In 1988, it was a house with an open door. Casey House was born in an old Victorian in Toronto's Gay Village, where a dedicated staff took in people dying from HIV/AIDS. "It's going to give many people a better last few weeks or months than they otherwise would have had," its founder, the late activist and journalist June Callwood, told The Globe and Mail.
Nearly three decades later, both the disease and the institution have changed. HIV/AIDS "is no longer a death sentence," Casey House chief executive Joanne Simons says. And Casey House, the world's only freestanding HIV/AIDS hospital, now has a new building of its own, a 59,000-square-foot wing appended to a Victorian manse.
Designed by Hariri Pontarini Architects with ERA Architects, it opened last week. What's remarkable is how comfortable and beautiful the place is: thoughtfully planned, carefully built; balancing privacy and public ambition; and with light, water and greenery at its centre. This is a place for life. The central question, the architect Siamak Hariri says, was: "How do we create the sense of something between a home and a hospital?" The result feels utterly unlike most of the hospital buildings that we construct today. There are lessons in that.
The architecture at the new Casey House makes it feel unlike most other hospital buildings built today.
One lesson: The project doesn't start with a blank slate. Most hospitals in Canadian provinces are huge buildings on suburban sites, organizations amalgamated to produce operational efficiencies. And, despite recent rhetoric about " patient-centred design," they tend to be grim places: sunless labyrinths of fluorescent light and antiseptic surfaces.
This place is different.
Seventeen years ago, Casey House – with a private donor's support – bought a grand 1875 house on Jarvis Street, which was once Toronto's best residential avenue, and kept that main building while developing the area behind it. Now, the eclectic brick-and-sandstone façade of the house, by prominent local architects Langley, Langley & Burke, has been cleaned up and restored by ERA Architects along with much interior detail; a spectacular barrel-vaulted ceiling arches over the entryway.
The house now provides space for client meetings, houses public events and makes the institution visible. "In the eighties, during the HIV crisis, there was huge stigma – as there is today – around HIV, and our facility was in the shadows of this community," Simons says. "Nearly 30 years later, we're making a very bold statement. We're not hiding any more."
The architects carved a skinny courtyard down the middle of the hospital, allowing light to penetrate right into the centre of the building along with views of water and greenery.
Lesson No. 2: It argues that quality can help people feel strong, and get strong. The main lobby in the new building is a double-height atrium surrounding a great fireplace; the warmth of the hearth, lined with rough-cut limestone, immediately establishes a tone of welcome and domesticity. That continues throughout the three floors devoted to outpatient services, where Hariri's trademark palette of natural materials – polished limestone and walnut – appear on nurses' desks and kitchens that serve the patients. "Clients absolutely feel the difference in those details," Simons says. "At the same time, we looked at the finishes very carefully to make sure they could survive the cleaning protocol."
That's no trivial thing. HIV/AIDS patients are immune-challenged, and so infection control is even more important here than for a typical hospital population.
On the other hand, those clients – a mix of inpatients and outpatients – are people who have spiritual and emotional needs, too. The usual hospital palette of stainless steel and plastics doesn't make anyone feel good. "Our clients are very much in the margin," Simons explains: Twenty per cent are homeless and another 20 per cent chronically ill-housed; and 60 per cent have mental-health challenges, often combined with substance abuse. Many "don't have anywhere else to go," Simons says. "The least we can do is reach our arms around them, literally and figuratively."
The architect’s trademark palette of natural materials – polished limestone and walnut – appear on nurses’ desks and kitchens that serve the patients.
Which leads to the third point: The building's layout is fundamentally different from most hospitals. Those are usually organized around double-loaded corridors – a hallway lined with rooms on either side, leaving nurses and other staff trapped in the sunless centre of a building. Here, Hariri Pontarini have taken that typical plan and carved a skinny courtyard down the middle; it allows light to penetrate right into the centre of the building and it also provides views to a copse of honey locusts. For the patients in the third-floor inpatient ward, this may be their only access to the outdoors; it is both beautiful and private.
Privacy matters, for the stigma that Simons mentioned continues to exist. "Individuals, within their families and their culture, may not want to be individually recognized" as HIV/AIDS patients, Simons says. "But at the same time we hear from clients all the time that we need to fight the blame and shame associated with HIV."
The exterior façade of the building expresses those dual sentiments. The side of the building is a complex grid of roman brick, different shades of limestone and dark glass; together these panels evoke a quilt. The quilt has been a familiar symbol of HIV/AIDS ever since San Francisco AIDS activists established a quilt as a memorial to the victims of the disease. Casey House has its own memorial quilt. The textures of the building façade allude strongly to that history of loss and remembrance. If you get the reference, it's powerful. It is a rare example of contemporary architecture employing explicit symbolism, and it works. At the same time, the dark, reflective glass shades the identity of anyone within, something that's still necessary.
Inside, the atmosphere of welcome is palpable – and clients feel it, said Rod Lightheart, an outpatient client of Casey House. "When you come into a hospital – we've all been there – you feel numb," Lightheart told me. "Here, it's more like coming home.
"For a bunch of people who are really not feeling that great, and in most cases have experienced stigma, anxiety and depression," he said, "it kind of wraps around you."
Lightheart, who has been coming to Casey House for three years, praises the sunny main-floor cafeteria, the "warmth of the materials" throughout the building and the presence of that fireplace. "How many medical facilities have a fireplace?" he asks.
Not enough. "I feel proud just walking in the front door," Lightheart says.
He and his fellow Casey House clients deserve that feeling of welcome and comfort. But couldn't all of those who are vulnerable benefit from such an embrace?