A Care Home Full of Heart and Soul

Charles Arnal, Senior Associate Director|
July 2022

Practising Empathy – An Experience in Immersive Design

The architect’s profession is deeply rooted in the ambition to serve people better, especially those who feel vulnerable in unfamiliar environments, among which the nursing home is an example. Together with the forward-looking team of St Joseph’s Home (SJH) and through an immersive design process, we as architects were able to create a new model of Nursing Home in Singapore, with care, love and faith at the very core. This is an account of the SJH design experience from inside out, which opened our eyes to the true meaning at the heart of a project and testifies that our work as architects can and should be as fulfilling and life-giving as this.

Before we embarked on the project, we, as architects, asked ourselves the following questions:

• What makes a Home? A family living together in a safe place, populated with familiar furniture, fixtures and friends. A place where residents feel a sense of belonging.
• What is nursing? Nursing is about improving the quality of life of individuals by providing appropriate care while helping to retain some level of autonomy and engagement.
• Who receives the care? Care extends to not only residents but also visitors, community and staff to facilitate bonding and emulate a sense of community.
• How can the architect shape the right home for this community to flourish?

The practice of empathy in design required us to watch and observe the people using SJH in detail. Our first encounter with the residents of SJH was in May 2014. It was a late morning and the pace of life there was slow. We stepped into a large green courtyard surrounded by a single-storey building. The materiality of the building was sturdy, with brick walls and terracotta roofs giving a strong sense of authenticity to the existing home. Inside the single storey building with a large roof overhang, and as we walked through the home, we found that it was punctuated with internal courtyards and day spaces filled with daylight.

Inside, residents, mainly wheelchair bound, gathered around tables in small groups, while others preferred to be on their own. Another group of residents who were bed-bound stayed in their bedrooms, although they were aware of the activity around them. Moving them out of their room was too challenging due to the bulkiness of their bed, so they were largely confined to the bedroom. There was an air of expectancy around, perhaps the residents were waiting for the highlights of their day – meal-time or organised activities. The nurses appeared alert and observant, having a precise schedule to follow.

In fact, we found that the religious sisters were always, but discreetly, present. They are the guardian angels of the home and make sure that all residents, including nurses, are well.

The majority of residents were wheelchair-bound, and even though the facility was a single-storey, the spaces and fixtures posed challenges to them. Some were making large detours to avoid a single step to access the courtyard. Another resident was trying to grab a glass of water by himself just like he would do at “home”. However, the sink was too high and the tap too far. Once successful, he left rolling on his wheelchair with the glass of water clamped between his legs. Even getting a glass of water was a challenge.

Essentially, we realised that small details like these were dramatically affecting residents’ autonomy and reducing their ability to take care of themselves.

Apart from observing the challenges faced by the residents, our workshops with the sisters and healthcare workers immersed ourselves in their daily operations: understanding how many residents each nursing team oversees; what challenges they face in space planning; what situations are prone to trigger resident’s anxiety; and what exactly is the condition and ability of different groups of residents.

While some residents are less mobile because they are wheelchair or bedbound, others may be more mobile but affected by dementia. The issue was how to keep them safe as they moved around. Together the healthcare workers and the design team developed the concept of “families” consisting of clusters of bedrooms at with a shared living room and pantry, with a view looking out to the central garden and chapel at the centre of SJH. We tested all nursing equipment to size the space properly but also focused on how to keep residents mobile without compromising their safety.

We had no idea how much energy, love and resilience was required in the daily duties of the care team, to continue giving care to the best of their ability. We also realised how taxing the work of healthcare workers are, when taking care of residents with dementia, as they may get agitated and distressed when they are unable to recognise their care-giver, often while bathing. These are daily traumatic upsetting experiences for them, as much as they are heart-breaking experiences for the nurses. We understood that they were caring and giving without conditions. We were moved to help them with better convenience and intuitiveness.

We understood it was critical for the new facility to become an enabler that enhances autonomy and movement for all while facilitating the delivery of care.

Bringing the Ground Level to Every Floor

In general, and despite the slow pace in the home, mobility appeared paramount to everyone. Some residents would go around continuously and enjoy doing so to pass the time. It was clear that the garden surrounding the chapel and courtyards punctuating indoor spaces were the main incentive to for residents to move around.

The redesigned SJH would need to provide opportunities for movement around each floor and help residents feel empowered. Widening the green spaces surrounding the home at regular intervals would also allow bedbound residents to be comfortably wheeled outdoors to enjoy the breeze – just like other residents. Offering them a variety of vantage points along this green journey would improve their daily routine and facilitate the work of nursing staff. The presence of greenery along corridors and the use of the right material to convey a sense of home would become crucial to shape a home that residents would hopefully connect with.

As we worked closely with the religious sisters who operate the home, we found that they were focused on the resident’s comfort and wellbeing. How to provide better care – This was the only thing that really mattered to them, and we were constantly inspired to help them as we immersed ourselves in the process of designing SJH.

Having built such a level of empathy through the early design workshop process, we gravitated towards the choice of a terracotta façade as an effective way to pay tribute to the memory of the original place while sustaining the idea of “home”.

