South Africa: Home or Hospice - the Debate Over the Closure of St Luke's Inpatient Unit

In South Africa, a heated debate has emerged over the closure of St Luke's inpatient unit in Cape Town. While most individuals prefer to pass away in the comfort of their own homes, some require specialized care that can only be offered in an institution. Established in 1980, St Luke's has been providing assistance to those with life-threatening illnesses since its inception. However, the closure of their inpatient unit in December 2024 has sparked controversy.

The inpatient unit, funded primarily through donations, has transitioned towards community and home-based palliative care. Long-serving volunteers and former staff seek to reopen the unit, arguing that its absence leaves terminally ill patients and their families without a secure place to receive care when they can no longer be cared for at home. The management of St Luke's, on the other hand, believes that their current approach allows the institution to serve more people.

The inpatient unit once cared for patients who could not be cared for at home. Former nurses claim it provided relief for pain and symptom control, with patients typically staying for five to seven days before returning home. Additionally, it provided respite for families struggling to care for a terminally ill relative, as they lacked the necessary knowledge and training.

The closure of the unit has left community nurses unable to refer patients to the inpatient unit when their needs become too challenging to manage at home.

Former doctors working at St Luke's confirm that not all patients are suitable for home-based care, particularly those residing in poor conditions. They emphasize that patients who are unable to afford private care facilities and have extremely difficult home circumstances should not be left dying in unsuitable environments. Volunteers working at the unit express concern for patients who cannot afford private care and whose homes present significant challenges.

Motlalentoa Motsoane, CEO of the Association of Palliative Care Centres, acknowledges that over 90% of care provided by their members occurs at patients' homes. However, he emphasizes that inpatient services still play a crucial role in offering short-term support, respite for families and caregivers, and terminal care requiring palliative nursing support.

South Africa's National Policy Framework and Strategy on Palliative Care explicitly recognizes the need for inpatient care facilities, as identified in the 2017-2022 framework.

The St Luke's board closed the inpatient unit after evaluating its usage, researching international and local palliative care, and considering the sustainability of their model. Despite receiving no government funding, the unit operated with ten beds, averaging three to five patients in the three years before closure. The board claims that they explored alternatives to closing the unit, including seeking government funding and philanthropic support, but were unable to secure long-term funding.

St Luke's has since redirected resources to community-based care, benefiting a larger number of patients. For those requiring inpatient care, the institution collaborates with other providers, such as Living Hope, referring patients in need of hospital-level care to public health facilities like Groote Schuur Hospital.