One of the driving design criteria was the question of choice both for the patient and for the family caregiver. If a patient wants to be in a patient room in the dark with no sound, we can accommodate that. If they want to have a lot of natural light, there are a lot of windows in the room. They might want to have TV, music or have their grandkids in the bed with them. We can accommodate all of that. Likewise, the family might want to be right next to the patient the whole time or they may want to take long walks outside. Family members can also sleep and shower right in the room, if they want to. 

Rizza: The center has a spa that has a special tub that’s large enough for patients to be lowered into. There’s also a playroom for young children and a small lounge for teenagers. The building is designed to be sustainable, with a geothermal heating and cooling system. All of the lighting is energy-efficient LED technology, and many of the products that we’re putting in have either a high-recycled content or can eventually be recycled. 

Dahlstrom: One thing that makes this center unique is that we’ll be able to conduct research here and provide educational opportunities. The whole field of hospice and palliative care is relatively new from a clinical specialty perspective, and we have much to learn about best practices for caring for these patients. This center provides an opportunity to incorporate research questions in a disciplined and organized way. 

We’ve also incorporated virtual education mechanisms into the building, so if clinicians are providing care at a patient’s home, we can connect virtually and provide education and support in the field.

Another key difference is driven by D-H’s palliative care philosophy. People will pass away while they’re here, but our purpose is symptom management for living well. People might come for a few days and have their symptoms managed so they can go home again if they prefer. 

Rizza: The underlying premise for end-of-life care is for patients and their families to be comfortable. There are still many hospitals that have a couple of rooms that are considered their hospice rooms, but you’re still in the hospital. You’re not in an environment that’s home-like. This is a time when you want to be removed from the rest of the world, and you want to be in a very comfortable, private and nurturing environment. Until you’ve been in this situation, you don’t recognize how important this is. I see this center setting a new benchmark for palliative and hospice care.