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Background: Little is known about how to design inpatient hospice buildings to maximise the wellbeing of the growing number of patients aged 65yrs or over. Aim: To investigate the impact of a hospice environment on the social wellbeing of older inpatients. Method: Interviews were conducted with10 staff, 2 visitors and 7 older in-patients at a UK hospice with 8 single and one 4-bed rooms, to elicit their views on the building, and 120 hours of non-participant observation, to find how space was used. Field notes and interview transcripts were subject to thematic analysis using NVivo X, using concepts derived from therapeutic landscapes theory. Results: (1) Supervision and independence -The building was constructed around a long blind-ended corridor, with a nurses’ station near the entrance. Those who were terminally ill or restless were allocated to single rooms near the nurses’ station. Frequent room transfers occurred in response to changing needs, and older patients disliked these. Room doors were kept open during the day, enabling staff to monitor occupants as they walked along the corridor. There were several complaints of loneliness from those in rooms at the end of the corridor, as staff visited less often. (2) Private and public space - Older patients spent most of their time in their rooms, usually seeing visitors at the bedside. Of the available social spaces, the hospice garden was the most visited, and older patients enjoyed contact with nature. They rarely entered the two patient lounges and conservatory, which were often occupied by staff for meetings, family conferences and meal breaks. Conclusions: To maximise older inpatients’ social wellbeing, the hospice environment should be designed to balance the need for supervision and independence, and for private and public space. Staff working practices should ensure that the use of the environment is patient-centred.

Aim: Recruitment of palliative care patients to research studies can be problematic. The aim was to generate recommendations about removing barriers to research in the palliative care setting. Methods: Three workshops were held in the UK (77 palliative care staff and patient representatives). There were presentations about the need for palliative care research and discussion around potential barriers. Nominal groups were held to make recommendations about how to overcome barriers and suggest areas for research. Each person made recommendations which were collated on a flip chart. Recommendations were sent out in an online survey to participants who were asked to rank how much they agreed with them on a scale from 1-9 (1 strongly disagree-9 strongly agree). Median scores and inter-quartile ranges (IQR) were calculated to assess consensus. Results: The top three recommendations to improve research in hospices were (Median:IQR): 1. Hospices and palliative care units should collaborate with each other in research and share best practice (9: 0.25) 2. A research culture needs developing (9:1) 3. Results from research needs to be presented to staff and patients (9:1) 4. National guidelines for research governance in hospices need developing (8.8:1) 5. A public health campaign is required to promote the need for research in palliative care (9:2.25) The main areas recommended for research were to establish the experiences of palliative care patients of out of hours services (8.5:2.75), experience of parents caring for children (8:2), whether palliative care is cost effective (8:2.75) and what is the impact on palliative care for people with no local support (8:2.75). Conclusion: Workshops raised awareness of the need for research in palliative care and allowed staff to generate their own solutions to overcome barriers, in particular improving recruitment. Networking was highlighted as key and is reflected in the recommendations.

Objective: To assess the extent to which a grants programme to fund improvements to English inpatient hospice buildings achieved its goals of involving and directly benefiting older people. Method: Qualitative content analysis was undertaken of all grant application forms which (a) resulted in funding, and (b) proposed to refurbish or replace inpatient hospice buildings. Data were extracted, and themes identified, on the nature and extent of the benefits envisaged for older people, and how older people were involved in the proposed building projects. Results: Of 227 grant applications, 139 (from 111 hospices) met the inclusion criteria. Four categories of building improvement were identified: interior decoration or equipment (n = 386, or 36% of the total); public spaces (n= 291, or 27%), private spaces (n = 283, or 26%), and health and safety (n= 116, or 11%). These improvements, while generally beneficial, were rarely targeted at older people. Most grant applicants stated that they had consulted service users, but only 13 specified that they consulted older people. Limited information was supplied about the methods or findings of these consultations. In 15 grant applications, older people were not mentioned at all. Conclusions: Older hospice inpatients, their relatives and advocacy groups should be involved more fully in decisions relating to the physical environment of care. Staff who prepare funding bids should receive training in conducting consultations with service users, and identifying and evaluating other relevant evidence. To ensure a consistently high standard of environmental provision for older people in hospices, evidence based assessment tools and guidelines should be developed.

