T. Boone Pickens Hospice & Palliative Care Center a Facility Design Exemplar

About 10 miles north of downtown Dallas sits a campus of buildings, walking paths and impeccable landscaping anchored around a five-acre pond. The connection of the buildings to the natural elements of the campus evokes a sense of tranquility and respite from the bustling Dallas-Fort Worth Metroplex.

This is the T. Boone Pickens Hospice and Palliative Care Center. Completed in January 2017, the center is the first standalone hospice in “Big D” and the centerpiece of Faith Presbyterian Hospice — one of the service lines of Forefront Living, a Dallas-based nonprofit provider of long-term care, rehabilitation, skilled nursing and senior housing.

The Pickens Center is notable for the size of the campus, as well as the attention to detail paid to providing wellness for its patients, their families and staff. The center was designed and built with one mandate: to reinforce and preserve the dignity of the people using hospice care as they live out their final moments.

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Faith Presbyterian Hospice’s success in meeting that mandate, its deft incorporation of nature and its scale, helped it earn first place in the 2019 Senior Housing News Architecture & Design Awards’ Best Hospice category.

The concept

Forefront Living (which changed its name last October from Presbyterian Communities and Services) had long wanted to open a standalone hospice, CEO Tim Mallad told Hospice News’ sister site Senior Housing News.

Dallas-Fort Worth was one of the few metropolitan markets in the United States without standalone hospice care and there was growing demand for hospice and palliative care services — nearly 12,000 families have been served by Faith Presbyterian Hospice since 2003.

“We came to a realization as an organization that the [hospice] services and quality we provide are often done in skilled nursing and acute-care settings, which don’t provide the environment that specializes in the delivery of these services,” Mallad said.

An aerial view of the T. Boone Pickens Center

Forefront reached out to the T. Boone Pickens Foundation, the charitable arm of the late oil-and-gas maverick and hedge fund manager T. Boone Pickens, for financial backing. After some intense vetting and several meetings between the two, Forefront had its financial backing as well as an active partner in the project, Pickens Foundation Director of Community Affairs Marti Carlin told SHN.

“When our foundation decides to support a [financial] request, that organization becomes our partner because we feel that our contributions are investments. From that point forward, we became intimately involved [in the project],” she said.

Forefront Living wanted to establish an inclusive approach to hospice care, with standalone buildings for inpatient care, bereavement, spiritual care and education. This allows for a more defined separation between the center’s clinical and wellness components, gave the design team the ability to tailor each building’s design to meet the needs of patients, families and staff, and create synergies with the natural elements provided by the pond and landscaping.

The inpatient care center contains 36 suites, all with abundant natural light pouring in and spacious patios where patients can be rolled out to connect with the outside elements. The suites contain storage space so that medical equipment can be stored when not in use. Families looking for a break from caring for their loved ones can decompress in communal lounges, cafes, conference rooms, a meditative space and a library.

Each building was designed so that everyone has clear views of the pond. Private and public walking paths were built to give families and staff opportunities to enjoy the outdoors and to reflect. The spiritual care center was designed to accommodate people of all faiths, with input from various clergy and operations staff.

The construction

The scope of Forefront’s vision for the Pickens Center required extensive input the design team — Dallas-based architect PRDG and design firm Faulkner Design Group and landscape architect Mesa Design Group — in addition to Forefront and the Pickens Foundation, PRDG Principal Kathryn Busch told SHN.

Forefront was able to clearly articulate its vision of the center to the design team, which added a complexity that would have otherwise gone unnoticed.

“We [essentially] had three clients that we were designing for: the patient, the families and the staff. When we think about hospice, the focus is [usually] on the patient, but the families are in distress, as well. So how can we make a building that is approachable, easy to navigate, and offers amenities for them as well?” Busch said.

After scouting several sites in the area, the new venture landed on 10 acres within an existing master-planned development. The pond, fed by a stream, proved to be the linchpin in the construction. Its size dissuaded other real estate developers from acquiring the site for commercial development. As soon as the team saw the pond, however, they knew they could work with it.

“If you’re looking [at the site as] a for profit developer and you’re looking at revenue producing square footage, you’re not going to get a lot out of this land,” Mallad said.

With the pond as the foundation of the development, the individual pieces began to fall into place. But there were still some hurdles to clear.

The pond needed to be shaped into something palatable, and there was a 25-foot elevation change between its location and where the buildings would eventually be built. Busch cites the efforts of Mesa as essential to the site’s construction. The firm found ways to arrange the buildings on the site so that they faced the pond, as well as separate the outdoor paths so that hospice staff, residents and families had as much separation as possible from the public pathways connecting the hospice to the larger development.

The design team also worked with Audubon Dallas to select native plants that provided a contrast of colors, needed minimal maintenance and would attract area birds and wildlife, further contributing to the tranquility Forefront Living intended.

Nature also plays a role in the Pickens Center’s entrance. A water fountain and exterior stone walls provide a subtle connection between the center and the landscaping.

The completion

When the Pickens Center opened three years ago, T. Boone Pickens himself believed it was unique among standalone hospices in the United States, and would eventually become the standard for what hospice care can be and how it should be done.

The T. Boone Pickens Center is home to a non-denominational chapel, utilizing stone, wood, and stained glass to connect to the center’s nature and spiritual elements.

As the Pickens Center enters its fourth year of operation, it has received high marks for service from the families of patients who spent their final moments in hospice care there, Mallad told Senior Housing News. Forefront Living surveys its families regularly and uses all commentary — positive and negative — in a constructive manner.

Carlin echoed Mallad’s sentiments.

“People are not shy about sharing with our organization [when] their [experience] has not met expectations. We have not received anything but unbelievable satisfaction and praise,” she said.

The size of the Pickens Center immediately captured the attention of THW Design Principal/Executive Director Eric Krull, a Senior Housing News Awards judge. And it wasn’t only the scale of the campus.

“When I saw that this [project] had 36 beds, all dedicated to hospice, it impressed me. There are assisted living and memory care [communities] that aren’t that big,” he said.

Krull also commended the decision to separate the buildings. Forefront Living could have built everything under one roof, which would have inadvertently highlighted the clinical aspect of hospice care. By separating the inpatient, bereavement and staff education components, it allowed the hospitality elements to take root, while also breaking down the scale of the campus.

“It doesn’t feel like a hospital or the end of life. [The design] removed the business [elements] from the home [feel],” he said.

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