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Translating “Integrated Care” in the Design of a Geriatrics Facility

by

Jo-An Pariwagun Yraola-Yulo

An undergraduate mini-thesis proposal

submitted to Professor Maria Luisa Santos

in partial fulfillment

of the requirements for

ARCH 197.2: Design Mini-Thesis Proposal

College of Architecture

University of the Philippines

March 30, 2012

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INTRODUCTION

Background and Rationale

Ageing

Ageing (British English) or aging (American English) is a natural process

among all living organisms. According to Dr. João Pedro de Magalhães in his essay

“What is Aging?” the term aging “refers to the biological process of growing older

in a deleterious sense” (de Magalhães, 2012). The process of becoming older is

genetically determined and environmentally modulated. In a lifespan, an individual

will undergo infancy, adolescence, adulthood and old age. This is accompanied

with physiological changes such as growth, development, maturation and

degeneration.

Old age is often associated with the degeneration of health and the quality of

life. A lot of studies on aging have focused on its effects on the individual’s cognitive

skills, particularly one’s memory. These studies showed that as a person advances in

age, his or her memory tend to weaken. But these may vary, depending on the length

of the person’s life and the changes to the brain brought about by aging. According to

The Royal Australian College of General Practitioners (RACGP), the physiological

effects of aging and deconditioning include medical conditions like;

• Delirium

• Dementia

• Depression

• Dysphagia and aspiration

• Falls and hip fracture prevention

• Incontinence – urinary

• Incontinence – fecal

• Infection

• Pain

• Pressure ulcers

• Respiratory infections – influenza

• Respiratory infections – pneumonia and

• Urinary tract infections.

Also mentioned are the psychological changes that accompany ageing and

expiration.

Ageing World

The number of the elderly has tripled

over the last 50 years; it will triple again over

the next 50 years.

In the year 1950, there were 205 million

persons aged 60 or over throughout the world.

At that time, only 3 countries had more than 10

million people 60 or older: China (42 million),

India (20 million), and the United States of

America (20 million). Fifty years later, the

number of persons aged 60 or over increased

about three times to 606 million. In the year 2000, the number of countries with more

Figure 1 : World Elderly Population (Source: Population Division, DESA, UN Report 2008)

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than 10 million people aged 60 or over increased to 12, including 5 with more than 20

million elderly people: China (129 million), India (77 million), the United States of

America (46 million), Japan (30 million) and the Russian Federation (27 million).

Over the first half of the current century, the global population of persons aged 60 or

over is projected to expand by more than three times to reach nearly a billion in 2050.

By then, 33 countries are expected to have more than 10 million people aged

60 or over, including 5 countries with more than 50 million elderly people: China

(437 million), India (324 million), the United States of America (107 million),

Indonesia (70 million) and Brazil (58 million).

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Figure 2: Annual Growth Rate (Source: Population Division, DESA, UN Report 2008)

Currently, the growth rate of

the older population (1.9 per cent) is

significantly higher than that of the

total population (1.2 per cent). In the

near future, the difference between the

two rates is expected to become even

larger as the baby boom generation

starts reaching older ages in several

parts of the world. By 2025-2030,

projections indicate that the population

of people over 60 will be growing 3.5

times as rapidly as the total population (2.8 per cent compared to 0.8 per cent). Even

though the growth rate of the 60 or over age group is expected to decline to 1.6 per

cent in 2045-2050, it will still be more than 3 times the growth rate of the total

population (0.5 per cent) by the end of the second quarter of this century.

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As the older population has grown faster than the total population, the

proportion of older persons relative to the rest of the population has increased

considerably. On a global scale, 1 in every 12 individuals was at least 60 years of age

in 1950, and 1 in every 20 was at least 65. By the year 2000, those ratios had

increased to 1 in every 10 aged 60 years or older and 1 in every 14 aged 65 years or

older. By the year 2050, more than 1 in every 5 persons throughout the world is

projected to be aged 60 or over, while nearly 1 in every 6 is projected to be at least 65

years old.

Geriatric Medicine

Geriatric is defined in the Fourth Edition of The American Heritage

Dictionary of the English Language as “of or relating to the aged or to characteristics

of the aging process”, “an aged person”. In the Complete and Unabridged Collins

English Dictionary, it is defined as “old, obsolescent, worn out, or useless”, “an older

person considered as one who may be disregarded as senile or irresponsible”.

In the Medical field, geriatrics is the study of the illnesses that affect old

people and the medical care of old people. It is a subspecialty of medicine that focuses

on health care for the elderly. It aims to promote health and to prevent and treat

diseases and disabilities in older adults. According to the American Geriatrics Society

(AGS), the criteria for geriatric patients are:

i. Patients with advanced old age or frailty usually with cognitive

impairment and/or physical disability.

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ii. Patients with medical and/or functional problems requiring

assessment for treatment, rehabilitation and support.

iii. Complex multiple medical system disorders.

iv. Difficulty coping with activities of daily living with potential for

improvement with therapeutic intervention and rehabilitation from

a specialized multi-disciplinary team

A geriatrician is an expert in the diagnosis and management of complex and/or

multifactorial internal medicine disorders impacting on the cognition and functional

status of the elderly. The approach of the Geriatrician is geared towards reducing the

occurrence of post-acute syndromes and functional decline associated with

hospitalization. The specific role(s) undertaken by Geriatricians depend on the local

needs of the population, workforce issues, rural or remote settings and the extent of

other medical services available.

ASD defines the role and responsibilities of Geriatricians as:

i. Acute Geriatric internal medicine and rehabilitation care of

older people in the hospital setting

ii. Hospital consultation/liaison services. These may be General

Geriatric medicine services, or highly specialized services (e.g.

orthogeriatrics, cardiogeriatrics)

iii. Outpatient clinics. These are usually General Geriatric

medicine clinics, but may include specialty clinics in areas in

which Geriatricians have particular expertise (e.g. cognitive

disorders, Parkinson’s disease, falls, continence, wounds)

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iv. Domiciliary care (home visits, residential aged care facility

visits), aimed at providing support to general practitioners in

the care of older people

v. Aged care assessment teams

vi. Research (includes both specific research units and in research

activities involved in day to day work). Research settings

include universities, academic medical units, general geriatric

medicine units and in private practice. Research includes basic

sciences, clinical research, clinical trials and quality

improvement activities.

vii. Management roles in academic units, hospital units or health

services

viii. The promotion of healthy ageing and health improvement for

older people

ix. The promotion of the dignity of the older patient

x. Improving attitudes toward ageing by the general community,

governments and the health care system

xi. Participation in research activities directed at improving the

health of older people, and the efficiency of health services for

older people.

Due to the increasing demand for geriatric medical expertise, in many

circumstances, other medical practitioners are called upon to fulfil the role of a

geriatrician. General practitioners, general physicians and rehabilitation specialists,

amongst others, have provided Geriatric medical services when workforce issues have

resulted in shortages of trained physicians in Geriatric Medicine. This underscores the

need for all medical practitioners to acquire some training and basic skills in the care

of older patients with multiple problems.

Specialized Care

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ageing.

The Integrated Care for the Elderly

Approach involves medical practitioners, care

givers, family, community, and the patient in the

effective management of healthy

Integrated Care is classified as specialized

palliative care, which incorporates a positive and

open attitude towards death and dying by all service providers working with residents

and their families. This approach, by shifting from a ‘cure’ to a ‘care’ focus, is

especially important in the advance stages of life.

Figure 3: A map for integrated residential health care

Active treatment for the resident’s specific illness may remain important and

be provided concurrently with a palliative approach. However, the primary goal is to

improve the resident’s level of comfort and function, and to address their

psychological, spiritual and social needs.

People with life limiting illnesses, or those who are dying due to the ageing

process, will benefit from receiving a palliative approach. The more complex illness

trajectories in the non-cancer older population can make it very hard to determine

when the end of life is near and no more ‘medical rescues’ are plausible.

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Geriatric Medicine in the Philippines

Philippine Society of Geriatric Medicine

The Philippine Society of Geriatric Medicine’s (PSGM) mission is to achieve

the highest standard of health care through relevant, scientific and competent practice

of Geriatric Medicine. As a working group of PSGM, the Specialty Board of Geriatric

Medicine aims to certify the competence of qualified health care practitioners in the

comprehensive, compassionate, and excellent practice of Geriatric Medicine in the

Philippines. The diplomate status in the PSGM is given to those who have:

completed fellowship training in an accredited institution (or its equivalent), obtained

at least diplomate status in the Philippine College of Physicians or the Philippine

Academy of Family Practice, and passed the Geriatric Board Examinations. The

examinee is expected to perform a comprehensive geriatric examination on an actual

patient, and present and defend his findings to a panel of board examiners but greater

emphasis is placed on her/his skills and attitude.

