Contemporary Hospice Architecture in England: Examining Homeliness and Homelike Design in Hospice Spaces

This thesis advances geographical and architectural understandings of the hospice by critically examining homelike design and experiences of home in hospices in England. Hospices support patients with life-limiting conditions, their families and carers. While advocacy for homelike hospice design is shown to be commonplace in academic literature, policy documents and architectural briefs, diverse interpretations, connotations and designs of home are rarely addressed, leaving the unanswered question of whose home is being emulated in palliative care settings with associated implications for inclusivity.This study explores these issues using an interdisciplinary methodology, combining approaches from human geography, architectural history and applied health. The architecture and design of a representative sample of 10 adult, inpatient hospices was examined through site visits and primary document analysis. Ethnographic field work followed in two contrasting hospices, exploring perceptions and experiences of patients (12), family members (7), staff (26) and volunteers (4) through non-participant observation, in-depth interviews and focus groups.The study found that homelike hospice design across England overwhelmingly reflects the homes of wealthier and majority-ethnic populations, including stately homes, suburban houses with gardens, and influences from hotel/spa design. Hospice buildings and surroundings are shown to substantially impact perceptions of hospice care and who it is for, raising further questions around the inclusivity of homelike design and potential contributions to documented inequity of access to hospice care.Ethnographic findings revealed disparities of experience, with homemaking practices not universally desired, engaged with, or possible for all hospice users. While some participants saw homelike design facilitating effective palliative care, it was commonly viewed as impractical, inappropriate or impossible to achieve.Evidence-based policy and practice recommendations are presented for inclusive approaches to hospice architecture and design, and directions explored for developing much-needed official UK hospice design guidance. Hospice design should facilitate flexibility and choice rather than imposing homelike experiences or aesthetics.