Home Hospice Service Use Trends in Israel 2014–2023

Background: In Israel, several policies have supported the growth of home-based hospice through a unique public–private care delivery and financing system. Yet, little is known about trends in home hospice use in Israel. Objective: To describe 10-year trends in diagnosis, length of stay (LOS), and discharge patterns among home hospice patients in Israel. Design: We conducted a retrospective cohort study of all patients admitted to Sabar Health’s home hospice program between 2014 and 2023. Demographic and clinical data were analyzed by primary diagnosis: Cancer, dementia, end-organ failure, frailty, and neurodegenerative disease. Trends in enrollment, LOS, and live discharge rates were assessed over time. Results: Among 25,673 patients, the proportion with cancer annually declined from 88.6% in 2014 to 57.8% in 2023, while admissions for dementia rose from 0% in 2014 to 19.6% in 2023. Median LOS increased from 20 to 35 days, with the longest durations observed among patients with dementia and neurodegenerative disease. Live discharge rates also rose, particularly in the dementia group from 12.2% to 20% over the observed period, with a growing share occurring after ≥180 days. Conclusions: Home hospice care in Israel has evolved significantly over the past decade, with increasing enrollment of patients with prolonged and uncertain illness trajectories. These trends emphasize the need for more adaptable eligibility frameworks, improved prognostic tools, and expanded caregiver support to meet the needs of a diversifying hospice population.