Spaulding Rehabilitation Hospital is in the business of improving the quality of life for patients with disabilities and their families, through its patient care, teaching, and research programs.

For 42 years, the organization, which is part of the not-for-profit Partners HealthCare (Boston), operated a facility on Nashua Street in Boston. But its small double-occupancy rooms, inaccessible bathrooms, and narrow corridors had become outdated, and there wasn’t enough outdoor space for therapy programs.

David Storto, president, Spaulding Rehabilitation Hospital, says the organization considered several options, including purchasing another healthcare facility, adding a new wing at the existing location, doing a gut renovation, and even moving to a suburban location. But none fully supported the organization’s objectives, which include advocacy efforts within the community and providing patients access to the outdoors for adaptive sports, such as kayaking.

“We wanted to stay on the waterfront to maintain that kind of programming,” he says. “And bringing the community into the facility is part of our desire to get rehab out of the basement, so to speak, and have people understand physical disability and rehabilitation in a different way.”

Two parcels at the Charlestown Navy Yard, which had been acquired by the Boston Redevelopment Authority (BRA) in 1979 for urban renewal purposes, offered possibility. The roughly three-acre setting was on the waterfront and had space to support desired programming, while the neighborhood itself was undergoing an urban renewal with residential and business developments.

But the location, which formerly served as part of the Boston Naval Shipyard as well as a timber receiving dock, was severely contaminated with polychlorinated biphenyls, oil, and grease. While ideal for its shore setting, that same factor also posed a risk for natural disasters and flooding.

However, Spaulding’s desire to remain in the city and on the water was strong enough to make the site a strong contender. Furthermore, Storto says, the opportunity to remediate the land was consistent with Spaulding’s rehabilitation mission.

The owner determined that the site could be cleaned up for $22 million and worked with the BRA to purchase the land from the city. A purchase price was negotiated that took into account the extra expenses, and Spaulding also received $7 million in brownfield tax credits.

Haley & Aldrich (Boston) was hired as the licensed site professional to oversee the regulatory compliance, remediation, and soil management work, which involved excavating more than 108,000 tons of soils classified as remediation waste and on-site treatment of over 25,000 tons of soil containing metals in excess of the Resource Conservation and Recovery Act hazardous waste criteria. The remediation process took approximately a year.

Once the cleanup was complete, the next step was designing a facility that took advantage of the site’s natural surroundings while also addressing some of the inherent challenges associated with it.

Resiliency on the waterfront
The initial design phase for Spaulding’s new $225 million rehabilitation facility was conducted from 2005 to 2006, during the time when Hurricane Katrina hit the southeast United States in August 2005. Ownership quickly recognized the potential for similar disasters on its waterfront location and used lessons from the event to identify a series of overall resiliency measures. (The project was put on hold during the recession and restarted in 2009.)

For example, the first floor level was set 42 inches above the 100-year and 30 inches above the 500-year flood elevations to factor sea level rise projections. In addition, the landscape incorporates a 3-foot berm around the perimeter to act as a protective reef.

Next, the entire critical mechanical and electrical infrastructure for the inpatient clinical areas was moved to the roof. The hospital also chose a gas-fired cogeneration unit for thermal energy and power, along with an emergency generator to serve as a back-up if the cogeneration unit fails. “It’s inherently more resilient to have your own on-site power generation,” says Robin Guenther, principal, Perkins+Will (New York). “It’s the power grid that’s proven to be more disruptive than natural gas service in urban areas in extreme weather.”

It’s also an energy-efficient power source for the LEED Gold-certified building, which uses the waste heat from power generation for heating loads, including hot water preheating.

A third resiliency feature is the incorporation of operable windows in the patient rooms, where staff can use a key to open the windows during emergencies to help prevent the building from overheating and provide fresh air.

“The prime directive of a hospital in an extreme weather event is to safely shelter in place,” Guenther says. “You need to maintain habitable conditions in the building so that the occupants can shelter in place until everything is back and running.”

Additional windows in the gymnasium and public spaces are tied to the HVAC controls and bring natural ventilation inside when weather permits. Lounges on the patient floors also have operable windows for general use.

Taking advantage of the natural site grading, which slopes up about 30 inches from the waterfront pier bulkhead to the sidewalk, a two-level parking structure was built below ground. Then all of the critical patient functions and infrastructure services were placed above the ground floor, to ensure that all the programs that would be needed for occupants to shelter in place wouldn’t be flooded.

Building solutions
Another goal for the waterfront location was to design a building that would become part of the urban fabric. “It’s always important to relate buildings to their surroundings,” says Ralph Johnson, lead designer, Perkins+Will.

The BRA regulates that buildings be sited away from the water’s edge to protect the open views. Based upon these guidelines, Johnson says the building is set back 100 feet and the scale of the 378,367-square-foot hospital was reduced by dividing the structure into two connected sections, with an eight-story patient tower that’s farther away from the shore and a three-story therapeutic gymnasium and pool that’s nearest to the water.

A glass curtain wall on the façade creates a sense of transparency and helps bring in daylight, with various sun-shading devices used to control heat gain.

The lower massing of the three-story building allows for a series of therapeutic rooftop terraces on floors three and four, which include outdoor exercise spaces and vegetable and flower gardens. Johnson says the horizontal lines of the steel and glass exterior also suggest movement, which ties into the facility’s rehabilitative nature.

Outside, trails are outfitted with different types of ramps, steps, and cobblestones to help patients practice different experiences they’ll face once they leave the hospital. An inlet called Little Mystic is also the setting for the facility’s adaptive water sports.

“Hospital architecture is more than just functional and dimensional planning,” Johnson says. “You have to think about experiential things as well—daylighting, outdoor space, the views—it’s all part of the healing environment.”

Active member of the community
The design and architecture also allow Spaulding Rehabilitation Hosp
ital to become a gathering place for the community—in good times and bad.

The facility is located along the Boston Harborwalk, and the BRA requires developers to provide public access on their ground floors. Therefore, 75 percent of the first floor is dedicated to public use, including meeting spaces, public restrooms, and a cafeteria.

Guenther says this also provided Spaulding with the chance to rethink how its programs could help patients re-engage in public by providing them opportunities to immerse themselves in the facility’s community spaces, too. “It’s a reverse inclusion idea,” she says. “If you can go down to the ground floor and eat as you’re getting better, you’re becoming more normalized and engaging as a citizen in society rather than like an invalid in an institution.”

The accessible design and open public spaces can also become a place of refuge for the community in an emergency. The ground floor café and meeting rooms can provide safe haven services if the community is impacted by a severe weather event or blackout.

“The idea of privatizing resources like waterfronts is an old idea that’s being replaced with notions of these shared elements or common resources,” Guenther says. “We’ll all care more about it, protect it better, and be willing to invest in these sorts of resiliency measures if we’re all sharing the benefits of them.”

For a source list relating to this project, see “Spaulding Rehabilitation Hospital: Project Breakdown.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at