Hospice Unit Generic Brief

Acknowledgements

The development of this generic brief has been made possible by the participation of many people from the Department of Human Services and palliative care services across Victoria.

Photographs courtesy of:

Silver Thomas Hanley, Architects

Palliative Care Ward, Repatriation Hospital, Hobart

Palliative Care Ward, Benalla Hospital

Wintringham Allen Kong, Architect.

Working party members included:

Jill Coyne, Aged, Community and Mental Health, Department of Human Services

Judy Kelso, Aged, Community and Mental Health, Department of Human Services

Ralph Hampson, Aged, Community and Mental Health, Department of Human Services

Jennifer Theisinger, Aged, Community and Mental Health, Department of Human Services

Published by the Aged, Community and Mental Health Division

Victorian Government Department of Human Services

Melbourne, Victoria

June 2000

Also published on the Aged, Community and Mental Health Division Website at http:\\

ISBN 0 7311 6079 7

(0280899)

Contents

1 Introduction 1

1.1Generic Brief 1

1.2 Functional Brief 1

1.3 The Framework for Service Provision2

2 Functions and Operations 3

2.1 Philosophy 3

2.2 Key Elements 3

2.3 Method of Operation 4

2.4 Staffing 5

2.5 Components 6

3 Design 9

3.1 Implications for People within the Facility 9

3.2 General Design Criteria 10

3.3 Building Services 16

4 Functional Zones and Relationships 19

4.1 Introduction to Functional Zones 19

4.2 Functional Relationships 20

4.3 Functional Zone 1: Arrival Areas 22

4.4 Functional Zone 2: Living Areas 23

4.5 Functional Zone 3: Clinical and Administrative Areas 31

4.6 Functional Zone 4: Service and Support Areas 36

4.7 Functional Zone 5: Staff and Volunteer Amenities Area 43

5 Other Planning Issues 45

5.1 Town Planning 45

5.2 Property Agreement 45

6 Appendices 47

Appendix 1: Accommodation Schedules 48

Appendix 2: References and Bibliography 52

Appendix 3: Glossary of Terms 54

1Introduction

1.1Generic Brief

A generic brief provides detailed guidelines for the planning and design of health and aged care facilities.

This generic brief has been developed for a hospice unit. The aim of this generic brief is to:

•Outline the guidelines for the development of project specific briefs for individual State-funded hospice units in Victoria.

•Provide a consistent and clear framework within which regions develop and negotiate health service delivery strategies with potential service providers.

•Provide general principles for quality design outcomes for hospice units in Victoria.

•Provide an overview of the services and activities that a hospice unit will commonly provide.

•Describe, in generic terms, the spaces required to conduct those services and activities.

•Reflect the current standards required to meet the objectives of Palliative Care Services in Victoria—A Vision and the accreditation standards developed by the Australian Council of Health Care Standards in conjunction with the Australian Association for Hospice and Palliative Care.

Each design should be refined to suit the service needs and community circumstances as identified in the agency’s service plan, which must be approved by the Department of Human Services.

Prior to considering the hospice requirements for service delivery, it is important that each health service provider develops a comprehensive knowledge and understanding of local community palliative care needs.

The Department of Human Services is committed to providing the highest quality, most effective and cost efficient palliative care services. These guidelines have been structured around this principle with the main objectives being:

•Respect for a person’s rights and dignity and continuous improvement in their quality of life.

•An environment for palliative care clients which promotes:

– A domestic lifestyle

– Self-respect

– Independence

– Social opportunities

– Flexibility to cater for clients with frailty, disabilities, symptom control and support needs which may vary as time elapses.

The selected design influences many elements of the economic viability of the facility. These include:

•Work practices

•Management

•Flexibility

•Maintenance

•Energy efficiency

•Operating costs.

This generic brief has been developed through literature review and an intensive consultation process. The processes used to develop the generic brief entailed:

•Obtaining information on palliative care services in Australia and other countries.

•Consultation with the Department of Human Services Victoria, palliative care service providers, policy advisers, service users, and project design and development advisers.

•A workshop with an expert group comprising key service providers and policy advisers.

•Site visits to existing facilities in Victoria, New South Wales, Western Australia and Tasmania.

Variations in developing each unit may be necessary in order to adjust the design to proposed sites, including consideration of refurbishment. While individual projects are subject to detailed negotiation and are dependent on the availability of capital and recurrent funds, the scale of the proposed developments highlights the need for a generic design brief to ensure consistency of approach, and efficient, appropriate planning.

Some sections of this document relate to specific legislative requirements such as building codes and safety specifications, however, many aspects are indicative or conceptual in nature, providing a framework which can be adapted to meet local needs. References are provided in this document on literature, websites and other useful information.

The development of hospice units in Victoria will be guided by this generic brief.