Background: Little is known about how to design inpatient hospice buildings to maximise the wellbeing of the growing number of patients aged 65yrs or over. Aim: To investigate the impact of a hospice environment on the social wellbeing of older inpatients. Method: Interviews were conducted with10 staff, 2 visitors and 7 older in-patients at a UK hospice with 8 single and one 4-bed rooms, to elicit their views on the building, and 120 hours of non-participant observation, to find how space was used. Field notes and interview transcripts were subject to thematic analysis using NVivo X, using concepts derived from therapeutic landscapes theory. Results: (1) Supervision and independence -The building was constructed around a long blind-ended corridor, with a nurses’ station near the entrance. Those who were terminally ill or restless were allocated to single rooms near the nurses’ station. Frequent room transfers occurred in response to changing needs, and older patients disliked these. Room doors were kept open during the day, enabling staff to monitor occupants as they walked along the corridor. There were several complaints of loneliness from those in rooms at the end of the corridor, as staff visited less often. (2) Private and public space - Older patients spent most of their time in their rooms, usually seeing visitors at the bedside. Of the available social spaces, the hospice garden was the most visited, and older patients enjoyed contact with nature. They rarely entered the two patient lounges and conservatory, which were often occupied by staff for meetings, family conferences and meal breaks. Conclusions: To maximise older inpatients’ social wellbeing, the hospice environment should be designed to balance the need for supervision and independence, and for private and public space. Staff working practices should ensure that the use of the environment is patient-centred.

Aim: Recruitment of palliative care patients to research studies can be problematic. The aim was to generate recommendations about removing barriers to research in the palliative care setting. Methods: Three workshops were held in the UK (77 palliative care staff and patient representatives). There were presentations about the need for palliative care research and discussion around potential barriers. Nominal groups were held to make recommendations about how to overcome barriers and suggest areas for research. Each person made recommendations which were collated on a flip chart. Recommendations were sent out in an online survey to participants who were asked to rank how much they agreed with them on a scale from 1-9 (1 strongly disagree-9 strongly agree). Median scores and inter-quartile ranges (IQR) were calculated to assess consensus. Results: The top three recommendations to improve research in hospices were (Median:IQR): 1. Hospices and palliative care units should collaborate with each other in research and share best practice (9: 0.25) 2. A research culture needs developing (9:1) 3. Results from research needs to be presented to staff and patients (9:1) 4. National guidelines for research governance in hospices need developing (8.8:1) 5. A public health campaign is required to promote the need for research in palliative care (9:2.25) The main areas recommended for research were to establish the experiences of palliative care patients of out of hours services (8.5:2.75), experience of parents caring for children (8:2), whether palliative care is cost effective (8:2.75) and what is the impact on palliative care for people with no local support (8:2.75). Conclusion: Workshops raised awareness of the need for research in palliative care and allowed staff to generate their own solutions to overcome barriers, in particular improving recruitment. Networking was highlighted as key and is reflected in the recommendations.

Objective: To assess the extent to which a grants programme to fund improvements to English inpatient hospice buildings achieved its goals of involving and directly benefiting older people. Method: Qualitative content analysis was undertaken of all grant application forms which (a) resulted in funding, and (b) proposed to refurbish or replace inpatient hospice buildings. Data were extracted, and themes identified, on the nature and extent of the benefits envisaged for older people, and how older people were involved in the proposed building projects. Results: Of 227 grant applications, 139 (from 111 hospices) met the inclusion criteria. Four categories of building improvement were identified: interior decoration or equipment (n = 386, or 36% of the total); public spaces (n= 291, or 27%), private spaces (n = 283, or 26%), and health and safety (n= 116, or 11%). These improvements, while generally beneficial, were rarely targeted at older people. Most grant applicants stated that they had consulted service users, but only 13 specified that they consulted older people. Limited information was supplied about the methods or findings of these consultations. In 15 grant applications, older people were not mentioned at all. Conclusions: Older hospice inpatients, their relatives and advocacy groups should be involved more fully in decisions relating to the physical environment of care. Staff who prepare funding bids should receive training in conducting consultations with service users, and identifying and evaluating other relevant evidence. To ensure a consistently high standard of environmental provision for older people in hospices, evidence based assessment tools and guidelines should be developed.

Relatively little is known about the type of physical environment which is needed and preferred by patients aged 65 and over, with a prognosis of 1 year or less, who are receiving care in hospitals, care homes and hospices, and their families and staff. A narrative literature review was conducted to identify and analyse evidence on this issue, with twenty-nine papers meeting the inclusion criteria. The patients were found to have a wide range of views on their environment, but there was some variation between the views of patients and those of their families and staff. Four main themes emerged: the physical environment should be ‘homely’; it should support patients’ need for social interaction and privacy; it should support the caring activities of staff, family members and patients; and it should allow opportunities for spiritual expression. It is evident that the physical environment contributes significantly to the quality of life of older people with a life-limiting illness, and there is a need for more research in this area. Regular assessment of patients’ environmental needs should form part of care planning.