Hospice of St. John

Material Information

Hospice of St. John thesis project
Kaufmann, Debra
Publication Date:
Physical Description:
81 pages, [8] leaves : illustrations, maps, plans ; 22 x 28 cm


Subjects / Keywords:
Terminal care facilities -- Designs and plans -- Colorado -- Wheat Ridge ( lcsh )
Terminal care facilities ( fast )
Colorado -- Wheat Ridge ( fast )
Designs and plans. ( fast )
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )
Designs and plans ( fast )


Includes bibliographical references (page 81).
General Note:
Submitted in partial fulfillment of the requirements for a Master's degree in Architecture, College of Design and Planning.
Statement of Responsibility:
Debra Kaufmann.

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
08815391 ( OCLC )
LD1190.A72 1982 .K38 ( lcc )

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The thesis project represents the culmination of an educational and personal experience. The selection of an appropriate topic to satisfy the goals and needs which I have defined for myself was a process which required careful thought and investigation.
Design of the Hospice of St. John answered my desire for a thesis with great human and psychological implications, as well as providing the design opportunity for some very special architecture. The way death is handled in our present day civilization has always frustrated me, it seems that we have become so separated from this natural process through technology that we can no longer deal with it in a healthy, loving fashion.
The hospice answers society's current need for a support facility to ease the process of dying for the terminally ill, as well as for their families and loved ones. In order to be admitted to the hospice, one must be diagnosed as having less than six months to live, and no patient is admitted until he or she is beyond curative measures. The goal of the hospice program is the palliation of symptoms so that patients can live out ther lives as comfortably and meaningfully as possible.
The opportunity to learn and understand about hospice is one I feel very lucky to have experienced. Without the help of Father Paul von Lobkowitz, of the Hospice at Georgian House in Lakewood, Colorado, this would not have been possible. Father Paul hopes to one day build a freestanding inpatient hospice, and my project attempts to program and design this building of the future.
I see my role as an architect as the designer of a space which provides ammenities allowing the highest quality of life possible to occur. My goal is not to create a place for death and dying, but an environment for life and living.

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"No people who tain theaA backs on death can be aJLLve."
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The concept of hospice dates back to the years before the first Crusade of 1099, when pilgrims and soldiers flocked to the Holy Land to earn indulgences, perform penances and chase away infidels. Christian traders established a mission near Jerusalem to offer hospitality to weary travelers. After the first Crusades were launched, the Christian mission, operated by Benedictine monks, was quickly transformed from a mere hospitality house to a hospital. Out of this was born the Sovereign Hospitaler Order of St. John of Jerusalem.
The Hospitalers were comprised of knights who took holy vows and when the situation demanded it, also took to the battlements to defend their faith. Although the Christians were eventually driven out of Jerusalem by the resurging Moslem horde, the Hospitalers found their way to Rhodes and later to Malta, where they still maintain their headquarters. Iheir members are known as the Knights of Malta.
Over the centuries in spite of the interruptions caused by the various Holy Wars, the order maintained its goal of attending to the sick, especially the dying. In 1597 it established on Malta the largest hospital in Europe. By the mid-nineteenth century, the philosphy of caring for the dying had spread. A group of Catholic women established a hospice in Lyons, France. About the same time the Sisters of Charity established a hospice in Dublin. By the turn of the century three other hospices had bee^ established in London, all by religious groups.
The early hospice was designed with the utmost concern for its patients and their families.
The hospice was located in the very center of town, immediately adjacent to the market place, so accessibility to visitors was easy. A pharmacy in the hospice was available to inpatients, outpatients, and citizens of the town. Both these features promoted the interaction of patients with the ongoing world, and decreased the separation and stigma associated with dying. To answer the special emotional needs of the dying a beautiful courtyard within the hospice walls was provided, a place in which many -patients undoubtedly found quiet and solace.
It is only in the past few decades that the hospice concept has moved to America. There are perhaps a dozen traditional hospices in the country, run by various organizations.
Most are centered in a hospital or a nursing home, though the ideal, as in Europe is to have a free-standing independent building.

America is unquestionably one of the most death denying societies in the world, but dying, like birthing is hardwork and in most cases is a process requiring assistance. The structure of American society no longer provides the framework for this assistance. Rural America was characterized by family and close friends who would care for their own sick and dying. After death, family and friends would gather in the home to pay their last respects, say their final goodbyes, and comfort the survivors. One reason we have so much trouble grieving is because we no longer have a strong community support system to turn to in times of need.
Since the popularization of Elisabeth Kubler-Ross's On Death and Dying there has emerged a flood of work and research into the needs, rights and care of dying persons throughout all quarters of society. It may be coincidental that during the same time period of about ten years, there has been critical public and governmental concern about the spiraling cost of medical care in the United States. In traditional settings in which dying persons ordinarily receive the last phase of care during illness there is a high incidence of unwarranted, excessive use of extreme or heroic means, inhumane emplymerit of 1 ifg support systems and undue prolongation of life.
Hospitals are geared to cure patients, to give efficient rather that individually optimized care. To the medical profession the dying represent failure, and once a patient has been labeled incurable there is a tendency for physicians and nurses to become more and more neglectful. Many persons who would have died earlier have prolonged periods of terminal misery precisely
because excellent medical care is available.0 Every person should be accorded the right to 'idie alive', not hooked up to tubes and wires. We must realize that healing does not necessarily mean making the body well.
People dying in hospitals complain that much of their misery is due to the fact that no one ever listens to them. Doctors are preoccupied with saving lives, clergy don't want to stick their noses in medical business, and family members may also withdraw, uncertain what to do other than leave the terminally ill person alone in a dark and haunted corner of dreams and drug imagery, which is real suffering. Families are often excluded unwillingly from intensive care units, withdrawing valuable support when it is most needed. Two of the most common signs of family life are children and animals, around them great affection centers. Unfortunately, the presence of both are discouraged in the hospital. In the terminal situation, the family is as necessary as any other form of care.
Care of the family and bereaved is an area also generally ignored by the hospital. The moment of death is a signal to the patient's family and the hospital staff to part company. In hospice this becomes a critical time when attention is even more strongly focused on the needs of the survivors.
Nursing homes are also an inapproporiate place for the terminally ill. Care for the elderly is essential, but for the 50% of those patients suffering from cancer who are under sixty-five years of age, the nursing home environment is inappropriate. If you have six months to live, you do not want to spend them with confused incontinent people. Anger and uncalled for

stress may result, and the same possibilities to contemplate and come to terms with death are not available.
A common clinical problem is how to persuade a patient who recognizes that his or her life span is limited to engage in pleasurable activity. Although modern hospitals have emphasized making physical facilities more attractive, they tend to ignore the patients personal sources of pleasure. In most hospitals the opportunity for pleasurable activity is usually limited, highly routinized and quite peripheral to the therapeutic program. If the afflicted person is not to become an object, dying must be assimilated and made a part of the life that remains. The act of dying must be both human and humane. To be humane, all who assist, aid and collaborate in the act must provide what is necessary to make the last act a truly human one- to relieve pain, listen, provide those things that have meaning for the dying person, and permit him or her to make the decisioriSgOn how, when and under what conditions to die.