Putting the Dignity of the User First

The most memorable feature of the redesign was to raise the profile of one specific room in the new home.

The room that other nursing homes might typically call the “last room” – usually one hidden away at the back of a home where a deceased resident is housed while awaiting funeral arrangements – is placed beside the main lobby at the entrance to SJH.

Named the Peace Room, this room is given a dignified yet discreet space in the main entrance of the SJH, signifying there is dignity in death. It is the belief of the religious sisters that as all residents of the home enter from the front door, they should eventually leave from the same door too.

The idea of a home away from home became even stronger when we realised that SJH was not only a home for elderly residents receiving care but also for the religious sisters and nursing staff themselves. At level 1, the sisters’ accommodations required total privacy and some open space for gardening while the rooftop at level 6 would house staff dormitories and recreational spaces. Levels 2 to 5 were allocated to elderly residents. We found this proximity between the accommodations of sisters, nurses and residents meaningful since it was representative of a model of care that celebrates dignity and respect.

Staying Connected Through Faith and a Shared History

When we began considering a multi-storey building for the new home, we realised that disconnecting residents from the ground-floor green courtyard was the biggest threat to the original character of SJH. It was not ideal for residents, who would now live on the upper floors, to feel detached from the greenery on the ground.

Hence, we reimagined a courtyard that would stretch to every floor, imparting to residents the feeling of still being connected to the ground. Every floor would then feel like a ground floor, allowing residents a view out to the chapel like they used to. The design communicates the value of being grounded in strong connections – to the land, to the chapel’s rich heritage, and to the religious faith of this community.

At the same time, the multi-story building would need to remain at a human, friendly and intimate scale. From what we have seen and learnt through design workshops with the clients, we designed for rooms to be clustered and screened for privacy, with each cluster grouped around a living room which opens to generous plant boxes and framed views of the chapel. We called each of these clusters a “family”.

The religious sisters always saw the home as a welcoming place for community, friends and volunteers. The home and chapel are strongly anchored in the community around and visitors represent a source of energy that energises residents. At the heart of the home is a childcare centre, which is open to the nursing staff and neighbouring community, and a playground where residents and children can mingle and participate in daily activities.

Overall, the team also aimed to design for community, mobility and dignity. First, the team incorporated and strengthened the existing chapel as a beacon for the whole redevelopment. We also maximised the natural ventilation, day light, and sun shading by orientating every ward at an angle determined by the prevailing winds and sun-lighting.

From a home with over 100 beds, SJH had 412 beds after it was redeveloped into a person-centred space for nursing, hospice care, therapy and even community services for people of all races and religions.

Despite the greater built-up area, the result is a home-like environment with wide corridors for easy mobility. Terracotta screens provide privacy and natural ventilation. The access to plenty of greenery also reduces stress levels for residents and the staff at the home.

A Genuine and Respectful Partnership

At our project kick-off meeting, the religious sisters welcomed us with warm smiles and greetings. Our design proposal was placed on an easel with a candle lit in front of it. We prayed before starting our meeting and we were told that SJH’s team had fallen in love with our proposal.

We were greatly humbled by this unusual warmth and expression of a client, which inspired us to put our hearts and souls into the project. Respect and love fuelled every step of the project development until completion.

Closing the Loop of the Immersive Design Journey

After handing over the new home to the care team in 2017 and residents started to move in, we received an invitation from Sister Geraldine, the Executive Director of St Joseph’s Home, to stay overnight and get a first-hand experience of the building.

On top of being incredibly mindful and generous, this invitation was a precious opportunity for us to close the loop of our Immersive Design journey.

Upon arrival, we observed how quickly the care team had personalised some of the living spaces bringing life and vibrancy in the interiors. The previously bare dining space was now equipped with al fresco dining décor, adorned with faux bricks, vivid colours, topped with decorative awnings and surrounded by artificial plants.

In other spaces, columns were wrapped with colourful ribbons and circular paper folded origami, while multicolour garlands and other pom-pom crafts appeared hanging from the ceiling.

Our architects’ mind being naturally drawn towards minimalist and sleek spaces, we were initially surprised. However, we quickly understood that this was the process of creating elements of a relatable domestic environment for the elderly residents to integrate and adjust back into living in the new building. In fact, we were spectators of something beautiful as it had successfully become a Home.

This experience taught us a lot about the user perception of the spaces we create, and that good design goes beyond a photogenic magazine-worthy minimalist space. The beauty and sense of affection that good architecture can impart to its occupants also comes from the successful and intuitive personalisation done by its users – who ultimately are the ones who give ‘home’ its true meaning. Home is where the heart is.

Project:
St Joseph’s Home

Location:
36 Jurong West St. 24, Singapore 648141

Size:
22,054 sqm

Status:
Completed 2016

Client:
Catholic Welfare Services Singapore

Services:
Nursing home

Collaboration:
BES Technologies (Hydrotherapy Pool design advice)

Project Lead:
Chan Chee Lun

Project Team:
Michael Leong, Chan Chee Lun, Charles Arnal, Darryl Toma

This article first appeared in SEEDS Journal, an architectural publication and thought leadership platform by the Surbana Jurong Group.