Translating “Integrated Care” in the Design of a Geriatrics Facility
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Transcript of Translating “Integrated Care” in the Design of a Geriatrics Facility
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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
26
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
27
METHODOLOGY
28
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.
30
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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39
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
14
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
46
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
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ELEVATIONS AND SECTIONS
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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