Background The architecture and design of healthcare settings impact health outcomes, satisfaction, and wellbeing (Ulrich, Zimring, Zhu, X, et al. HERD. 2008;1(3):61–125). Homelike design is recommended for hospices internationally (Verderber, Refuerzo. Innovations in hospice architecture. Taylor & Francis Group; 2010), but the kinds of domestic residence evoked by homelike hospice design in England have not been identified, nor how they relate to those of the population served.

Aim To establish the extent to which hospice buildings in England are homelike and explore the types of residence homelike designs reflect.

Methods A database of all hospices with adult inpatient units in England was created using a dataset provided by Hospice UK. A representative sample of 10 sites was selected using a sampling frame based on size, location, organisational model, area demographics and building type. Sites were examined and photographed by a researcher trained in architectural analysis. The approach to homelike design in primary documents from each site was assessed. Data analysis was informed by critical geography of architecture approaches (Lees. Ecumene. 2001;8(1),51–86).

Results All hospice buildings visited included some degree of structural or decorative homelike design features but the presentation of homelike design varied. Hospices in converted residences typically retained their appearance as large detached houses with private gardens, a residence type negatively correlated in England with the most deprived areas, social renters, and households with a black, Asian or minority ethnic household reference person (Ministry of Housing, Communities and Local Government. English housing survey: households report, 2017–18; 2019). Purpose-built hospices varied from visually institutional and un-homelike, to homelike settings reflecting the layout of detached homes with private gardens, or inspired by luxury hotel and spa design.

Conclusion The reflection in homelike hospice buildings of design associated with the homes of majority ethnic and wealthier demographics, and the design of luxury settings, raises questions as to the inclusivity of this design trend and its potential to contribute to the documented inequity of access to hospice care among disadvantaged and minoritized groups (Nelson, Wright, Peeler, et al. Am J Hosp Palliat Med. 2021;38(11):1378–1390).