Committee on Aging and Degenerative Diseases

The National Institute of Health under the University of the Philippines was

approved by the Board of Regents at its 1094th meeting on 26 January 1996, and with

it, the Gerontology and Disabilities Programs Cluster, through the Committee on

Aging and Degenerative Diseases. The Institute focuses on value added life through

scientific research, training and education, and specialized services for the Filipino

elderly. The committee is composed of various physicians, academicians, and allied

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medical professionals within the UP-PGH system. The Committee on Aging and

Degenerative Diseases, through its multidisciplinary membership, is involved in the

development and management of various clinical programs within the UP-PGH

system, including:

• Outpatient geriatric evaluation and wellness clinic

• Hospitals and Health Care Providers

The Aging Population in the Philippines

The total number of Senior citizens (60 years old and over), based on the 2000

Census of Population and Housing, was 4.6 million, accounting for 5.97 percent of

the 2000 Philippine population. This number registered a 22.18 percent increase from

1995 (3.7 million persons). In terms of the average annual population growth rate, the

elderly population grew at 4.39 percent during the 1995 to 2000 period, higher when

compared to the 1990 to 1995 growth rate of 3.06 percent. If the growth rate

continues at 4.39 percent, the number of Senior citizens is expected to reach seven

million in 2010 and to double in approximately 16 years.

The rapidly increasing absolute number of Filipino Senior citizens is attributed

to its declining fertility rate and increasing life expectancy and the density of Filipinos

that are entering their 60’s. The recent Philippine Census in 2007 had figured an

average annual population growth rate of 2.04%. It was the lowest annual growth rate

recorded for the Philippines since the 1960s.

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The total number of the population and actual number of Senior citizens based

on the actual NSO survey on 1995, 2000 and 2007 is a scenario where the fertility rate

is going down while the number of Senior citizens is rapidly increasing.

In 2015, there will be 8.8% or more than 8.72 million Filipino Senior citizens.

In 2050, the Philippines will be ranked No. 10 amongst the most populous countries

in the world. It will continuously increase in a very fast phase with unforeseen

impacts on culture, society and economy. This poses a challenge that could threaten

the Filipino families’ strong familial relationship.

Coping With Old Age

Majority of Filipino Senior citizens still live in their own homes or

community, thus, it is essential to look into the level of their physical functioning and

circumstances affected by poverty. This represents the Filipino Senior citizen’s

situation “in a nut shell” at the community/home which is divided into four main

categories:

1. Active SC- can perform Activities of Daily Living (ADL), independent

and contributes to the community by participating in Senior Citizens

Organizations (SCOs) and /or taking care of family members or doing

household chores.

2. SC at risk- can perform basic ADL but would need assistive devices.

They are still healthy but have limitations on their physical activities

and mostly stay at home.

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3. Inactive SC- they would require continuous medication and are fully

dependent on others for their ADL for a prolonged period.

4. High Risk SC- they would need specialized high-cost medications to

ease the pain, and with life threatening diseases, they are fully

dependent on their ADL.

Poverty in old age remains to be the primary precipitating factor, whether they

would be categorized as resource, minimal resource, dependent or burden. Those

who have the capacity to pay can access medical services and acquire quality care.

Also, remaining active in the community and doing household activities could deter

the transition from being active to being a burden.

Government Initiatives for Senior Citizens

The Philippine Government is one of the signatories in the Madrid

International Plan of Action for Older Persons and also in the forefront in the

conceptualization and ratification of the previous international plans (e.g. Macau Plan

of Action for Older Person 1998 and Shanghai Implementation Strategy 2002). The

Philippine constitution recognizes the positive role of older citizens in our society,

encouraging them to contribute to nation-building and to develop community

organization as well as providing support to NGOs working for the older citizens.

The salient features of the law are the provision of privileges in the form of

discounts in the purchasing of medicines and basic commodities for the personal

enjoyment of the Senior citizen (i.e. movie houses, recreational places, etc.) and the

establishment of the Office of the Senior Citizens Affairs (OSCA) headed by a Senior

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citizen. It is mandated to fully implement the provisions and serve as a link for Senior

citizens and Senior Citizens Organizations (SCOs) to its local government.

Filipino Senior Citizen as the Head of the Family

Families in less developed countries are well positioned to provide informal

care because they are larger, have a stronger connection, and are more

multigenerational than in developed countries. While it is true that the Filipino

Family remains to be resilient and extended in nature, there is a distinguished role for

the Senior citizen within the family.

More than half of the household population 60 years old and over (57.41%)

were household heads and nearly one-fourth was spouses of the household heads. Of

the total number of households in the Philippines (15.3 million), 17.13% (2.6 million

households) were headed by Senior citizens. The head of the family provides direct

supervision to the children left behind by overseas workers and manages the

household.

Looking at this unique familial relationship, it is essential that relevant studies

should be undertaken to look into the special contribution of the Senior citizen in the

Filipino family. Nonetheless, this could be the effect of the feminization of the

Filipino migrant worker especially in the health sector, which is attributed to the

ageing population in developed countries where Filipino health care workers are the

most in-demand due to their innate values of taking care of their elderly. But,

Filipinos are still unaware of the effects of this generational lost, where the

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grandparent takes over the responsibilities and roles of the biological parents in

providing care and guidance to their children.

Challenges of the Filipino Senior Citizen in the 21st Century

New situations which face us as a result of the changing population and family

structures and the inadequacy of our public services should be seen as challenges, not

problems. (Bond John, Coleman Peter , 1990). One of the main challenges of the

Filipino Senior citizen in the 21st century is still poverty and the lack of proper

healthcare.

The recent worldwide recession aggravated by the lack of safety nets and

social protection remains to be the primary obstacle to achieving a better quality of

life especially for Senior citizens. It is the most substantial issue being faced by every

country, most especially in developing countries like the Philippines where the

average poverty incidence of population is 32.9%. The Filipino family safeguards

the interest of its members, but the ill effects of poverty to the most vulnerable

members of the family like the Senior citizens and the children, is widely felt. To be

left behind devoid of their rightful entitlements. The number of impoverished Filipino

senior citizens is increasing, yet, they are still not being given critical attention.

Moreover, the pattern of disease at the end of life is changing and more people

are living with serious chronic circulatory and respiratory diseases as well as cancer.

Despite evidence of a dramatically increased need for supportive and palliative care,

this area has been relatively neglected in health policies and research. It is true that

until now, majority of Filipino Senior citizens have been cared for at home but, let’s

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not take for granted that there is an increasing number of old-old category, which

means that there is a higher possibility that they will become dependent due to high

risks in communicable and degenerative diseases. Given that majority of Senior

citizens lack healthcare insurance aggravated by the high cost of medical services,

most of the Senior citizens have been fully dependent on government medical

subsidy.

In the Philippines, communicable diseases are still widespread and considering

the weak resistance of Senior citizens, they have been more likely to suffer from these

and continue to suffer due to poverty, limited access to health care facilities and

inadequate health services. Likewise, Filipino Senior citizens and their families are

still unaware of the cognitive problems attributed to old age and family career

burnout, thus, it requires comprehensive interventions, combining the medical and

psychosocial aspects in dealing with the adverse effects of cognitive impairment to

Senior citizens and their families.

It is important to note that scientific concern for the elderly in the Philippines

is new, probably due to two factors namely, the relatively small size of the elderly

population and cultural perception that the elderly do not pose a problem to society

because they are taken care of by the family. While the proportionate size of the

elderly group is comparatively low because of the youthfulness of the Philippine age

structure, the growth rate of the elderly population has been substantially and

progressively going up.

The Philippine scenario is comparable to other developing countries or

economies in transition. There is a need to provide emphasis on improving the quality

of life through research and policy/programme development responsive to the

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emerging needs of the Senior citizen. In responding to the predicament of having the

highest absolute number of Senior citizens in the Asia Pacific region and the lack of

health care insurance, there is a need to develop a cadre of advocates especially in the

Academe and helping professionals (i.e. Geriatrician, Geriatric Social Worker,

Geriatric Nurses and Gerontologist) to create awareness on the challenges faced by

the Senior citizen and their family.