Hospice differs from hospital and nursing home environments in that it focuses on caring for the sick by striving to enable the individual to live as fully as possible for whatever remaining time he or she has left. The National Hospice Organization states its philosophy of hospice care as follows:
Dying is a normal process whether or not resulting from disease. Hospice exists neither to hasten nor to postpone death. Rather Hospice exists to affirm "life"- by providing support and care for those in the last phases of incurable disease so that they can live as fully and comfortable as possible.
The goal of hospice care is to provide acute treatment of the patients and their family as a total unit, and as total persons, emotionally as well as physically. Father Paul von Lobkowitz of the Georgian House Hospice in Lakewood describes hospice as "a place where you go to live as long as you can, as comfortably as you can. Instead of burning up one's last energy in a continual trauma over staying alive, in denying the inevitable, the patients are encouraged to come to terms. With God perhaps, with themselves at least. Maybe both. The goal is the elimination of fear".
And indeed, careful listening to those is the stages of terminal illness reveals that people do not fear death as much as they fear dying.
To die alone, and in pain is a nightmare that no one deserves to have. A major component of hospice care is the expert management of pain and other symptoms. Hospice personnel and other sources of comfort are available whenever needed.
But perhaps the most unique support system of the hospice is among the patients themselves. For who can understand what it is like to face death better than the person in the next bed?
Bereavement services for the family of the deceased is a very important function of the hospice. It is often difficult for families to confront the reality of a loved ones death, and the hospice staff seeks to aid in this acceptance process by providing a supportive environment after a death has occurred; by listening, caring, and counseling the bereaved if it is requested. The family may also need assistance with some of the confusing details of insurance. Medicare, Social Security, will and estates, and taxes. This can be handled in small classes specifically designed to deal with the problems of survivorship.
There are three forms of hospice programs; the traditional inpatient hospice, home hospice care and an intermediary day or part-time form of hospice care. All seek to meet the needs of the individual family.
The daycare program meets the needs of those dying persons who are not well enough to be left alone, but are capable of traveling to an inpatient hospice during the day while their spouse or primary caretaker is at work, or otherwise occupied. In this type of program, the support system and pain control capabilities of the hospice may facilitate the needs of many more persons than the bed capacity of the building allows for.
The home hospice program attempts to go back to past times, when it was a natural phenomenon to die at home. It seeks to supplement the family or community structure that once existed

in our society for the majority of people. In order to be accepted for the home hospice program, it must be established that there are available at least two primary caretakers for the dying person. It is unfair, and unhealthy to place the burden of care on one person's shoulders, as care for the dying is a twenty-four hour a day job. Fatigue and stress results in this situation, which is certainly detrimental to the caretaker, and does not help the dying much either.
There are many factors to be considered in the decision to die at home. If there are children in the family it may be a growth experience for them to witness a death, if they are capable of dealing with what is happening- but it also may be a terribly difficult situation to cope with. Also, if the primary caretaker is attempting to care for small children as well as the dying individual, the task may be too great.
Another consideration is the aftermath of a death. If the terminally ill person is moved to a hospice, it allows the survivor to begin the process of living alone and adjusting to the inevitable separation. It may be very difficult to continue living in a house in which a loved one has died, as well, and is a factor which requires serious thought.
The capacity of the caretaker to cope with the medical side of support for the dying is also important. Most people would not know what to do if the dying person began to hemorrage or choke, and then ultimately how to handle the momment of death. No matter how well prepared one thinks they are, the natural reaction seems to be to say no, this can't be the end, and to call 911.
The home hospice care program aims to help terminally ill patients die peacefully at home. A visiting nurse is committed to help each family and meet the special needs of pain control, and emotional support. The nurse schedules a part of every week to relieve the primary caretaker from the responsibility of care, and is available on call to the family in time of need. A volunteer program also supplements home hospice care.
To be involved in any part of hospice care requires a special investment of self. Dying is an event that asks us to be present for one another with heart and mind, bringing not only practical help as necessary, but also attentive awareness and appreciation of the individual involved. At its finest it elicits from us the frankly and fully offered human companionship that brings positive benefits and a kind of joy to any shared venture.

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interior iSttace
"The. hoi pice concept ii motie tho.t bnlcki and mo titan.. A good building can make a diflflenence to the backi and fleet ofl the itaflfl, and to the ipinlti ofl everyone involved. Beauty it> very healing."
Vn. Cicely Saundeni St. ChrU&topheAA Hoi pice,

