Pediatric Home Hospice as a National Service in Israel

Pediatric home hospice allows children with life-limiting illnesses to receive end-of-life care in familiar surroundings, supported by interprofessional teams. Despite recognized benefits, utilization remained limited in many countries, and few studies evaluated national programs outside of Europe and North America.

To describe the characteristics, service utilization patterns, and end-of-life outcomes of children enrolled in Israel's largest pediatric home hospice program over a 12-year period.

This retrospective cohort study included all patients aged 0-21 years enrolled in the Sabar Health pediatric home hospice program between 2012 and 2023. Data were extracted from clinical and administrative records and included age, sex, diagnosis, ethnicity, length of stay (LOS), place of death, and discharge status. Descriptive statistics and group comparisons were performed using chi-square and Mann-Whitney U tests.

The cohort included 277 patients, of whom 221 (79.8%) had cancer and 56 (20.2%) had non-cancer diagnoses. The median LOS was 40 days (interquartile range [IQR]: 12-89) for cancer patients (p = 0.012) and 84 days (IQR: 20-173) for non-cancer patients. Among the 201 patients who died on hospice, 96 of 221 had cancer (43.4%), and 17 of 56 had non-cancer diagnoses (30.4%). Live discharge occurred in 50 of 221 cancer patients (22.6%) and in 26 of 56 non-cancer patients (46.4%). Most patients were older than five years (n = 228, 82.3%).

This study highlights that pediatric home hospice in Israel primarily serves older children and those with cancer diagnoses, while younger children and those with non-cancer diagnoses are less likely to access these services. They are also less likely to die at home. These findings emphasize the need for flexible, diagnosis, and age-sensitive hospice models with early recognition of relevant patients. System-level investment is essential to align pediatric hospice care with clinical realities and family preferences.