Social Gerontology is a relatively new field. Being at its incipient stage, there

is yet no compact bibliographic volume where researchers in Gerontology can easily

access locally-produced materials that centrally focus on the diverse social and

cultural aspects of the Filipino aging experience. With that, studies related to the

Filipino Senior citizen are quite limited and few, which is still not given emphasis due

to lack of support and non-prioritization.

Looking at the ever-increasing absolute number of Filipino Senior citizens, it

must require a multi- stakeholder approach, to enable them to involve and participate

in community development. Active participation of Senior citizens in the cultural and

social activities and establishment of organizations that will truly represent the grass-

root older persons in every local council will be a big step in enabling older people to

regain their lost prestige. A drastic shift towards scientific-based decisions and

sharing and accessing of financial and human resources between non-governmental

organizations, government agencies and SCOs to develop comprehensive, diversified

and specialized programs responsive to the needs of the Filipino Senior citizen should

be given critical attention.

Successful and/or active ageing as a concept should be culturally tailored. For

Filipinos, it is the continuous support of the Senior citizen to their family whether in

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financial form, or taking care of their grandchildren and contributing to their

communities by joining SCOs. Given the extended family structure in the

Philippines, the family remains to be the primary concern of each member,

especially to the Senior citizen and it is considered as a lifetime responsibility. At the

same time, Senior citizens view their family’s caring role as a fulfilment and not as an

unwanted chore.

Poverty is the foremost obstacle in achieving active ageing in the Philippines.

Given the limited resources to support its burgeoning Senior citizen population, the

Philippines should rethink and shift its focus on enabling the sector to become an

asset through encouraging its Senior citizens to contribute and volunteer for societal

development. The real challenge is to proactively respond to the health care needs

and poverty incidence among seniors and the strain in familial relationships attributed

to migration and other factors within the Filipino family and society.

Statement of the Problem Given the premise of both global and local increase in geriatric population and the

fact that elderly people are often fragile and sickly there is a need to study current medical

facilities and their efficiency in addressing healthcare for the elderly.

The research seeks to propose a conceptual framework that will examine the potential

of built environment as an integral component in providing elderly wellness. Designing a

physio-social-medical facility for the care of the elderly must be studied to become more

responsive to the needs of this segment of the population.

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Objectives The objectives of this study are:

to present an overview of the current condition of Geriatric Medicine in the country;

to identify social and spatial factors that are contributory in building an integrated

health care facility; and

to provide a design guideline in developing healthcare facilities for the elderly.

Significance of the study

The study by highlighting the need to focus on the holistic well-being of the

elderly can facilitate the improvement of the quality of geriatric medical care by

providing better healing space.

By creatively integrating ubiquitous and interactive devices, geriatric facilities

can stimulate the patient’s senses, improving things like their physiology and mood

— important factors when it comes to healing the elderly and improving their quality

of life.

Expected Output This study aims to produce a design guideline that bares solution to the limitations

and insufficiencies of present geriatric care facilities. These will be design guidelines that are

translatable to practice, as opposed to theoretical, in consideration of its features, cost, scope

and other build requisite. The thesis will therefore produce a sample out-patient geriatric

medical facility that is capable of servicing at least 10% of the total target clientele per day in

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terms of space availability, notwithstanding administrative limitations, like staffing, which is

beyond the scope of this thesis.

Scope and Delimitation

The project would be limited to the development and design of a primary care hospital

for ambulatory elderly. This excludes emergency cases, terminally ill or patients on life

support. The medical procedures and care provided by the facility would be limited to

routine check-ups, diagnostic examinations and minor medical procedures like nebulisation,

(non-emergency) allergic reactions, among others. To determine the medical procedures that

can be done in the center, we will use the parameters set by the Philippine Medical

Association.

Assumptions The basic assumption of this thesis is that elements of previous

researches, studies and design solutions from Europe, United States, Australia

and Japan may be applicable to the local context, particularly in the aspect of

geriatric care.

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Definition of terms

Aging

Used in this research as a biological process of growing old, following the universal

definition of the term.

Caring and Curing

Used in this research liberally to identify the foci of geriatric medicine. This research

particularly promotes caring or ensuring holistic consideration of patient’s welfare, to

include psychological, emotional and/or social needs together with their medical

needs. However, curing or treating ailments, disorders and/or diseases is also a major

consideration, as the research will design a medical facility.

Geriatric

Used in this research to refer to persons who have or who are undergoing aging;

particularly referring to aged population who are requiring medical attention. The

specific focus of this research is intended for non-emergency non-terminally ill

geriatric.

Geriatric population

Used in this research, without intended prejudice or discrimination, to refer to a sector

or a demographic grouping in society who are from age 60 and above.

Geriatric medicine

Used in this research to refer to a branch of medicine focused on curing and caring for

geriatric population. The term may also refer to practitioners or the system of curing

and/or caring.

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Integrated care

Used in this research to refer to the medical facility being design in this research.

Integrated care is two pronged. First is to integrate the services needed by an

outpatient; second is to integrate both caring and curing in one design solution.

Outpatient

Are patients that require medical attentions however are non-emergency, non-terminal

cases. Geriatric patients, similar to pediatric patients, are required to have constant

consultation with doctors for their health care, treatment of life-long or degenerative

diseases.

REVIEW OF RELATED LITERATURE

Geriatric Medicine in the Philippines

The total number of senior citizens (60 years old and over) based on the 2000

Census of Population and Housing was 4.6 million, accounting for 5.97 percent of the

2000 Philippine population. This number registered a 22.18 percent increase from 1995

(3.7 million persons). In terms of the average annual population growth rate, the elderly

population grew at 4.39 percent during the 1995 to 2000 period, higher when compared

to the 1990 to 1995 growth rate of 3.06 percent. If the growth rate continues at 4.39

percent, the number of senior citizens is expected to reach seven million in 2010 and to

double in approximately 16 years. (NSO)

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Innovations in Hospital Architecture

Today's architects must provide hospitals which enable high-quality care for

diverse patient populations in carbon neutral care settings. Verderber considers the future

of the hospital and what needs to be done in order to meet that challenge. The

contemporary hospital is viewed in the context of global climate change, the planet's

diminishing natural resources and the spiralling cost of operating healthcare facilities.

Architecture and design are becoming integral components of the approach to

treatment and recovery. Special uses of light and color, sustainability in the choice of

materials and the flexibility of rooms: all form innovative concepts in contemporary

hospital architecture – whether brand new buildings, conversion, or extension project

(Verderber, 2010).

Healthcare buildings are to be designed as living spaces for patients rather than

warehouses for the sick. It has to be kept in mind that a hospital is not a factory in which

the assembly lines dictate all aspects of design but is a community in which the patient is

fundamental to the successful working of the whole. Needs and expectations of the

patients have to be visualized, analyzed and fulfilled. The hospital building should

provide the patients a sense of safety, comfort, dignity and repose. It should also provide

pleasing spaces for patients, families and visitors as well as imbibe the cultural concerns

of the community. The design of a healthcare setting should welcome the patients’

family and friends, value human beings over technology and provide flexibility to

personalize the care for each patient. The aim is to have a humanizing architecture that

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can positively contribute to the healing process. It should make the patient say that “I

feel like I am at home here”. Design must also satisfy professional requirements.

The hospital of the future views itself as being a modern service provider: the

patient is a customer who is wooed with a care-focused medical service. A central aspect

of this new thinking in the field of health care provision is the quality of life and the

well-being of patients, staff and visitors.

Healing the Mind, Body, and Soul

There is ample evidence that the primeval forces of nature i.e. the Sun,Wind,

Earth, and Water all have a mystifying positive effect on health. The physical

environment of the healthcare facility should firstly, do no harm and secondly, facilitate

healing process. Natural sounds, including those created by running water, have a

calming and relaxing effect. This should be gainfully employed in the form of fountains,

artificial springs/waterfalls or rivulets. Colour may also be used as a visual stimulator or

volume enhancer. Landscaping should be appropriately planned to create a healing

environment.

Design for flexibility and expandability

Therapeutic gardens have been used throughout time and can be integrated into

health care settings today. Whereas medicinal advances in health care have been made,

the use of nature in healing is not commonplace. However, the restorative qualities of

nature are very much existent, as shown by studies. Additionally, design elements

derived from successful therapeutic gardens, horticultural therapy gardens, and enabling

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gardens have shown how nature can become an integral part of any health care setting

(Sternberg, 2009).