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Above all, the hospice must be a secure and supportive environment for patients and families of the dying, which helps them to adapt to what they will be facing, and to deal with their fears The patient seeks to adopt the hospice emotionally as a temporary home, when the atmosphere is warm and friendly, feelings of security will develop.
Anti-anxiety treatment should begin outside the hospice. Pleasant driveways and interesting landscapes may set the stage for a less ominous environment, and visual access to patios with activities in progress can lessen fears and apprehensions to a greater degree.
The positive qualities of living should be stressed within the institutional environment, and every effort should be made to create a warm, homelike setting. The furniture, selection of colors and interior design should communicate that hospice is a setting for living. The environment should also reflect the involvement of family members.
The special needs of hospice patients must be taken into account in design of the building.
In the last stages of terminal illness energy levels tend to be low, and the building must permit the greatest independence of movement possible. Many patients will be wheelchair bound, or bedridden and any degree of selfsuf-ficiency is extremely important. Patient control of the environment is desirable, air changes, temperature, and lighting requirements will be individually interpreted. All door openings should be wide enough to allow beds to pass through, and social spaces should be' large
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enough to accomodate several beds.
Hospice design must permit both privacy and communality. When the dying person wants to be alone, or be with people, that option should be available. It can be provided by having private or shared rooms in conjunction with family rooms where the person can retreat from the 'sick' room environment to a living room or sitting room furnished in a homelike manner, having both warmth and comfort. One of the most important activities of hospice patients is receiving visitors. The patients rooms must have adequate space for several visitors at a time, which means the rooms must be larger than the standard minimum which allows for an uncomfortable three foot clearance around the bed.
Personalization of patient rooms should be encouraged. Display of personal belongings can be inivited by windowledges, shelves and tackable wall surfaces. There should be open floor space for a favorite chair, and even beds from home may be substituted if the patients comfort is enhanced.
Staff needs must also be met in order to moral and high quality care to be maintained. The nursing station should be within eye and ear shot of as many rooms as possible, to save steps and energy. Staff lounges play an important part in avoiding burnout and providing an area of escape where stress can be released and support groups can form.
Providing visual access to the outdoors adds much to the comfort of patients. Ceiling to floor glass permits a better visual scan of the out of doors from bed or chair. If there are patios, plantings, or birdfeeders provided there

will be a variety of interesting attractions to watch, especially important to the bedridden. Being in close contact with the earth and nature is comforting and healing, and increases opportunities to spend part of the day outdoors if weather permits.

Programming the building was a major portion of prethesis preparation. Two design studios which had an emphasis on programming prepared n\y for this task.
The information was gathered through a series of interviews with Father Paul von Lobkowitz, the client for the project who has some very deffin-ate ideas about the buildings composition. Observation of the existing hospice at Georgian Mouse and interviews with other staff members supplemented Father Paul's suggestions. Research into building standards and some of the many books written about hospice care helped to tie things together, and the following program is the result of n\y analysis.
Summary of Program:
Name of Room___________________Square Feet
1. Patient Room (Double Occupancy) 5,250
15 units, 350 sq. ft. each
2. Patient Room (Single Occupancy) 2,200
10 units, 220 sq. ft. each
3. Family rooms 2 units, 400 sq. ft 800
4. Lobby 200
5. Dining Room 2,500
6. Kitchen 300
7. Dietary Office 100
8. Living Rooms 2 units 400 sq. ft. each
Name of Room
Square Feet
9. Chapel 1,000
10. Chaplain's Apartment 400
11. Therapy/Screaming Room 140
12. Recreation/Occupational Therapy 600
13. Occupational Therapists Office 100
14. Physiotherapy 400
15. Nursing Station 200
16. Director of Nursing Office 250
17. Staff Lounge 550
18. Linen Storage/Clean & Dirty Utility 350
19. Laundry 250
20. Patient Laundry 144
21. Conference Room 500
22. Executive Director's Office 170
23. Administrators Office 140
24. Volunteers Office 200
25. Doctor's Office with Exam Room 240
26. Front Office/Reception 250
27. Outpatient Care 400
28. Basement Storage
- H.I.H

Name of Room
Square Feet
29. Public Restrooms & Janitor's 450
30 (Mechanical & Circulation 0 20% 3,777
TOTAL 22,551
Additional Spaces 1. Guest Cottage 500
2. Dog Kennel 135
3. Parking 7 Handicap Spaces 26 Regular Spaces 9,920

PATIENT ROOM, Double Occupancy, With Full Bath
7 square feet of wheelchair storage, closet deep enough for chair 4 square feet personal storage for each person 50 square feet for handicap accessible bathroom call light to nursing station
# units;
15 rooms if
room: 300 sq. ft" bathroom: 50
total sq. ft.:
Recieving visitors is one of the most important events, enough space provided for family to gather.
Primary space for patient, place for personal reflection, anger, depression, anxiety, grief and joy.
Nursing station less than 120 feet away
Linen storage
Quality of Environment
Allow for personalization; own furniture, pictures, plants to be brought in
Special attention given to preference for shared or private room
Variable lighting, under patient control
* Shared rooms give each patient the opportunity to watch another die, this is an effective rehearsal for one's own death and may alleviate a patients anxiety about his or her own death.
Schematic Representation
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PATIENT ROOM, Single Occupancy with Bath To answer the need for special privacy, as in the instance of a married or similarly related couple. Possibility for a double bed. # units: 10 rooms 1 room: 170 || bath 50 1 total sq. ft. : 220 1
Activities Adjacencies I
Same as for double room.
Quality of Environment
Similar to double room, with increased privacy
Schematic Representation

§ FAMILY ROOMS, Hide a bed, kitchenette, dining area # units : two rooms
400 each
total sq. ft.: 8oo
j Activities Adjacencies
For overnight stay of visitors Family meal preparation and dining ; Private gathering space for family, no staff allowed unless invited. Possible direct access to j patient rooms i
Quality of Environment
Schematic Representation
As homelike as possible
Eating around a table is one of the symbols of family life, allows the family to continue involvement in the care of their loved one,

LOBBY, not a waiting area, but a transition/parlor space Bulletin boards for information
# units =
This one entrance is for everyone, people will not be given the sense that they will be hidden.
Information and reception Additional living room space
Quality of Environment
The manner in which a patient is received when entering the hospice may have a profound effect upon his or her perception of being welcome as a human being or as only the bearer of a disease to be treated.
total sq. ft.: 2flo Adjacencies
Reception office
Visual access to public parts of facility
This should be a transition space which helps to psychologically ease the patient into the hospice

Family-like table arrangements, separate for staff and patients Seating for wheelchair users should be at least 2'-6'* on center Tables should be 3-6" wide if chair users are to face each other.
Everyday meals and special gatherings
# units:
total sq. ft. 2,
Ki tchen
Dietary Office
Quality of Environment
Mealtime is one of the few things these people have left, what is served, how and where may be of single importance to the welfare of sick persons. There are almost no important human events which are not given their power and expression through food and drink.
* The space should be broken up into more intimate dining areas rather than as a vast cafeteria.
Schematic Representation


Meal preparation, food storage, cleanup
Dining Area Dietary Office
Quality of Environment
Schematic Representation

DIETARY OFFICE, for use by Dietary Supervisor
# units:
total sq. ft.:
Ordering of food and supplies Preparation of menus
Dining Room
Quality of Environment
Schematic Representation

