The Hidden Power of the Environment in Palliative Care
By Sepehr Pandsheno
As an urban planner, I’ve always known that our surroundings shape the way we live. But seeing their impact on people at the end of life made me think in a new way.
Given the primary function of hospice buildings, when we hear about them, the last thing we might think of is their environmental features, visual aspects, or surroundings. We often assume that those in the final stage of life simply need a place to be. In a way, we are all in the same situation—perhaps in the final stage of our own lives. The only difference is that they know it, while we do not.
I remember standing on the balcony of a hospice, talking to one of the residents. They looked around, sighed, and said, "You know, I haven't seen a single tree from here. Not even a patch of green. All I see is concrete." Their words stuck with me. It wasn’t just an observation—it was a deep longing for something simple yet essential: a connection to a more thoughtfully designed space.
This made me wonder: how much does the physical environment affect people in palliative care? For many, a hospice is their final home, and the way these spaces are designed can greatly impact their comfort, mood, and sense of dignity.
Why the Environment Matters in Palliative Care
Stephen Verderber and Ben J. Refuerzo, in the “Innovation in Hospice Architecture” book, emphasized that a well-designed space can help reduce stress, ease pain, and improve emotional well-being—especially in palliative care. Factors such as lighting, noise levels, spatial arrangement, and personalization of rooms play a critical role in creating a supportive environment.
A recent study under the Aging in the Right Place (AIRP) framework examined the environment of hospices that serve older adults who have experienced homelessness. While these places aim to provide compassionate care, they often lack important design features like privacy, autonomy, and sensory comfort. Many residents - like the one I spoke to on the balcony - spend their days in cold, institutional spaces that feel impersonal and detached.
More Than Just Green Spaces
When we think about improving hospice environments, it’s easy to focus only on adding greenery. While nature plays an important role, environmental well-being is about more than just having a view of trees. It includes aspects like noise control, accessibility, natural and artificial lighting, air quality, and the flexibility of spaces to support both social interaction and personal retreat.
Some hospice buildings may have balconies or patios, but they often overlook busy streets or blank concrete walls, making them uninviting. Similarly, harsh artificial lighting and constant background noise from medical equipment can contribute to stress rather than ease it. How can we expect people to feel a sense of peace when their surroundings are sterile, loud, or visually overwhelming?
Designing Spaces for Comfort and Dignity
To improve hospice environments, we need to rethink their design holistically. The AIRP-Hospice Environmental Assessment Protocol (AIRP-HEAP) offers key principles to enhance end-of-life care. This includes creating personalized spaces where residents can bring personal items, artwork, or photos to foster a sense of home. Thoughtful lighting and sound design also play a vital role—balancing natural and soft artificial lighting while minimizing disruptive noise helps create a soothing atmosphere. Ensuring privacy and autonomy by giving residents control over elements like lighting, airflow, and room layout contributes to preserving their dignity. Additionally, incorporating multi-sensory comfort through soft textures, calming colors, and peaceful sounds supports both emotional and physical well-being. Finally,designing flexible spaces that allow for both social interaction and private retreat helps meet the diverse needs of each individual.
Looking Ahead
As cities grow and space becomes limited, we have to ask: Are we designing care facilities for efficiency, or for human well-being?
The resident who longed to see something other than concrete was not alone in their feelings. Their words highlight a larger issue: the way we overlook the power of the environment in care settings. Improving these spaces isn’t just about better design—it’s about respect and dignity. If palliative care is truly about providing comfort, then the physical space should reflect that mission.
That conversation on the balcony stays with me as a reminder: sometimes, care isn’t just about medical treatment—it’s also about the spaces we create for people to truly live, even in their final days.