Since most outdoor landscapes at health care facilities are nonexistent or fail to

meet the user needs, it is imperative to design a therapeutic garden that really takes into

consideration the mental and physical needs of the users. An emphasis needs to be made

that although the clients of most projects are the administrators of a facility, the design

needs to focus on the users, which are the patients and residents.

Living For The Elderly

Quality living in old age is one of the important topics of our time. Architects

and builders can contribute innovative types of housing, intelligent concepts for barrier-

free buildings, and advanced systems of care for people who are fragile or suffering from

dementia.

Intelligent design solutions can push back the limits on housing and care, on

residential architecture and care facilities, on individual, collective, and assisted forms of

housing, and even on the various phases of life in favor of a comprehensive trend toward

integrated forms of housing (Verderber, 2010).

Another approach that was introduced in Germany is by empowering care home

residents, encouraging their collective input into the design of a communal living space to

increase their social identification with others in the home and improve their sense of

psychological comfort (Mccullough, 2010).

This study provides strong evidence that empowering care home residents, by

encouraging their collective input into the design of a communal living space, had a

number of significant and positive consequences for both them and their careers. In

particular, engaging with groups in this way led residents to have a greater sense of

psychological comfort and social identification with others in the home. Residents tended

to display more considerate citizenship behaviour towards their fellow residents, and they

reported and exhibited improved life satisfaction and physical health. Finally, the group

of residents who had been collectively engaged in the design process was then found to

make much more use of the new communal space than those in the control group.

Indeed, in the period after the move, residents in the empowered condition used their

main lounge nearly four times as much as those in the controlled condition, and

maintained this high level of use throughout the experiment.

Active Ageing: Towards Age-Friendly Primary Health Care

In a publication released by the World Health Organization (WHO), it was discussed that

“In order to prepare for unprecedented population ageing, it is of utmost importance that health systems in developing countries are prepared to address the consequences of demographic trends.” (World Health Organization, 2004)

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With the rate of population ageing growing rapidly, social and economic

development in developing countries may be left behind. For countries like the

Philippines, the population may already be old but the economic and social state of the

country may still be underdeveloped.

Also discussed in this publication are the barriers that face the elderly when it

comes to acquiring basic health care. Some of these are accessibility of health care

centers or facilities, high-cost, uncomfortable settings, and incompetent health care

providers. Because of these, the World Health Organization (WHO) has recognized the

need for accessible facilities adapted to the needs of the ageing populations all over the

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world. After working with different national groups and conducting researches, a set of

Age-Friendly Principles were developed.

These Age-Friendly Principles not only cater to the elderly, but also to those

who have functional limitations or those who have disabilities. These principles address

three major areas:

• Information, Education, Communication, and Training

• Health Care Management Systems

• The Physical Environment

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METHODOLOGY

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Related lit. works/precedentsProblem conception and needs analysis

Data Collection

Problem definition

Interviews

Observation

Related lit. works/ precedentsProblem evaluation and transformation to architectural challenges

Data Collection

Interviews

Observation & documentation

Site visits and mapping

Site visits Data Synthesis and Analysis

Solution

Architectural

Programming

Schematics

Solution evaluation and cross reference to goals and challenges

FINAL DESIGN

Getting the Data This research is a multi-phased research. On the first phase the output will be

problem conception and needs analysis. Data gathering will be done through review

of related literature, interviews and observation. On the second phase, the problem

will be evaluated and transformed into architectural challenges. Again, a round of

review of related literature, interviews, observation and documentation will be done

on this phase. Site visits and mapping will be added to gather data necessary in

programming. The third phase will involve gathering of data necessary for drafting

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an architectural solution. Site visits, programming, schematics, then data analysis and

synthesis will be done. Before final design is drafted and submitted, a solution

evaluation and cross referencing vis-à-vis the goals and challenges (stated on the first

phase) will be conducted.

Since the objective of this paper is to “translate” integrated care into a physical

space for infirmed elderly population, the research will be dependent largely on

previous researches and interview.

Method/Plan of Analysis

1.1 Systems of Inquiry

The system of inquiry that will be used is positivism. It is assumed that the truth that

the researcher wishes to find is out there. It is up to the researcher to find the sources that

will help answer the research problem and to analyze that data in an objective way.

1.2 Research Design or Strategy

The research aims to design a Geriatric Center in the Philippines that will improve the

quality of life of the elderly. It will provide medical services, rehabilitation and long term

accommodation to insure the health and wellness of the elderly. Qualitative research is

the most appropriate method to use in studying the elderly needs. Through this method, it

will be easier for the researcher to collect information and knowledge about the elderly

needs and the current design of similar facilities. The outcome will depend on the

researchers’ analysis and assessment of all the data gathered.

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This can also be combined with case study. It will include the gathering information

from similar facilities and comparing them. This will provide information on the

advantages and disadvantages of current designs.

1.3 Tactics

The researchers’ primary source of information will be taken from secondary

sources such as books and other published or unpublished materials. The proposed

facility is a specialized hospital which is very common in western countries. They have

books on the design and management of such facilities.

Visits to Geriatric Departments will provide information on how to design

similar facilities. The researcher will document the facility and observe the activities that

occur in it. The researcher will also have information as to what facilities or spaces will

be included. Information such as common ailments, disabilities and other demographics

can be obtained from the institution.

Interviews with the staff especially geriatric doctors and nurses will provide

information on some of the things the researcher will need in the design. It will include

the common problems they encounter at work, their observed and experienced problems

with current building designs, their needs and other information gained from their

experience with the elderly.

DATA PRESENTATION AND ANALYSIS

Findings/Data

USER

Profile The Facility is for the use of individuals 60 to 80++ years old. Two figures below

details the profile of target users.

Mobility is usually hampered by disabilities in basic sensual faculties like hearing and

sight. Low vision was the common disability among senior citizens (54.11 percent). Others

suffered from difficulty of hearing (9.7 percent), partial blindness (8.43 percent), partial

deafness (6.43 percent), and total blindness (4.52 percent).

A higher percentage of female person with disability (PWD) senior citizens suffered from

low vision (56.48 percent vs. 51.16 percent), partial blindness (8.60 percent vs. 8.22 percent)

and total blindness (4.81 percent vs. 4.15 percent) while more male PWDs suffered from

difficulty in hearing (10.45 percent vs. 9.10 percent) and partial deafness (7.01 percent vs.

5.96 percent).

Source: NSO, 2000 Census of Population & Housing

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In the following figure, ten causes of mortality were identified by the Philippine

Health Statistics of 2000. Six of which are causes of more than 50% of geriatric mortality—

cardiovascular diseases, pneumonia, tuberculosis, COPD, diabetes, diseases of digestive

system, nephritis and scepticemia. All of which are manifestation of decline in the major

organs functions (lungs, heart , kidneys and liver) usually pose a challenge to untrained

medical professionals.

As implied 90% of the users suffer from multiple medical conditions which requires

the patient to go to several medical facilities for their various illnesses.

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33

The facility that is to be designed will therefore adhere to supporting the need of the

patients, particularly alleviate pain, assure security, emphasize sense of purpose, provide

comfort and independence.

The facility is projected to accommodate 126 patients a day. This is about 30% of the

geriatric population in Quezon City.

Since it is the first facility of its kind, the design will serve as pilot in testing

adaptability of the integrated approach as compared to the more familiar and popular

specialized clinic visits in tertiary or private clinics.

Industry Profile

Hospitals with geriatric facilities and Wellness Place & Care Homes in the Philippines

At the time of writing geriatric medical care, including

treatment and rehabilitation relies on existing tertiary hospitals.

Among those who pioneered this particular practice were: the

Center for Healthy Aging and Geriatric Wellness in The

Medical City, Geriatric Multidisciplinary Clinic in Manila

Doctor’s Hospital, Geriatric Outpatient Services in the

Philippine General Hospital, Geriatric Center in St. Luke’s

Medical Center and Geriatric Center in the University of Sto.

Tomas Hospital.

Despite the number of geriatric

patients and the natural condition of man to

age, geriatric medicine is ironically coined as

a new field. Fortunately, practitioners who

specialized in this are now available in the

Centers mentioned above. Accessible health

care, comprehensive treatment plan and long term care are among the priority of these

Centers. Some of them, particularly St. Luke’s, go as far as developing Home Care Program

to accommodate patients who already has mobility problems.

Another innovation in the Philippines that addresses well-being and healthcare of the

elderly population are wellness centers and care homes.