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LIVING ROOMS, two, with fireplaces # units: two 400 each
to seat 15 in each
number of air changes increased to avoid hospital odors total sq. ft.: 8oo
Activities Adjacencies
Relaxation, T.V. watching, Fire gazing, conversation Patient Rooms
Outdoor space
Qualify of Environment
The most successful spaces allow people to break into groups.
The fireplace will help to draw people together and when it is burning, provide a counterpoint to conversation.
Schematic Representation

1 CHAPEL, divided into three parts; sacrament chapel (Roman Catholic) ecumenical chapel, meditation chapel (non-ecumenical), which are able to become one space for special functions Able to accomodate hospital beds, closet to contain vestments Stained glass windows, 7' center aisle to accomodate funerals # units: total sq. ft.: iooo
Activities Adjacencies
Contemplation, prayer Chaplain's apartment
| Should be easily accessible to patients
| Quality of Environment Schematic Representation
pi Special attention given to the quality of light |j This space should have a feeling of availability without religious pressures |j For use by patients, staff, and family - p ~

CHAPLAIN or DIRECTOR'S APARTMENT, bedroom, sitting room and dinnette, bath
# units:
total sq. ft.:
Provide for the availability of a support person 24 hours a day. Sitting room functions as a homelike counseling space.
Quality of Environment
Homelike as possible
Feeling of privacy for occupant and visitors
Schematic Representation

| THERAPY/SCREAMING ROOM, Counseling room with daybed, comfortable chairs For staff or patient use # units total sq. ft.: 140
1 Activities Adjacencies
w Counseling, private release of anger and anxiety
| Quality of Environment Schematic Representation
Visible nature played down Sound insulated, private feeling 111 f*I'lifilfj^,; 11 If^fHlf^f

RECREATION/OCCUPATIONAL THERAPY, walls lined with cupboards and counters | craft tables, sink and cleanup area J Handloorns, potter's wheel, painting equipment | leather working tools, woodworking tools, # units:
| sewing machines total sq. ft. 6oo
| Activities Adjacencies
| Pleasurable activities to pass time, fulfill creative and expressive needs of patients | Social and physical support in terms of creative actions ( Occupational Therapist Office 8
Quality of Environment Schematic Representation
Workshop feel to it, patients and staff should feel free to come in and work at their own choosing

Quality of Environment
Natural light desirable
Schematic Representation

PHYSIOTHERAPY, exercise space, examination and massage space, hydro and heat therapy area parallel bars, exercise whell, treatment tables with pads 3'x 6 whirlpool, bathtubs
Exercising, treatment and training in ambulation and activities of daily living, use of water movement and heat as massage
Schematic Representation

hub of patient medical care, writing desk, legal files,
cabinet storage area, outlet for nurses call system
lockable drug storage, supply storage
minimum of 6 lineal feet of counter
chart rack for 40 charts (41 wide x 16" deep)
# units:
total sq. ft.:
Control of nursing unit, charting communications, storage of supplies Monitoring of patients
less than 120 feet from patient rooms Janitorial closet Linen closet
Director of Nurse's Office
Quality of Environment
Schematic Representation
Visual and physical access to patients

DIRECTOR OF NURSES'S OFFICE, shared with assistant # units:
total sq. ft. : 250
Activities Adjacencies
Administration of proper care procedures Nursing Station p
Quality of Environment Schematic Representation §
Natural light desirable

I STAFF LOUNGES, escape, relaxation, and changing area men and women's locker rooms with shared lounge and 1 restrooms 22 SW 1 # units: Bath/Locker 175 each sex Lounge 200 total sq. ft. : 550
1 Activities Adjacencies
i Changing clothes, storage of personnal items, relaxation, socializing Removed from major patient areas
Quality of Environment
Feeling of privacy, removed from patieBt areas Staff needs this time to themselves in order to release emotions, and recharge
Schematic Representation

LINEN STORAGE CLEAN AND DIRTY UTILITY ROOMS Clean Utility: 12 ft. minimum work counter with back splash, instrument sterilizer, 2 sinks, drawers and cabinet storage Soiled Utility: Clinical sink bedpan flusher, work counter, waste receptacles # units: Linen: 150 Utility: 100 eacl total sq. ft. : 350
Activities Adjacencies
The nature of terminal illness precipitates frequent linen changing and clean up. Storage and assembley of supplies, and cleaning of equipment will occur in these spaces. Patient Rooms Nursing Station tg
2 Quality of Environment Schemaiic Representation I


LAUNDRY, washing machines and dryers, storage 12 washers and dryers sound proofed or removed from areas where noise generating equipment would be disturbing # units: total sq> ft.: 250
1 Activities Adjacencies
j| washing, drying, storage of linens, dressing gowns, patient clothing Removed from social areas
Adjacent to other services
| Quality of Environment Schematic Representation

PATIENT LAUNDRY, coffee area, 2 washers and dryers, water hookup and drains # units:
total sq. ft. : 144
Opportunity to do one's own laundry, social space as well
Patient Rooms
Quality of Environment
Schematic Representation

Quality of Environment Schematic Representation |
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EXECUTIVE DIRECTORS OFFICE, full height storage closets, pegboard # units: total sq. ft. 170
Activities Ad jacencies
Coordinate hospice programs, work closely with staff on hospice care Provide individual counseling ( Centrally located
Quality of Environment
Schematic Representation
Very visible office, easily assessible to patients and staff


ADMINISTRATOR'S OFFICE, desk, file .space, space for visitors
# units:
total sq. ft.:
: 140
Works 8 to 10 hours per day Responsible for facility organization
Front office/reception
Quality of Environment
Schematic Representation

VOUNTEERS OFFICE table, chairs, lockers for personal items # units: total sq. ft.: 200
Activities Adjacencies
Lounge, meeting area, place to leave personal belongings Removed from patient areas Staff lounge
Quality of Environment Schematic Representation |
Private space where volunteers can get away


DOCTOR'S OFFICE WITH EXAM ROOM, desk chair, file space, exam table,
changing area, counter with storage
# units:
office: 100 exam: 140
total SC|. ft. : 240
Examination and decision making concerning medication and patient care
Doctor's Office
Quality of Environment
Pri vate
Schematic Representation
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j lamp
writing desk