1.2Functional Brief

The information in this generic brief can be taken and adapted by an agency, in conjunction with an architect to develop a project-specific functional brief from which a building can be constructed or redeveloped. Development of a project-specific functional brief that will deliver well-planned hospice units involves extensive consultation, investigation and coordination. In the planning stage, consultation for individual facilities will involve the Department of Human Services, service providers, consumers and carers in the community. Information on the development of a functional brief should be obtained from the Department of Human Services Capital Development Guidelines.

Particular note should be taken of the guidelines for:

•Policies and procedures for undertaking capital developments

•The planning and evaluation phase

•Fire risk management.

Proposed capital redevelopment projects should be supported by a current needs analysis and service plan which has been approved by the Department of Human Services.

A project control group is formed to manage and ensure a capital project complies with functional requirements, approved scope of works, and is delivered within the scope, budgets and time constraints of an individual project. The project control group gives final endorsement for the project. Final written approval for each phase of a project must be obtained from the Department of Human Services.

Representatives from the Department of Human Services at a regional, branch and program level, together with representatives of the agency, will participate in individual project control groups to contribute constructively to the planning, design, development and implementation of the service and to facilitate the approval processes.

1.3Framework for Service Provision

Palliative care as an identifiable philosophy, practice and discipline began with Dame Cecily Saunders at

St Christopher’s Hospice in the United Kingdom several decades ago. A world-wide movement followed and palliative care services began in Australia in the early 1980s.

In 1995, the Department launched a report titled Palliative Care in Victoria: A Vision which outlined a

10-year vision for palliative care services in Victoria.

It recommended a seamless service system focusing on the diverse needs and interests of patients of all ages including children, adolescents young adults and aged persons as well as their carers and families. The document made clear the need to ensure a full range of service options are available to all terminally ill people of every age group and diagnoses and that the services be structured in a way that allows patients to move with ease from one service type to another. The report emphasised that continuity of care depends on the integration and coordination of services and organisations involved in a person’s care. These include community-based services, inpatient hospice care and acute hospital support.

The Department released Palliative Care in Victoria:

The Way Forward in 1996. This document provides guidelines on minimum catchment populations, bed-to-bed ratios, staffing elements, education and training, quality of care accountability, and funding priorities. The Way Forward re-affirms the central role of community-based programs in the provision of palliative care services throughout the State and the establishment of regional community-based palliative care consultancy services.

2Functions and Operations

2.1Philosophy

‘Palliative care’ as defined by the Australian Hospice and Palliative Care Association should be understood to encompass a philosophy of care, a program, and a collection of services. Traditionally the word ‘hospice’ referred to a place where people received terminal care.

Since the late 1960s the word ‘hospice’ is often used to refer to the concept of care for people living with an incurable illness, whether at home or in an inpatient facility. The words ‘hospice’ and ‘palliative care’ are often used interchangeably.

In this document the term ‘hospice unit’ refers to an identified palliative care inpatient unit.

The philosophy and principles of palliative care include:

•Recognition that the unit of care includes the patient and the family or support group.

•Understanding that the term ‘patient’ includes people of all ages, beliefs and backgrounds and recognises the special needs related to each cultural, religious, ethnic or age group.

•Respect for the right of each patient to make informed choices about their own care, including the type and site of care, and the right to die with dignity and without unnecessary intrusions.

•Holistic, client-centred care that provides physical, psychological, social and spiritual support for people who are dying as well as support for families and friends, including grief and bereavement support.

•Continuity of care, reflected in a seamless range of services available to patients, families and supporters, linked with existing medical and community services.

•Good communication between the different professional groups and settings involved in care.

•A multidisciplinary approach that encompasses medical, nursing, allied health and volunteer services.

2.2Key Elements

2.2.1The Triangle of Care

The hospice unit will operate within the integration framework of the triangle of care. The framework will encompass community-based or home care, inpatient hospice care (hospice units), and acute hospital support.

Service integration is based on and affirms the principles and philosophy of palliative care. Operating within the triangle of care ensures the provision of palliative care that meets the needs of patients through the final stages of their illness.

The triangle of care may be provided through different service structures depending on the area served and the services in place within different communities. The pattern of use will vary for each individual. All palliative care clients should have access to the full range of service options and be able to access the three settings according to their clinical care or support needs.

2.2.2Achieving Integration: Planning for

Communities

Service integration requires all relevant service providers in an identified geographical area to work collaboratively and to achieve common ownership of the objectives, quality and performance of the service system. This necessitates:

•Coordination of human and financial resources

•Coordination of client access and support services

•Effective communication between agencies.

The nine Department of Human Services regions are the basis for the planning and purchasing of services. Planning will be on the basis of population to ensure equitable distribution of resources across Victoria’s communities.

Department of Human Services palliative care planning and resource guidelines prescribe geographical catchment areas and population sizes and identify a planning ratio of a minimum of 50 (publicly funded) hospice beds per million (one per 20,000) total population. Beds are to be provided, where possible, in units of hospice beds to achieve quality, multidisciplinary care and economic viability.