Wellness Place and Care Homes is an example of this facility. It was established by

Dr. Hernando Delizo in 2001. Wellness place provides recuperative, rehabilitative and

assisted living for handicapped adults in the Philippines. According to him, their aim is “to

provide continuous and integrated services that cater to the special needs of the aged.” 34

35

In their facility located in residential communities, the Home also provides spiritual

care, community activities, individual development program and medical care; including but

not limited to nursing care and medical monitoring, supervision of medications, rehabilitation

and exercise program, health education, prescribed dietary regimen, nutrition screening and

assessment, 24/7 on-call doctors, well trained support staff with geriatric health experience

and training facilities for Asian Institute of Healthcare specialty geriatric program. Patients

may chose to be in-residence or on day care. They also partner with geriatricians,

psychiatrists, nurses, counsellors, physical/occupational therapists and other care givers to

provide comprehensive care to their residents/patients.

In essence Wellness Place and Care Home is a community where healing and well-

being for senior citizens is the main goal. It is a holistic center that aims to enable a geriatric

patient to receive healing while enjoying a more suited quality of life, than what is expected

of an infirmed individual confined in a regular hospital.

Operational and Functional relationship

Figure 4: Existing Organizational Structure

This chart illustrates a full-staff roster for a medical facility. Blue fields refer to

departments, while the yellow and green fields refer to units. Yellow fields are for non

medical units which are handled by a President and Chief Executive Officer. Green fields are

correlated units, some are handled by auxiliary administration but operates within the

organization.

Based on this structure geriatric care is considered as a specialized clinical

department. This poses a problem since a lot of geriatric patients have complicated medical

conditions and the existing multi-tiered protocol for care proved to be complicated to follow.

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Figure 5 Basic operational structures

In this figure, it is shown that hospital operations have three main branch—

administration, diagnostic & treatment, and research & training; two target service sectors—

inpatient and outpatient. Relationship for both inpatient and outpatient are three-pronged,

illustrating the connection of operations between the three departments vis-a-vis inpatient or

outpatient. A connecting line was also drawn to illustrate connection of inpatient, outpatient

and service. In this particular illustration, service is drawn much closer to inpatient as it

implies that hospital operations/resources are usually more focused on developing inpatient

services. By shifting the focus on providing better service to outpatient may contribute in

reducing inpatient statistics, which is also an aim of integrating care.

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Figures 2 & 3 illustrate the functional relationships of personnel to patients. In Figure

2 Typical Hospital Structure, it was shown that personnel of different departments directly

contacts or relates to the patient. In this illustration, it appears that there was no direct

coordination between the personnel which may also imply a fragmented or sectional

approach in caring for patient. Figure 3, on the other hand, illustrates a more integrated

approach. All personnel are shown to be in contact with each other. At the same time,

individually they too have direct contact with the patient.

The functional relationship that is illustrated on Figure 3 is most ideal for this project

of Integrated Care for Geriatric Patients.

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Existing

Existing medical care facilities are usually found annexed to tertiary hospitals as

medical arts building. While the ground floor is reserved for administrative functions,

service or business centers, doctors’ clinics can be found on upper floors, which requires the

patients to use elevators or staircase. Waiting areas are small, which are typically 3x4 meters

per doctor’s clinic situated along halls and general circulation zones of about 5x9 meters,

making it inconvenient to keep a patient on wheel chair. Doctor’s clinics are generic rooms

of about 6x5 meters, all to serve as reception area, diagnostic area and records storage.

Emergency rooms (ER) are found in the most accessible location in hospitals. Given that the

cases brought to the ER requires fast and immediate attention, a common room lay-out is

usually preferred. What is not recognized here how the urgency and abruptness of

movements and crowding affects the patient, especially the infirmed elderly. Various

laboratories are found either on a separate wing of the hospital or on basements. This was

done to ensure that toxic and communicable substances are isolated from the patients and

their companion. However, in cases that the geriatric patient has difficulty in mobility, as it

is usually the case, going to laboratories becomes an ordeal.

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Area Summary Based on Hospital space survey

Administrative Service

Lobby

Waiting Area 0.65/person

Information and Reception Area 5.02/staff

Toilet 1.67

Business Office 5.02/staff

Medical Records 5.02/staff

Office of the Chief of Hospital 5.02/staff

Laundry and Linen Area 5.02/staff

Maintenance and Housekeeping Area 5.02/staff

Parking Area for Transport Vehicle 9.29

Supply room 5.02/staff

Waste Holding Room 4.65

Dietary

Dietician Area 5.02/staff

Supply Receiving Area 4.65

Cold and Dry Storage Area 4.65

Food Preparation Area 4.65

Cooking and Baking Area 4.65

Serving and Food Assembly Area 4.65

Washing Area 4.65

Garbage Disposal Area 1.67

Dining Area 1.40/person

Toilet 1.67

Clinical Service

Emergency Room

Waiting Area 0.65/person

Toilet 1.67

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Nurse station 5.02/staff

Examination and Treatment Area

with Lavatory/Sink

7.43/bed

Observation Area 7.43/bed

Equipment and Supply Storage Area 4.65

Wheeled Stretcher Area 1.08/stretcher

Outpatient Department

Waiting Area 0.65/person

Toilet 1.67

Admitting and Records Area 5.02/staff

Examination and Treatment Area

with Lavatory/Sink

7.43/bed

Consultation Area 5.02/staff

Nursing Unit

Semi-Private Room with Toilet 7.43/bed

Patient Room 7.43/bed

Toilet 1.67

Isolation Room with Toilet 9.29

Nurse Station 5.02/staff

Treatment and Medication Area with

Lavatory/Sink

7.43/bed

Central Sterilizing and Supply Room

Receiving and Releasing Area 5.02/staff

Work Area 5.02/staff

Sterilizing Room 4.65

Sterile Supply Storage Area 4.65

Nursing Service

Office of the Chief Nurse 5.02/staff

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Cadaver Holding Room 7.43/bed

Primary Clinical Laboratory

Clinical Work Area with

Lavatory/Sink

10

Pathologist Area 5.02/staff

Toilet 1.67

Radiology

X-ray Room with Control Booth,

Dressing Area and Toilet

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Dark Room 4.65

Film File and Storage Area 4.65

Radiologist Area 5.02/staff

Notes:

1) 0.65/person – Unit area per person occupying the space at one time

2) 5.02/staff – Work area per staff that includes space for one (1) desk and one (1) chair,

space for occasional visitor, and space for aisle

3) 1.40/person – Unit area per person occupying the space at one time

4) 7.43/bed – Clear floor area per bed that includes space for one (1) bed, space for

occasional visitor, and space for passage of equipment

5. 1.08/stretcher – Clear floor area per stretcher that includes space for one (1) stretcher

NEEDS ASSESSMENT/ SITUATIONAL ANALYSIS Based on findings presented above, there are three points are to be subjected to

assessment and analysis to be able to envision an Integrated Care Geriatric Facility—what the

patients need, what the patients prefer and how to provide it. The design solution being

offered by this project, not being a medical project will focus on addressing comfort of

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patient, accessibility of specialized medical care needed and sensitivity to the patient’s

condition.

Fist to be considered is the comfort of patients. In the design solution being offered, it

should be easier to set an appointment with doctors and laboratories; waiting and consultation

sessions should be more physically comfortable; however not being too cumbersome for

medical staff to facilitate, attend and monitor.

Second to be considered is accessibility to specialized medical care. Rather than the

usual situation where the patient has to go to several separate clinics, the design solution will

direct medical staff to do the “rounds” on clinics in one facility. This would save both the

doctors and the patients’ time commuting, waiting and searching for their several

appointments.

Third to be considered is sensitivity to the patient condition. Since discussed above

that disability or inability to move at ease are common among geriatric patients, the design

solution would take note of these as a basic consideration. The facility therefore would be

suited/accessible for people with visual, aural, mobility impairment; as well as the manner or

equipment that aids their mobility. It would also consider the social aspect or requirement of

geriatric patients, particularly their need to socialize and/or have a constant private space.

Regulations. The facility is under Group D-Division 2 based on the classification of the National Building

Code. The maximum allowable height of building is 15 m or duly approved building height

limit of the area. The formula for allowable maximum total gross floor area is BHL times

70% of total lot area.

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The size of an average automobile (car) parking slot must be computed at 2.50 meters by 5.00

meters for perpendicular or diagonal parking and at 2.15 meters by 6.00

meters for parallel parking. A standard truck or bus parking/loading slot must be computed at

a minimum of 3.60 meters by 12.00 meters.