FRONT OFFICE/RECEPTION, two desks, file space for records
# units:
total sq. ft.250 Adjacencies
Reception, record keeping, billing
Admi nistration
Quality of Environment
Schematic Representation
Lockable space

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OUTPATIENT CARE, lounges similar to living room spaces, with storage for personal items, to accomodate 10 people
SQ. FT. # units:
Integrated with regular hospice duties, but patients only spend part of the day at the hospice
total sq. ft.: 400 Adjacencies
Living Rooms Occupational Therapy Dining Room
Quality of Environment
Schematic Representation

BASEMENT, storage for hospital furniture replaced by patients personal items preferably rarnped to ease movement of furniture # units: total sq. ft.:
Activities Adjacencies
Movement of furniture in and out of hospice, and in and out of storage. Patient Rooms Exterior Loading Area
Quality of Environment

GUEST COTTAGE, living room with fold out bed, kitchenette, dining area bathroom
call light to nurses station
# units:
total sq. ft.:
Family gathering space removed from hospice building, but within earshot if help is needed.
To be used for limited time periods.
Quality of Environment
Private, removed from hub of hospice life
Schematic Representation
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DOG KENNEL, to accomodate four dogs, enclosed shelter with exercise space workroom for food prep and cleanup compartments for each dog 5 x 5, dog runs 5'x 15'
# units:
Building: 135 Yards: 300
total sq. ft. : 435
Boarding of patient pets during their stay at hospice
Quality of Environment
Shade trees for summer cooling, stove to provide heat in winter
If possible kennel should not be built where neighbors or hospice patients can be annoyed by barking at night
Schematic Representation

PUBLIC RESTROOMS, JANITORS CLOSET, storage and cleaning of house equipment
# units:
Restrooms: 400 Janitor: 50
total sq. ft. : 450
Public areas
Quality of Environment
Schematic Representation

i PARKING, 26 spaces plus 7 handicap spaces, H units 33
total sq. ft. : 9.920
Activities Adjacencies
Parking lot is the first place visitors experience. It is the gateway to the building. It should provide a transition area which allows for the mental preparation involved in visiting dying persons.
Quality of Environment Schematic Representation I
Pleasantly landscaped, protected from elements either by landscape buffer or construction



volunteer office j
t herapy rooms
patient rooms
C7iiterior SpacecRe[aLion$fiij.K
nursing station

Daylighting is a dynamic phenomenon. In the hospice design it is particularly important, not only because it is more healthful than artificial light, but also because it accentuates the passing of time in a palpable way. Knowledge of time and surroundings ties the patient and family to the outside world and it's rhythms.
Good daylighting design does not simply mean large windows. It must be approached both quantitatively and qualitatively on broader and more sensitive design terms. Daylighting seeks optimum amounts and areas of natural illumination for biological needs and tasks. The impact of heating and cooling must be addressed in conjunction with lighting, and trade offs made appropriate to location and time. Since the hospice falls midway between a load dominant and a skin dominant building, a great deal of solar gain will not be desirable, but natural light will be a key design factor.
Glare needs to be controlled to ensure that light will be comfortable and pleasant, as well as adequate in quantity. Appropriate surfaces need to be illuminated to dispel the perception of gloom.12 if the places where light falls are not the places you are meant to go towards, or if the light is uniform, the environment is giving information with contradicts its own meaning. It will be desirable to create alternating areas of light and dark throughout the building, in such a way that people naturally walk toward the light, whenever they are going to an important place.
A Buddhist monk lived in the high mountains, in a small house. Far, far away in the distance was the ocean, visible and beautiful from the mountains. But it was not visible from the monk's house itself, nor from the approach to the house. However, in front of the house there stood a courtyard surrounded by a thick stone wall. As one came to the house, one passed through a gate into this court, and then diagonally across the court to the front of the house. On the far side of the courtyard there was a slit in the wall, narrow and diagonal, cut through the thickness of the wall. As a person walked across the court, at one spot where his position lined up with the slit in the wall, for an instant, he could see the ocean. And then he was past it once again, and went into the house.1^
The view from a building is a major asset to the quality of life it allows for. The site for the hospice was selected in part for the exceptional views it has to offer, of the mountains, and a small pond across the road.
My hope is that these views may enhance the patients stay in the hospice, and provide an opportunity for contemplation and reflection, or distraction from their inward state of mind.
Interpretation of the paragraph which introduces this section provides some direction for the design and placement of windows to encompass the special views available from the site.

The Pattern Language makes some wonderful suggestions; to put windows which look on to the view at places of transition- along paths, in the hallways, and in entry ways. If the windows are placed correctly, people will see a glimpse of the view as they come up to a window or pass it, but the view is never visible from the place where people stay.
It will be desirable to incorporate this philosophy in the design of the building, with special exception to the patient rooms. Given that many patients will be bedridden, a room without a view may become a prison for the person that has to stay in it. The view from these rooms may be the greatest entertainment a patient has, my plan is to have these rooms adjacent to gardens or landscaped areas where there is activity, possibly social patio spaces, or a least a birdfeeder.
Windows also provide escape valves for family and patients experiencing the stress of the dying process. Openings to the outdoors allow patients to see family members, visitors and staff coming down the road, and at the same time to be in close contact with the earth and nature, which is a healing aid in itself.
It is important that consideration be given to all the sources of distracting and disturbing sounds in the institutional environment. This is not to suggest that a noiseless environment is desirable, but rather to recommend elimination or control of harsh institutional sounds.
For example, the hospice building should not have a paging system sounding messages throughout the building. Carts used to transport linen, food, medication or cleaning equipment should have large rubber wheels that are properly lubricated. A study of floor and wall treatments, acoustical surfaces and sources of noise will be made so that interior design can reduce the negative quality of institutional living.15 The acoustic privacy to grieve will be important in design of patient rooms, and especially in the screaming room provided for the release of stress and anger.

