From the Design Quarterly: What happens when hospitals move out?

Truth be told, most older hospitals are inward-facing with only a tiny window (the main entry) facing the community. Most functions, even public dining, are located deep inside and don’t invite interaction with the broader community.

So, perhaps when a hospital uproots, the space that’s left has a second chance—an opportunity for a renewed, more vibrant relationship with the community. To investigate the possibilities and strategies that a former hospital site allows, Stantec’s US East Health Sector Leader Brenda Bush-Moline started a conversation with Stantec’s Steve Kearney from our Urban Places group.

Brenda: When a hospital is planning to shutter and relocate operations from an urban setting, what are some of the best opportunities for reuse? These hospitals can be bargains for organizations seeking a rehabilitation facility or a health-related reuse. What other purposes can they serve, realistically?

Steve: Finding a reuse for a hospital campus can be challenging for the reasons you mentioned and more: the inward-facing aspect, large floorplates, non-transparent first floors, etc. Importantly, before one can talk about reuse, one would have to understand what the economic and market realities and surrounding context are for each of these neighborhoods. Are they located in predominantly older, lower-income, residential neighborhoods? Or are they in or adjacent to downtowns where new housing, retail, and other signs of increased revitalization are evident?

With that said, these buildings can serve many non-health related purposes. Bed towers that have a width of 55 feet to 65 feet can be converted to housing—market-rate, if the demand exists, senior affordable housing, or possibly mixed-income. The width of the buildings would likely only support one-bedroom units, so affordable housing for families may not be feasible. Many of these hospital campuses have existing structured parking, a great benefit to a residential development. Buildings with larger footprints could serve as combination community centers and workforce development training facilities or offer training programs in health care services. One opportunity may be partnering with a local university or other entity to create a maker space. The high voltage and larger gas lines and other infrastructure needed for the operating and emergency rooms could support the technology and equipment required by a makerspace.

Brenda: What are some general strategies toward making these buildings more usable?

Steve: Regardless of the future opportunities, an early focus would need to be reversing the inward-facing nature of the campus. Physical barriers such as fences and gates need to be removed. Where it is possible and financially feasible, selective demolition can be used to punch holes into the building facades to make it feel more open and to enliven connections with the streetscape.

Brenda: Often these city hospitals have a variety of retail businesses and health-related services offered in their immediate orbit, but if they close and move, those businesses and the immediate neighborhood are in jeopardy. What are some urban places interventions that can help these areas transition or recover quickly?

Steve: It’s important to focus on maintaining active streetscapes with lights on in the buildings and pedestrians on the street.

A unique intervention we included in a recent plan was a restaurant incubator. In this community (and many others), there were restaurant entrepreneurs who were working out of a food truck or very low-rent locations. With support from the city through several grants, they are reconfiguring an existing building with a professional kitchen and three small restaurant spaces. By creating three options, community members have both choices and the comfort that there will be space available for them. As these entrepreneurs grow their business, the goal will be for each to move to their own permanent location in the downtown.

One could also investigate streetscape improvements and events programming to activate the street level.

Brenda: What urban places strategies can begin before the hospital closes down to soften the transitions?

Steve: Encourage the hospital owners to partner with the city and/or neighborhood organization to initiate a conversation and start planning for the future. We know any replacement facility envisioned by the hospital has a 5-to-10-year planning and construction horizon—so there is time to plan for the future. These campuses were deliberately designed into super blocks and are typically cut off from the surrounding street grid. Roads that have been closed off from the surrounding street grid could be reconnected. Green space, if available at the hospital can be a potent asset. Perhaps there are interior courtyards, lawns, or other green spaces that can be opened up and programmed for public use—actively drawing people back into the building. Reconnecting to the neighborhood is critical, and many infrastructure improvements are necessary to accomplish this.

Can the hospital work with the city to share costs? What projects can be identified and included on the city’s capital improvement program (CIP)? The sooner these can start, the better. Seeing the campus change and open up will be a positive sign for the community, and it will benefit the hospital owners to be seen as a partner. In Urban Places, we can work with the hospital and city to identify local potential new tenants.

Brenda: What kind of buy-in from the community local government is needed to make this happen? What strategies for consensus building, listening, and engagement are most effective?

Steve: Transparency is key, as is engaging the community early on. And a collaborative relationship between the hospital owners and the local government is essential. Many of the public improvements can be done through government funding opportunities, and this can accelerate planning efforts and help attract new uses to the site. By providing a community with the appropriate parameters, they can work together to build a realistic vision that can be implemented.

Brenda: There are some health-related buildings (old hospitals for tuberculosis), sanatoriums, and asylums that may not be in the urban core—perhaps in more pastoral settings but are still parts of communities and often passed over for reuse, often for irrational reasons like stigma for a population that no longer inhabits the institution (e.g. the mentally ill). What kind of possibilities are there for say, a suburban hospital from the early 20th Century? What can we do with these sites to address today’s problems like loneliness?

Steve: Yes, these sites often come with histories. Plus, there are other issues such as patient burial grounds, environmental problems, and very high costs associated with rehabilitation of these historic structures (although federal and state tax credits can create real incentives). Yet there are numerous examples across the country of these historic structures becoming destinations in themselves or anchors of new developments. They have been converted into boutique hotels, learning facilities, and mixed-use redevelopments. These historic structures create a true sense of place, of authenticity. And the characteristics inherent in the buildings can inform the character of the new buildings.

They are typically surrounded by significant open space that can create opportunities for those living and working here as well as amenities shared with the surrounding neighborhood. Like urban hospital campuses, these long-isolated properties need to connect to and welcome in their surroundings.

With careful planning, research and consultation, retired sites—urban or suburban—offer tremendous potential for landowners and city officials alike to generate revenue and opportunities for the communities they serve.