Specific Uses or of Occupancy (refer to Section 701 of this Rule)

Reference Uses or Character of Occupancies or Type of Buildings/Structures

Minimum Required Parking Slot, Parking Area and Loading Space Requirements

4.2. Division D-2 Private hospital O One (1) off-street cum on-site car parking slot for every twelve (12) beds; and one (1) off-RROW (or off-street) passenger loading space that can accommodate two (2) queued jeepney/shuttle slots; and provide truck maneuvering area outside of the RROW (within property or lot lines only)

*Excerpts from the National Building Code

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SITE SELECTION PARAMETERS

Quezon City is the most populated city not only in Metro Manila but in the entire

country as well. The site selection process considered three areas in Quezon City because it

also has the largest concentration of senior citizens. These are the GSIS Property, North

Triangle and East Triangle.

GSIS Property North Triangle East Triangle Location

Elliptical Road, Brgy. Old Capitol Site

bounded on the North by North Ave, on the south by Quezon Ave, west by EDSA and on the east by Elliptical Road

bounded on the north by Elliptical road, on the south by EDSA, on the west by Quezon Ave and on the East by East Avenue

Area 29,884 m2 54.37 has 109 has

Existing Land Use

vacant/ abandoned

institutional ( area occupied by Phil Science HS, Children's Museum & Library, Occupational Safety, Phil Children's Hospital

predominantly institutional, occupied by different National Government Offices

institutional based on approved revised CLUP Commercial

portion of the Phil. Zoological & Botanical Garden occupied by informal settlers

Present Ownership

National Government National Government Center

Potential Uses

Mixed-use development

Development being administered by the newly created North Triangle Development Committee Mixed-use development proposed mixed-use development integrated with Institutional

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existing MRT depot

Urban Forest/ Ecological Waste Management

The criteria used for the site selection are as follows:

1. Proximity to Specialized Hospital

It is essential that the site is or at least in close proximity to a specialized or

tertiary hospital. This is fundamental in the site-selection process due to the facility’s

nature of operation.

2. Land-use Classification

Due to the nature of facility’s function, it is essential that the site must be

under institutional land-use classification.

3. Cost Acquisition

The cost of lot will not be limited to cost at the time of acquisition but must

include projected earning potential of the site.

4. Easily Accessible

The target market of the project must easily access the site.

The site must be accessible not just by private and public vehicles but more

importantly it should be convenient for ambulances to access the facility

5. Lot Size

The site must not restrict the footprint of the facility so that it can maximize its

functionality. There must also be adequate space for green open spaces in the site

which will also be integrated to the structure to keep in the theme of nature. Also, a

parking space for private vehicles is also imperative.

6. Environmental Impact

Close proximity to residential establishments should be avoid to reduce the

risk of outbreaks or contamination.

The three potential sites of the Geriatric Facility will be scored based on the

parameters discussed above. A score of three (3) will be given as most advantageous site

while one (1) as the lowest score. The site with the highest total will be selected for this

project.

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SCORE TABLE: PROSPECTIVE SITES

PARAMETERS SITE A: GSIS SITE B: North SITE C: EAST

Proximity to Specialized Hospital 2 2 3

Landuse classification 1 2 3

Cost Acquisition 3 1 2

Easily Accessible 3 3 3

Lot Size 1 2 3

Environmental Hazard 1 2 3

TOTAL 10 13 17

Table 1 The score table weighing the three sites against each other

SITE The project site is on the East Triangle of Quezon City.

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Vicinity Map

The site is part of District IV of Quezon City. The area is approximately 109 h. It is

geographically located at latitude 14°38'56.29"North of the Equator and longitude 121°

2'52.06" East of the Prime Meridian on the Map of Manila.

The Philippine Heart Center, National Kidney Institute, Philippine Lung Center,

Quezon City Memorial Circle, Quezon City Hall, SM North, Trinoma Mall, Centris, and the

Wild Life Park are among the establishments with in the 25KM radius.

Location Map

Bounded on the north by Elliptical Road, on the south by EDSA, on the west by

Quezon Avenue and on the east by East Avenue.

SITE

Figure 5: A google map image of East Triangle Site

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Land Use Plan

The site is under the institutional land use classification based on the Quezon City

Land Use Map of 2009.

Policy Zone Map

Regeneration Development Areas (RDA) are zones within major urban centers where

new construction and development of factories, higher educational institutions, among others

are to be contained. Urban Promotion Areas (UPA) are zones wherein industries may be

promoted in order to serve as alternatives to activities which may no longer be feasible in the

RDA's. Urban Control Areas (UCA) are zones considerably residential and commercial in

nature. Environmental Preservation Areas (EPA) are zones which are environmentally

sensitive and where limited land use activities could be allowed (Quezon City, 2008).

In the case of the East Triangle, it is classified under UPA. The establishment of high

income generating structures with in the area is encouraged.

Road Network/ Accessibility and Transportation map

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Figure 6: Road Map

The site is accessible to private and public transportation. Novaliches –

Alabang bound public busses, jeepneys from Cubao, San Mateo and Fairview

passes the site. Three MRT 3 stations ( North Ave, Quezon Ave and GMA Kamuning

) are in close proximity to the site.

Topography

Quezon City’s topography is mostly rolling with alternating ridges and

lowlands. The city’s slope is generally manageable ranging from less than 8% to 15%.

Thus, topography will not necessarily be a concern (Quezon City Government, 2008).

Soil map

SITE

According to the Bureau of Soils, Quezon City’s predominant soil type is of

the Novaliches Loam series, commonly called adobe. Adobe is mainly characterized

as hard and compact. It is extremely fine grained---made of microscopic particles---

and contains little or no organic matter. The quality and hardness of the soil vary as

the depth increases (Quezon City, 2008).

Climate Map

Figure 7 Gaph showing climatological normals of Quezon City

The micro climate on the site is identical to the general climate pattern of

Metro Manila. The average temperature of 27.7 °C (82 °F) to 31.7 C. The highest

monthly average high temperature is 34 °C (93 °F) in May while the lowest monthly

average low temperature is 22 °C (72 °F) in January & February. The site receives

an average of 2061 mm (81.1 in) of rainfall per year, or 172 mm (6.8 in) per month.

The driest weather is in February when an average of 7 mm (0.3 in) of rainfall

(precipitation) occurs across 3 days while the wettest weather is in August when an

average of 474 mm (18.7 in) of rainfall (precipitation) occurs across 22 days. The

average annual relative humidity is 73.8% and average monthly relative humidity

ranges from 64% in April to 82% in August & September. Sunlight hours range

between 4.3 hours per day in July & August and 8.6 hours per day in April. There is

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an average of 2105 hours of sunlight per year with an average of 5.8 hours of

sunlight per day.

Utilities

The site acquires its water from the MWSS and its private distribution

concessionaires – Maynilad Water Service Inc. (MWSI) and Manila Water Co.

(MWC). The electric power requirement is serviced by the Manila Electric Company

or Meralco. Communication is serviced by three major companies, PLDT, BayanTel

and Digitel.

OPERATOR AREA/LOCATION INSTALLED LINES

PLDT Quezon City 208,283

PLDT Novaliches 88,894

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Bayantel Novaliches 32,640

Bayantel Batasan Hills 36,320

Bayantel Cubao 36,320

Bayantel Diliman 40,320

Bayantel Project 8 39,680

Bayantel Roosevelt 73,600

Digitel Libis 2,288

TOTAL 558,343

Table 2: The corresponding operator for different locations in Quezon City

Sewerage

The site is connected to the East Avenue sewage treatment plant which is

(STP) considered to be the biggest in Quezon City. It is designed to treat as much as

16 million liters of wastewater daily before discharging it back to creeks and rivers.

Site Photos

PHC NKI

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QCMC ELIPITACAL RD

DESIGN DEVELOPMENT

Design Philosophy: The Care Building

Medical professional administer monitored care to control degeneration of the

patients’ condition. To care is to make provision of what is necessary for the health,

welfare, maintenance, and protection of someone. The design philosophy of this project is

to create a caring facility. It covers therefore, the improvement of the quality of life of the

patient, not only their healing. It takes inspiration from the bee hive. A structure that

provides shelter, protection, nourishment and social inter action amongst its user.