"AppAopalate management o{) death -involves both Selene and hit."
Paul M. VuBo-Ia

1. Applicable Building Codes:
City: Wheatridge County: Jefferson
2. Zone : H-l (hospital)
3. Occupancy Group: 1-1
4. Other Regulations: State Board of Health
5. Floor Area
Construction Type Occupancy Type Basic Allow. Area
II III & IV IV 1-1 1-1 1-1
6,800 6,800 5,200
Fire Zone Three Increase: Areas of building over one story and the total area of all floors of multistory buildings shall not exceed twice the area allowed for one-story buildings. No single floor area shall exceed that permitted for one-story building.
Side Separation Increase: Where public space, streets or yards more than 20' in width extend on all sides of a building and adjoin the entire perimeter, floor areas may be increased at a rate of 5% for each foot by which the minimum width exceeds 20'. Such increases shall not exceed 100%.
Automatic Sprinkler Systems: The area specified in Section 505 (Basic Allowable Area) may be tripled in one-story buildings and doubled in buildings of more than one story if the building is

provided with an approved automatic sprinkler system throughout. The area increases in this subsection may be compounded with that specified in paragraphs 1, 2, or 3 of Subsection (a) of this section.
Proposed Building Area: 22,660 square feet 6. Fire Resistive Requirements (Table 17-a)
Construction Type: II III IV V
Exterior Bearing
Walls 1 4 4 1
Interior Bearing
Walls 1 1 1 1
Exterior Non-Bearing
Walls 1 4 4 1
Structural Frame 1 1 1 or HT 1
Permanent Partitions 1 1 1 or HT 1
Shaft Enclosures 1 1 1 1
Floors 1 1 HT 1
Roofs l 1 HT 1
Building Height
Allowable Stories: One
Fire Sprinkler Increase: May be increased by one story
Total Allowable Stories: Two Maximum Height: 65'
8. Occupancy Loads
Occupant Group: 1-1 Sq. Ft. per Occupant: 80 Total Persons per Floor: 50 patients, 25 staff
Total Number of Persons in Building: 75

hour F.R., walls in elevation with
9. Exit Requirements
Number of Exits Required Each Floor: Min. 2 Required Exit Width: 44"
Ramps Required: Yes Corridor Widths: 8
Corridor Construction: One and ceiling, no change out ramp
Stairway Widths: Minimum 44"
Stairway Landing Depths: equal to width of stai rway
Smoke Tower Required: no Exit Signs Required: yes Exit Sign Separate Circuit: yes
10. Occupancy Live Loads
Uniform: 40 Concentrated: 1000
11. Other Requirements:
Enclosure of Vertical Openings: Fire resistive construction
Light: Natural light provided by exterior
glazed openings= to one tenth total floor area
Ventilation: Exterior openings with area not less that one twentieth of total floor area
Fire Extinguishing System Required: In every story or basement of all buildings when then floor area exceeds 1500 sq. ft. and there is not provided at least 20 sq. ft. of opening entirely above the adjoining ground level in each 50 lineal feet or fraction there of of exterior wall in the story or basement on at least one side of the building.
Dry Standpipes Required: if greater than
20,000 sq. ft. per floor, non-sprinkled
Wet Standpipes Required: no

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Job Title: Hospice of St. John
Address: 8900 West 38th Avenue, Wheatridge, Co.
County: Jefferson
Governing Authorities:
Building Permit Department: City of Wheatridge Planning and Zoning Commission: same
Governing Codes and Ordinances:
City of Wheatridge, Colorado
1. Proposed.iLand Use
Existing Principle Use: none/open space Proposed Principle Use: Hospice
2. Zones
Existing Regular Zone: A-l, Agriculture
Required Zone: H-l
Adjacent Zones: H-l (sanitori urn)
Restricted Commercial (law offi ce)
3. Lot Size
Existing: 152,400 So. Ft.
Minimum Allowed: 1 (min. width of lot 200 ft.)
4. Building Heights
Maximum Allowable in Feet: 35 ft.
5. Setbacks Required
Front yard minimum depth: 30'
Side yard (on each side): 50
Rear yard 10'
6. Yard Use Limitations
No fence, wall or hedge to exceed 42" in height placed within 55* of an intersection of two or more street right of way lines.
Fence types permitted: masonry wall
ornamental iron woven wire wood hedges
7. Required Off-Street Parking
Size : 180 sq. ft. regular space 220 sq. ft. handicap
Number: 26 regular, 7 handicap 33 total
1.0 per each 5 beds and one per employee of maximum shift. Handicapped 2% of total parking spaces.
8. Required Parking Screening
Location: adjacent to parking Type: landscaped buffer Wi dtjh: 15*
If parking is placed between public right of way and structure, 42" high buffer required in form of plants, berms or wall.
9. Access to off-street parking and loading Curb cuts: Minimum width: 12', Max. 30*

10. Signs Allowed:
Arcade- maxi mum height bottom of balcony, canopy or awning to which it is attached. Minimum height 7* above grade. One per building entrance, maximum area 4 sq. ft.
Freestanding: max area 20 sq. ft., or two for each 1000 sq. ft. of lot area, maximum 32 sq. ft. per sign.
Illuminated: one per street frontage, maximum height 12', indirect lighting source only.
Wall or Painted: shall pertain to the nature of business where it is located, maximum area 2 sq. ft. for every lineal foot of side of building to which it is attached.
11. Other Special Requirements of Non-Resident-
ial Districts
a) Required within the landscape setbacks abutting public rights of way, one tree, deciduous or evergreen, for every 20 or portion thereof of street frontage. This should not be construed to mean trees placed 20' on center.
b) In addition to trees required based upon public street frontage, one tree or other shrub is required for every 1,000 sq. ft. of lot area.
c) A 12* landscaped buffer area is required when adjacent to a residentially zoned lot. This may be used to satisfy other landscaping requirements.
d) Required landscaped areas shall be as follows:
- a minimum of 15% of any required yard (setback) not fronting a public street if used for parking or surfacing shall be landscaped
- a minimum of five percent of any required yard (setback) not fronting a public street if used for parking or surfacing, shall be landscaped.
- provided that all such landscaping shall not be less in total than 15% of the gross lot area, unless joint parking is provided, then 10% is required.
12. Acceptable Street Trees
Norway Maple Schwedler Maple Ohio Buckeye Chinese Cat.alpa Western Catalpa Common Hackberry Downy Hawthorn Washington Hawthorn River Hawthorn American Linden Little Leaf Linden
Green Ash Honeylocust Kentucky Coffee Tree Black Walnut Flowering Crab Tree American Plum Newport Plum Red Oak Bur Oak English Oak European Mt. Ash

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The following information was obtained from DHEW Barrier-Free Design Data Index, Minimum Requirements for Accessibility.
1. Parking Lots
a. Special parking spaces should be provided. A minimum of 12' in width for head-on parking or when placed between two conventional diagonal spaces is required.
b. Maximum travel distance 200'.
Identify and control parking for physically handi capped.
ccop location