2.2.3Quality of Care

In order to enhance the efficiency and quality of services, individual hospice units should:

•Define and document the purpose, goals and philosophies of the unit.

•Document the principles underlying clinical performance, assessment, admission criteria, ethical issues and case management.

•Provide in-service education and a quality environment for all staff.

•Evaluate and analyse clinical performance, quality assurance and case management issues on a regular basis.

2.2.4 Accountability

All hospice units in receipt of public funds, through either State or Commonwealth specific purpose funding, the aged care budget, their successors, or hospital budgets, should:

•Be in or enter into a ‘Health Service Agreement’ or ‘Funding and Service Agreement’.

•Provide required data for evaluation and monitoring purposes.

•Establish quality assurance mechanisms.

•Meet accreditation standards.

2.3Method of Operation

2.3.1 Hospice Units

A palliative care client is a person whose condition has progressed beyond the stage where curative treatment is effective and cure is attainable, or who chooses not to pursue curative treatment.

The client must have:

•Been diagnosed as having a terminal illness.

•A progressively deteriorating condition.

•A life expectancy of about six months or less, or require earlier support in facing a significantly foreshortened life expectancy.

Control of pain, of other symptoms and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achieving the best quality of life for patients and their families.

The role of the hospice unit in the ‘Triangle of Care’ is to provide:

Respite Care

The patient may be admitted to a unit on a short term basis to provide the family or carer with respite time.

Symptom Management

The patient is admitted for assessment, diagnosis, consultation and treatment of symptoms. When the symptoms are stabilised or treatment completed, the patient can return to their home and family or carer with the ongoing care and support of their general practitioner and the community palliative care service.

End Stage (Terminal) Care

End stage care may be provided when it is not appropriate or possible for a person to remain at home until they die.

2.3.2 Hospice Beds

To ensure that high quality palliative care is available within a range of inpatient care settings, and that patients have realistic choices, the Department of Human Services will fund, as budget capacity allows, identified hospice care beds to meet the planning target of 50 beds per million population. These beds will be sited to meet local needs within regions, on the basis of geographic areas and populations.

Where it is not appropriate to move patients or there are no unoccupied palliative care beds in the hospice unit, ward staff (that is, palliative care physician and unit charge nurse) could provide advice to other hospital ward areas. Hospitals without hospice units will be supported by a regional palliative care consultancy service.

2.3.3 Service Models

Hospice beds are to be provided in facilities that are designed, built or refurbished to deliver care in accordance with the principles of palliative care. Separate entrances to these facilities will be provided wherever possible. Environment is important, with an emphasis on ambience, accessibility, and availability predominantly of single rooms. Provision of these facilities, coupled with a community-based service and effective education programs for nursing and medical staff, will do much to improve the quality of care to palliative care patients.

The Department of Human Services does not support expansion of stand-alone hospices. Models refurbished or developed may be:

•Fully integrated (sharing staff and infrastructure support), for example, one- or two-bed units

•Partially integrated (sharing only some aspects of service provision)

•Collocated (located together, but functioning independently of each other).

The refurbishment or development of hospice units as part of a parent hospital, extended care service or other facility has a number of advantages. Some of these advantages include:

•Utilisation of existing referral and funding sources and hospital infrastructure which can include existing hospital accountability and peer review processes.

•The availability of palliative care consultants to other services within the hospital or facility.

•Ease of access to radiotherapy, oncology, haematology, psychiatry, neurosurgery and anaesthetics and other specialist services for the unit.

•Continuity of holistic patient care.

•Facilitation of the combination of practice, teaching and research.

•Opportunity to educate a wide range of hospital staff in the principles and practice of palliative care.

2.3.4 Professional Development

A formal association with universities providing medical and nursing education creates an opportunity for nursing and medical students and junior medical staff to spend time on the unit, overseen by specialist senior staff. This process maximises opportunities for professional education and facilitates continuity of care.

2.3.5 Academic Services

The clinical chairs of palliative care linked to the undergraduate school at Monash University and the University of Melbourne have a multidisciplinary training and consultancy role. These clinical chairs contribute to providing general practitioner and other medical accredited training, and have a role in education curricula for nursing and other disciplines. Both academic units have established research programs.

2.4Staffing

Hospice units must ensure that patients have access to a multidisciplinary team approach that includes medical, nursing, allied health, chaplaincy/spiritual care and volunteer support. They also need to ensure that the family or carer has access to grief counselling and bereavement support.

Effective full-time (EFT) staff hours for a multidisciplinary team will vary according to the size of the hospice unit. Hospice units may consist of one- or two-bed units in less populated areas to five, ten or more in larger populated rural and metropolitan areas.

Where the unit is situated within a hospital or extended care facility, staff should be encouraged to extend their role by providing an advisory service to other hospital wards. They may spend time at a hospice day care centre, if one is located nearby, in order to interact with terminally ill people who may be admitted as inpatients in the future.