Overall Concept The overall concept of the project is Integrated Care,

which in colloquia implies a “one-stop shop” to address the

medical and care needs of geriatric patients. It is an

environment intended for healing, however providing an

ambience that is non-ascetic. It is a place that integrates the

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old with the new, a venue to repair and re-tire the aging individual comfortably.

Concept breakdown Concept Detail

Functional zoning

Integration of various activity zones to provide more efficient service

Design Fire zones to reduce life risks in event of fire

Architectural space

Behavioral Settings- The facility would require provisions for increase social interaction. Facilitate interaction among patients, care providers, and family members.

Mood/Image: The therapeutic Environment should be made to make the visit as unthreatening and comfortable as possible, and to make the patient's experience more like going to a vacation than to a doctor's office.

Enhance Spatial Transparency

Circulation and accessibility

Proximity of various co related activity zones

Provide a multi axial core.

Horizontal & vertical accessibility. The facility should make possible convenient circulation and access for mobility challenged individuals from zone to zone

Site Analysis 1. Physical property of the site. Strong tree line is present on the northwestern

portion of the site along the Elliptical Road area. Some of these trees are 10 to 20

years old. Noise and air pollution emanates from the North and East side of the

site. The site naturally drains along the East side.

2. Access and Utilities. The site is accessible to vehicles from the North and East

side only. Point A provides convenient access to south bound vehicles, It also

avoids the traffic congestion along East Ave. Point B on the other hand is long

the public transport route and is a good drop off point. Water , electricity and

communication lines are supplied from the east side of the site.

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.

Figure 8: Site Access

3. Relation to other

buildings. There are

four nodes wit in the

site vicinity, the North

Triangle Commercial

Area, Centris, GMA

Network Office, and

Philcoa. Two

landmarks, the Quezon

Memorial Circle and

the Quezon City Hall ,

are within 1 km radius. Communities of the A,B and C demographics are within

the site circumference.

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Figure 9: Built environment

Consideration for building axis are the Philippine Heart Center and the Geriatric Lung Center as co-operator in the building’s function, the community on the east side and the QMC Monument in recognition of the city.

SWOT ANALYSIS

Strengths

• Proximity to established tertiary hospital

• Strong accessibility • Can accommodate a wide range of

project types • Enhance the viability of the project

Weaknesses

• Noisy • Rush hour traffic congestion of

adjacent main through fare • limit the range of projects that may be

accommodated • negatively impact on the viability of

the project

Opportunities

• Facility and resource sharing •

Threats

• increasing air pollution

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Development Program

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Figure 10: Hive cell as concept image

The design takes inspiration from the hive and its properties. The cell wall connects and provides support to its neighboring cell.

The adjacency of spaces was designed so that they would provide support to the neighboring spaces.

Figure 11: Preliminary Plans

The hexagonal figure was taken as a recurring element to design to evoke the hive’s nurturing qualities and as multi axial core to significant spaces.

Figure 12: Initial Building Study

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TRANSLATION FRAMEWORK

Architectural Programming

Users’ Needs Schedule Number of doctors

Outpatient Department

6 Cardiologist 6 Pulmonologist 3 Oncologist 6 Endocrinologist 3 Urologist 3 Gastroenterologist 6 Geriatrician/ general medicine 3 Orthopaedic 3 Psychiatrist 3 Rheumatologist

3 EENT 3 Dentist

Projected Building Traffic per day

Main Doctors 14 Other Doctors 2 OD Assistant 2 Patients 56 Patients Assistant @2 per 112 Receptionist 1 MD Assistant 2 Auxiliary Spaces Pharmacist 2 Records Keeper 2 Interns 7 Housekeeper 3 Bldg Maintenance Engineer 3 Laboratory Lab Tech 2 General Tech 1 Assistant 1

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Radiologist 1 ER Doctor 1 Triage Nurse 1 Ambulance Driver 2 Ambulance Nurse 2 Commercial Spaces Staff 3 with 5 Stores 15

Per day occupants 232

Space Performance Requirement

OUT PATIENT DEPARTMENT

OPD ACCOMMODATION

Space to stay while waiting for the doctors. This space will serve as both venue for the check-up and waiting period. It should be made comfortable by assigning bigger area and better furnishing. It should have provisions for reading, social inter action, naps and eating.

RECEPTION

It should be easily seen and approached. Provide space for computerized check-in and scheduling. Provide PA system

STAFF BASE AND CLINIC SUPPORT ROOM

DOCTORS' HUB

patient -doctor-care provider interaction center, private spaces where they can discuss sensitive issues .

SPECIAL PURPOSE CE AREA

Common Exam Area should provide a level of privacy for the ECG and other visual assessments . Provide enclosure

CLEAN SUPPLY STORAGE Near door for easy replenishment

SOILED SUPPLY CHUTE Near door for easy pick up and maintenance

CIRCULATION Design halls and circulation spaces for wheel chair bound individual

IN PATIENT DEPARTMENT

ACCOMODATIONS

Suites must contain bed for patient plus one, a small kitchenette , bathroom , cabinet, tv and small seating area

DUTY STAFF STATION Table station for 2 Nurse and 1 Doctor. Provide space for medicine cabinet,

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computer station, portable equipments

SUPPLY & EQUIPMENTS RM

Oxygen and Equipments rm. vitals monitoring machine, dialysis machine, respirator, crash cart

DIAGNOSTICS AND IMAGING

XRAY ROOMS

Provide operator room with lead wall, spaces for film printing machines, x-ray machine for both standing and lying down patients. ADA compliant changing area

ULTRASOUND & CI BONE DENSITOMETER Provide bed and machine monitor space

CT SCAN

Provide space for operator, spaces for film printing machines, ct scan machine. Circulation space should facilitate transfer from wheel chair to machine.

BLOOD & SPECIMENS TESTING LAB

Provide space for specimen collection, storage, haematology analyzer machine,

RESULT PROCESSING Computer station

WAITING AREA

Seating room with provision for wheel chair bound patient, wheel chair stow away, tv and refreshment nooks

ER ROOM PATIENT ACCOMMODATION Medical Beds and with privacy curtains DOCTOR AND NURSE STATION

Table and chair, ER medical tower, Medicine cabinet

TRUMA ROOM Bed, crash cart, med tower, OXYGEN TANKS

OTHERS MEDICAL SPACES

EDUCATION

Lecture and conferences spaces for a group of 10 to 15 pax. Study centers with computer and internet access. E-library, class room for 3 to 4 students.

DENTAL Rented space. Provide utilities OPTALMOLOGIST Rented space. Provide utilities PHARMACY Rented space. Provide utilities PT REHAB Rented space. Provide utilities

NON MEDICAL SPACES

FAITH CENTER Inter-faith center, provide prayer and meditation area

Mechanical-Electrical-Information Facility (MEIF)

Control room for air and electrical supply, elevator operation. Provide space computer server and operator.

HOUSE CATERING Provide space for food handling and distribution only. Provide utilities

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Cafe and Food Stalls Rented space, provide utilities

House Keeping Space for housekeeping supplies and equipments.

SUPPORT SPACES

CR

ADA compliant, circulation with in the area must accommodate wheel chair bound individual.

EMPLOYEES LOCKER RM Provide space for lockers, shower and changing, resting and social interaction

MD HUB Provide space for lockers, shower and changing, resting and social interaction

DIRECTORS OFFICE

Provide space for shower and changing, receiving sofa, conference table and file cabinets

OTHERS PARKING ENERGY CENTER & Facility Manager

Generator room and offices for facility management and maintenance

MATERIAL WASTE MANAGEMENT

Repository for one-stop garbage collection. Provide four bins for; toxic non-bio degradable (TNB) , toxic biodegradable (TBio), house non-biodegradable (CNB), house biodegradable (CBio)

STP

Water tanks for initial water treatment, rain water storage tank and filtration system, Provide space for Filtration machine and 2 operators

PUMP AND UTILITY RM Provide artificial ventilation

Area Requirement

OUT PATIENT DEPARTMENT UNITS AREA IN M2 TOTAL

PATIENT'S ACCOMODATION 16 5 80CR 6 3.5 21RECEPTION 1 19 19STAFF BASE AND CLINIC SUPPORT ROOM 1 30 30DOCTORS' HUB 4 10 40SPECIAL PURPOSE CE AREA 4 7 28CLEAN SUPPLY STORAGE 1 4 4SOILED SUPPLY CHUTE 1 4 4CIRCULATION 1 125 125TOTAL 351