2. Walks
a. Public walks shall be made to form a continuous common surface uninterrupted by steps or abrupt changes in level.
b. A walk shall have a level platform at the top which is a minimum of 60 x 60 inches if a door swings out toward the platform or the walk. This platform shall extend at least 12 inches beyond each side of the doorway. If the door does not swing toward the platform or the walk, there shall be a level platform at least 36 inches deep and 60 inches wide, extending at least 12 inches beyond each side of the doorway.
3. Ramps
a. Ramps shall have a maximum grade of one foot rise in 12 feet of run.
b. Ramps shall have non-slip surfaces.
c. There shall be a straight clearance of at least 72 inches at the bottom of each ramp.
Ramps shall be provided with handrails 32 inches in height on at least one side and preferably both sides. The rails must be smooth and extend at least 12 inches beyond the top and bottom of the


4. Entrances
a. At least one primary entrance to each build ing must be usable by people in wheelchairs
b. Entries should be protected from weather.
5. Doors
a. Doors must have a clear opening of at least 32 inches when open and must be operable by a single effort.
b. Thresholds shall be flush with the floor if possible.
6. Floors
a. Fldors must be on a common level through out a given story, or connected by ramps.
7. Hallways
a. Handrails recommended at both sides.
b. Minimum corridor width of 6 feet.
c. To avoid hazards doors should not swing into public corridors.
8. Cafeterias and Dining Rooms
a. Main aisles at least 5 feet wide. Side aisles are a minimum of 3 feet.
b. Pedestal base tables with radius corners and bumper edges are most appropriate. Avoid hardware projections underside of top. Minimum knee clearance 2'-2".
9. Bathrooms
a. Door with 2'-8" clearance, opening outward avoids blocked doorway in case of fall.
b. Sink height must provide minimum of 2'-2" clearance for knees in order to also insure comfortable table leyel for use of sink.
c. Mirrors should be 3V above the sink height of 31" to 33" using a 6" deep sink.
d. Grab bars capable of supporting 250 lbs. should be provided at the water closet, shower and elsewhere in the bathroom.

For a rion-ambulant person Lo enjoy street activity, the window sill height preferred is 2,-4u, although up to 2'-9" is acceptable depending on floor level.
b. Sliding windows are preferable because it takes less effort to open them.

S9T? SdH&LliSVCS Tfu Site T/tc Cfimatt ''Tucrtjv Considerations Lamiscajjiita
"Whan I cite I usLti bz tianAplanted fiioin tli-u, garden to the next golden." Patient
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Selection of a site for the proposed Hospice of St. John was another primary task in prethesis preparation. Because the project has not developed beyond planning stages in reality, there is no actual site.
Father Paul provided some requirements for the location of the site; it was to be located in Jefferson County, he estimated that acres would be necessary to accomodate the building and grounds, and he did not feel that the hospice had to be isolated. With the knowledge I had acquired about hospice, and after speaking with patients and family members of hospice patients, I added my own criteria. Since the hospice serves people from all over the United States, and sometimes Europeans, I felt it was important that it be easy to reach the hospice from major transportation networks. Also, since family care and interraction is so much a part of the hospice facility, I thought it especially important to make traveling to the hospice as uncomplicated as possible. It was desirable to me to find a location which was accessible by a bus line if possible.
The other important characteristic of the site was that it have some special quality, and provide the sense of place which could do so much to set the stage for hospice care. I also felt that the hospice should not be isolated from the rest of the world, in agreement with the historical concept of the hospice in the center of town, adjacent to the marketplace.
My search was long, and took into account the exploration of a large part of Jefferson County. The work paid off, however, and the site I discovered for the Hospice of St. John answered
my criteria far better than I had hoped.
The site is located at 8900 West 38th Avenue, in Wheatridge, Colorado. Wheatridge is a suburb of Denver, which has maintained some of the rural qualities of the past. There is still a good bit of open space remaining in the area, and it is not uncommon to see a horseback rider on the side of the road.
However, the site is located only seven and a half miles from downtown Denver, is easily reached from all major highways, and is only thirty minutes from Stapleton International Airport. The number 38 RTD busline has a stop directly in front of the site, with link ups to other buslines running on Wadsworth Boulevard and Kipling Street which border the site area on the East and West, respectively.
The area immediately adjacent to the site is predominantly residential, with services located on Wadsworth and Kipling. There is a sprinkling of commercial development along W. 38th Avenue, and Lutheran Hospital is about four blocks east of the site. The property is currently owned by the Wide Horizon Christian Science Sanitori urn. Their total parcel of land is equal to twenty-six acres of land, a small part of which is taken up by the sanitorium building and parking areas. The director of the Sanitorium felt that hospice would be an appropriate use for a portion of their property, in keeping with their desire to maintain the park-like setting and peaceful quality of the si te.
The site commands a magnificent view of mountains and valleys to the west, and green plains to the east. There is a small pond located on the sanitarium property, and another private

