Home or hospice: The debate over the closure of St Luke’s inpatient unit

St Luke’s, a respected institution in Cape Town, has been caring for patients with life-threatening illnesses since 1980. However, there is a debate over the closure of the institution’s inpatient unit in December 2024. Despite a budget of about R25-million a year, St Luke’s has shifted its focus towards community and home-based palliative care.

Former staff and volunteers are urging the reopening of the unit, arguing that its closure has left many terminally ill patients and their families without a safe place to receive care.

St Luke’s Combined Hospices offers palliative and hospice services to over 600 people daily across the city, free of charge. The inpatient unit, which cared for patients who could not be cared for at home, is seen as a vital component that is now missing. Former staff and volunteers explain that a bed in the inpatient unit was used to relieve pain, bring symptoms under control, and provide a safe place for patients who could not be cared for at home.

The closure of the unit means that community nurses no longer have an option to refer patients to the inpatient unit when the need becomes too great to manage at home.

A former St Luke’s doctor confirmed that it is not always possible to provide adequate care for every patient at home, particularly in poor conditions. He emphasized that losing a secure place with trained staff to guide patients and families through the dying process is a significant loss. Volunteers, who spoke anonymously, expressed concern for patients who could not afford private care and whose home circumstances were extremely difficult.

They noted that some patients repeatedly requested respite care, stating that they had never experienced basic comforts such as having their feet rubbed or someone listening to them. These patients, who do not pay for services, are now without access to the inpatient unit.

The St Luke’s board closed the inpatient unit after evaluating its usage and exploring alternatives, including seeking government funding and philanthropic support. Despite these efforts, the board found that the unit was operating as a ten-bed facility with insufficient funding for long-term viability. They implemented "phasing out" measures but ultimately decided that keeping the unit open was no longer feasible.

Instead, St Luke’s has redirected its resources to community-based care, benefitting a larger number of patients. For those requiring inpatient care, the institution works with other providers, such as Living Hope, and refers patients to public health facilities like Groote Schuur Hospital. The board stated that there are no plans to reopen the unit but would reconsider if there was evidence of a clinical need that cannot be effectively managed through home-based care or existing partner healthcare facilities, along with a long-term funding commitment to cover the costs of 24-hour staffing.