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IN PATIENT DEPARTMENT ACCOMODATIONS 10 32 320DUTY STAFF STATION 1 32 32EQUIPMENT RM 1 29 29TOTAL 381DIAGNOSTICS AND IMAGING XRAY ROOMS 1 30 320UTRASOUND 1 15 15CT SCAN 1 30 30BLOOD & SPECIMENS TESTING LAB 1 41 41RESULT PROCESSING 1 7 7CR 4 3.5 14WAITING AREA 1 163 163TOTAL 590ER ROOM PATIENT ACCOMODATION 3 2 6DOCTOR AND NURSE STATION 1 39 39TRUMA ROOM 1 14 14OXYGEN TANKS 1 6 6TOTAL 65OTHERS MEDICAL SPACES EDUCATION 1 195 195DENTAL 1 67 67OPTALMOLOGIST 1 20 20PHARMACY 1 47 47PT REHAB 1 146 146TOTAL 475NON MEDICAL SPACES ME RM 29 29CATERING 49 49HOUSE KEEPING 9 9CR 22 3 66TOTAL 153SUPPORT SPACES EMPLOYEES LOCKER RM 101 101MD HUB 131 131DIRECTORS OFFICE 64 64CIRCULATION 693TOTAL 989TOTAL SPACE BUILDING SPACE 3004

OTHERS PARKING 0

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Ambulance parking 2ER Parking 7Others 33

ENERGY CENTER & FACILITY MANAGEMENT 1 100MATERIAL WASTE MANAGEMENT 1 75STP 1 75PUMP AND UTILITY SERVICE RM 1 739

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Spatial Proximity

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Technical Requirement STRUCTURAL SYSTEM

Large span curtain walls of glass would be using “tension and compression system”

for its bracing. Please see attached document for specifications

MEDICAL EQUIPMENT

Since the actual equipment to be installed in the facility is determined by the client,

the space allocation for medical equipments are given an additional 5% based from the

specifications provided by Absolute Medical Equipment.

CT scanner Dimensions

The technology used for these devices are always changing, so the sizes and features

are subject to change. Usually though, the maximum part size is 1000 mm diameter x 5000

mm long x 2000 kg.

The CT slice thickness is 0.5 – 5 mm and the spatial resolution is 1.0 – 0.4 mm. This

will also hinge on the density contrast and the scanning mode used. The resolution and image

display varies, but 16-bit grey scale images and 4096 x 4096 sizes are not uncommon. The

scanning mode may include 3D computer tomography and 2-D digital radiography.

X-Ray Machine Dimensions: 300mA Radiographic X-ray

An x-ray of this type usually has a high frequency inverter system for the generator.

The filtration is 2.5 mm (Al equivalent) and the heat storage is at least 300,000 HU.

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The tube current is 300 mA and the tube voltage is 40-150 kV minimum. The dual

focus is 0.8/1.5 mm. The locking device is electromagnetic and movements are vertical,

lateral and horizontal.

The X-ray table ratio is 12:1 and the interspacer is aluminum. The control specs are as

follows: the line voltage adjustment is 180-260 V. The technique selector should be

kilovoltage (kV), time (sec or msec and/or pulse) and milliamperage (mA).

Medical Ultrasonography Dimensions

The SonoSite 180 Plus measures 2.5" L x 7.6" W x 13.3" H (6.35 cm L x 19.3 cm W

x 33.8 cm H). The system weighs 5.7 lbs (2.6 kg) if one transducer is connected to it. The

battery life is good for up to a couple of hours.

UTILITIES

Other technical requirements are; elevator lifts, air conditioning filtration system, sewerage

treatment system, power generators and water pumps.

The facility uses an air–cooled chiller (ACC) system and that produces and delivers cold

water to vent air blower. Air conditioning for the facility is zoned as follows;

Zone 1: Outpatient & ER & admin office

Zone 2: Laboratory

Zone 3: Commercial spaces & education spaces

Zone 4: Inpatient Suites & adjacent spaces

The system reduces affected areas and downtime during service maintenance. Air filtration

system are required in OPD, laboratories and ER spaces. Vent mount units are prescribed.

Please see attached document for specification.

DESIGN TRANSLATION

Functional zoning

Integration of various zones to provide more efficient service.

Integrate medical and non- medical zone.

Fire Zoning. Isolate high fire risk zone from high life risk zones.

Architectural space

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The facility would require provisions for increase social interaction. Facilitate interaction among patients, care providers, and family members.

a. Open space layout

b. Inclusion of centripetal activity spaces, Patient and non-patient spaces on 2nd floor

c. spacious inpatient accommodation, patient plus one

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Mood/Image: The therapeutic Environment should be made to make the outpatient visit as unthreatening and comfortable as possible, and to make the patient's experience more like going to a vacation than to a doctor's office.

incorporate plantscape in building design

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Enhance Spatial Transparency to promote visual stimulus.

Curtain walls

Circulation and accessibility

Vertical garden wall

The facility should make possible convenient circulation and access for mobility challenged individuals from zone to zone.

Multi axial core

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SITE DEVELOPMENT PLAN

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FLOOR PLANS

76

ELEVATIONS AND SECTIONS

77

ENGINEERING PLANS S

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PERSPECTIVES

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CONCLUSIONS AND RECOMMENDATIONS

Designing care facility for the aging population, whether it be hospice, hospital or

recreation facility, the challenge for the architect is to learn and understand the target users.

Designing a medical facility for geriatric patients is thus more challenging as it further

requires the architect to become aware of basic medical procedures and condition of target

users. Designing a geriatric hospital that is intended for integrated care requires knowledge

of both the needs and preferences of geriatric patients, and basic medical procedures and

condition. In addition to this, knowledge and understanding of the concept of integrated care

should also be understood and applied.

Integrated care pertains to incorporating positive and open attitude towards death and

dying by all patients and their families. Its primary goal is to improve patient’s level of

comfort by addressing their needs, including but not limited to psychological, spiritual and

social needs.

This study presented the state of Geriatric Medicine in the country by reviewing its

existing condition with relations to general users and the target users. This study also

identified social and spatial factors that are contributory in building an integrated health care

facility. Finally this study presented a design guideline in developing healthcare facilities for

the elderly.

It was realized that a project of this nature is viable to be built in proposed location as

it responds to specific needs of the target user population, such that the medical facility being

proposed is close to established tertiary hospitals, therefore has strong accessibility. It could

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also produce opportunities for facilities and resources sharing with the neighboring medical

and welfare facilities. The weakness however lies on the condition that the proposed project

is on intersections of main thoroughfares, hence the noise and pollution levels are quite high.

At the same time, expansion of the facility cannot go beyond what is already allotted as the

rest of the land is already devoted for transit.

The design of the facility relies largely in responding to the idea of integration of

functions to promote maximum care and comfort for patients and their carers. The design

was translated in a way where various zones are integrated to provide more efficient service,

increase and facilitate social interaction among patients, carers, family members and medical

staff. At the same time the facility is designed to promote therapeutic environment to make

the visit of patients unthreatening and comfortable, which promotes the idea that going to the

doctor is not an officious task.

BIBLIOGRAPHY

de Magalhães, Joāo Pedro, “What is Aging? Definitions and Concepts in Gerontology”,

www.senescence.info/aging_definition.html, 2012

Kagioglou, Mike and Tzortzopoulos. Patricia ed. Improving Healthcare through Built

Environment. Malaysia: Blackwell Publishing Ltd, 2010

Mccullough, Cynthia S. ed. Evidence-based Design for Healthcare Facilities. Indianapolis:

Sigma Theta Tau Harmon, 2010.

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Moussavi , Farshid. The Function of Form. Cambridge, Massachusetts: Harvard University

Press, 2009.

Schulz- Norberg, Christian. Existence, Space and Architecture. New York, Praeger

Publishing, Inc.

Philippine Daily Inquirer, “ Manila Water completes sewage treatment facility”, November

17, 2010.

Quezon City Government. (2008). Comprehensive Land Use Development Plan. Quezon City

p. 34

Sternberg, Esther M. M.D. Healing Spaces: The Science of Place and Well-Being.

Cambridge, Massachusetts: Harvard University Press, 2009.

Verderber, Stephen. Innovations in Hospital Architecture. New York : Routledge Taylor &

Francis Group, 2010.

Verderber, Stephen and Refuerzo, Ben J.. Innovations in Hospice Architecture. New York :

Routledge Taylor & Francis Group, 2006

_______. World health statistics 2010. Geneva, Switzerland. WHO Press. 2010

______. World Population Ageing 2009. New York. United Nations Publication