pond directly across the street from the land the hospice is proposed to occupy. In the back of my mind I had hoped to find a site with this rare combination (for the Denver area) of water and mountain view, and this parcel of land answered n\y criteria to the fullest extent.

~~~ IWheatridge, Colo.

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The Hospice of St. John is to be located in Wheatridge, Colorado- a suburb of the Denver Metropolitan area. The area enjoys the mild, sunny, semi-arid climate that prevails over much of the Central Rocky Mountain region, without the extremely cold mornings of the high elevations and restricted mountain valleys during the cold part of the year, or the hot afternoons at lower altitudes. Extremely warm or cold weather is usually of short duration.
The moderate climate results largely from Wheatridge's location at the foot of the east slope of the Rocky Mountains in the belt of the prevailing westerlies. During most summer afternoons cumuli form clouds shade the city so that temperatures of 90 degrees or over are reached on an average of only thirty-two days of the year. The scattered afternoon thunderstorms of July and August also have a cooling effect.
Winter has the least precipitation accumulation of the seasons, only about 11 percent of the annual total, and almost all of it snow. Weather can be quite severe, but as a general rule, the severity doesn't last long.
Situated a long distance from any moisture source, and separated from the Pacific source by several high mountain barriers, Wheatridge enjoys a low relative humidity, low average precipitation and considerable sunshine.
In any climate, the design of buildings for human comfort is critical. Based on temperatures alone, Wheatridge falls into the human
OftTiWil'liMidl yte
comfort zone for approximately one month in both early and late summer. Mo additional heating or cooling devices are needed in order for a person to feel comfortable when temperatures and other climatic features fall within this zone. Climatic design in this area must be directed primarily for cold winter conditions and secondarily for an overheated summer.

cTnerff Covsi/e rations
A building separates inside spaces from the outside environment with the primary purpose of creating comfortable conditions for the occupants. Mechanical systems are designed to provide heating and cooling whenever outside conditions make the inside spaces uncomfortable. Dependence on mechanical systems can be greatly reduced if building design is responsive to the outside climate. Energy conservation involves building to isolate the interior of a structure from an 'alien' climate, and passive design involves opening the same interior to a 'friendly' cli mate for natural conditioning. Any building can be considered a 'solar' building, simply because it exists in the sun, and with the energy constraints of today's world, the relationship between building and climate are a foremost design priority.
The following principles are some of the design priorities I will have in mind for this project.
1. Let the sunlight in during winter months. Sunshine provides a good opportunity for solar heating in this climate.
2. Keep the sun out when it is too hot for comfort. Shading devices calculated to b block summer rays offer the best protection from the sun.
3. Protect the building from cold winter winds. Evergreens can be used on the north and west sides of a building as a landscape feature to divert the wind.

4. Place secondary use functions such as bathrooms, laundries and storage spaces against cold north and wet walls.
5. Use insulated window coverings: shutters, drapes or insulation can be added when temperatures are too cold for comfort. *
* Pictures courtesy of AIA Research Corporation

The grounds surrounding the Hospice of St. John will play a large part in it's image and the healing process that may occur in the building.
The importance of interraction with the earth and nature by people in all stages of life cannot be stressed enough. Especially for the bedridden of the hospice facility, what goes on outside their window is so very important, and for the physically able, the possiblity for gardening is planned.
A number of gardens will be a part of the site development, as well as a patio area that serves as a transition place between the outdoors and interior of the building. Given the mild climate of this part of Colorado, outdoor space may be used for the greater portion of the year, as long as the sun is shining.
It is often overlooked that plants can aid in the implementation of effective energy alternatives. Protecting the north side of a building from the wind with evergreen trees, or using deciduous trees for shade in the sunnier months are two important applications of energy conscious landscaping.
In Colorado it is not unusual for 65 75% of the water delivered to a building in summer to be used for lawn irrigation. Scarcity and increasing cost of water call for the use of drought tolerant plants and efficient sprinkler systems. The use of native plants could reduce our overall water consumption by as much as 25%. In addition certain foreign species, which are adapted easily to semi-arid conditions can aid in the attempt to conserve water. The following matrix suggests a number of trees which are appropriate to the area.
O to
c ?
m 1 c O 65
m O
c £
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-1 70
- => Z
o o
m m p
U Cl o to C~ m p
m O
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CJ m

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<. a
K, < V S A
< a A
* A V
< \ <
A \ <
N a A
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A \ V \ \ A <
A a < < \
< \ \ V
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"JuJi> t want to haw. a little. peace to cUe., and a intend ofi ttfjo I love at hand."
Robert Hunter

CONCEPTS 4 weeks
1 week
4 weeks
5 weeks
There is something about facing death that brings people right to the edge of their existance. People die in the same way that they have lived, if given the opportunity. An authentic death or an appropriate death is dying in accordance with one's own desires and is congruent with one's life, including cultural practices that may seem strange to those from other backgrounds.
The hospice can provide the supportive environment necessary to achieve death with dignity.
The availability of pain and symptom control, the independence and choice allowed the patient, and the recognition of the total humanity and aLtuencd-i of the terminally ill patient, all combine to create the special form of care which is hospice. How long will hospice care be necessary? For as long as people die.

1. Patrick A. McGuire "Hospice" (Denver Post, October 7, 1979).
2. Ibid
3. Ibid
4. Paul M. DuBois The Hospice Way of Death (N.Y.: Human Sciences Press, 1980). p. 61
5. Theodore H. Koff Hospice, A Caring Community (Cambridge: Winthrop Publishers, Inc., 1980).
6. Parker Rossman Hospice (N.Y. : Association Press, 1977). p. 15
7. DuBois, p. 43.
8. Rossman
9. Koff, pp. 14 15.
10. McGui re
11. Koff, p. 130.
12. Marguerite Villecco "Strategies of Daylight Design" (AIA Journal, September, 1979). p. 68
13. Christopher Alexander A Pattern Language (N.Y.: Oxford University Press, 1977). p. 646
14. Alexander, p. 642.
15. Koff, p. 130.
16. N0AA, Local Climatological Data, Denver, Colorado (Asheville, North Carolinai, 1981)
17. AIA Research Corpora Li on, Regional Guidelines for Building Passive Energy Conserving Homes (Washington, D.C., 1980). p. 66

1. AIA Research Corporation. Regional Guidelines For Building Passive Enerqy Conserving Hones, Washington,
D.C., 1980. ---------
2. Alexander, Christopher. A Pattern Language N.Y.: Oxford University Press, 1977.
3. City of Wheatridge, Planning and Zoning Requirements For The City of Wheatridge 1981.
4. DeChiara, J. and Callendar, J. Time-Saver Standards For Building Types
5. DHEW. Barrier Free Design Data Index, Minimum Requirements for Accessibility
6. DuBois, Paul M. The Hospice Way of Death N.Y.: Human Sciences Press, 1980.
7. Foster, Laurie D. Energy Conservation Through Landscaping, City of Boulder Energy Office
8. Koff, Theodore H. Hospice, A Caring Community Cambridge: Winthrop Publishers, Inc., 1980.
9. McGuire, Patrick A. "Hospice" Denver Post, October 7, 1979.
10. National Oceanic and Atmospheric Administration, Local Climatological Data, Denver, Colorado
Ashville, North Carolina, 1980.
11. Rossman, Parker. Hospice N.Y.: Association Press, 1977.
12. Uniform Building Code, 1979 Edition California: International Conference of Building Officials.
13. Villecco, Marquerite, with Steven Selkowitz and S.W. Griffith. "Strategies of Daylight Design"
AIA Journal, September, 1979.

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