In 2022, a single conversation shifted Prof. Pia Raanani’s perspective on family caregivers (relatives, friends, or neighbors who provide assistance related to an underlying physical or mental disability), sparking her mission to secure their recognition as vital partners in patient care.
Raanani, head of the Hematology and Hemato-Oncology division at the Rabin Medical Center, Petah Tikva, was on the phone with a woman whose husband was undergoing hemato-oncology treatment. The wife described the daily strain of managing her spouse’s care at home and the difficulty of navigating a medical system that offered no formal recognition and little support.
“Suddenly, I understood how much we focus on the patient and fail to see the person standing behind the patient,” Raanani told the Magazine.
In recent years, a generalized shift toward home-based care has begun to highlight the importance of caregivers. In Israel, one and a half million caregivers provide daily assistance to loved ones living with physical disabilities, cognitive impairment, or chronic, life-limiting illnesses.
Unlike in the United States, where caregivers are paid for their efforts, in Israel those who look after their sick, wounded, or aging relatives not only do so for free, but do so without institutional recognition, operating largely outside the official healthcare system, though it increasingly relies on them to sustain treatment at home.
Recognizing the health and wellness of caregivers
Raanani, who established the Hematology Oncology Inpatient unit at the Rabin Medical Center-Beilinson Campus Davidoff Center for Cancer Care and Research in 2007, was unaware of the major oversight that left caregivers to navigate the complex medical system alone on behalf of their patients.
Following the 2022 phone call, she began to understand that there is no standard process for identifying or supporting caregivers, no routine check for burnout, and little recognition of caregiving as a health risk.
Official support, when it exists, is typically reactive rather than preventive, offered only when a crisis has already emerged. Unlike patients, caregivers are not formally assessed, documented, or supported.
Recognizing the insufficient attention paid to the emotional and physical toll caregivers endure, Raanani – a physician for close to four decades – decided to transform an afterthought into a primary concern, positioning the Davidoff Cancer Center’s hematology division as a pioneer in an area the healthcare system has widely overlooked.
She explained that with the home and family as “the arena of care,” the person who is there for the patient day after day, observing, monitoring, and paying attention, becomes enormously important: “From clinical experience, we see that adherence to treatment directly affects response to it, and the moment a family member becomes worn down or collapses, the treatment is affected as well.”
She began addressing the gap by partnering with Rachel Ledany, founder of the Caregivers Israel association, which, since 2014, has worked to raise awareness about the needs of family caregivers.
In 2022, Raanani published an interview with Ledany in the journal Acta Haematologica titled “Make Family Caregivers Visible, Valued, and Supported: An Interview with Patients’ Caregivers’ Advocate.”
In the interview, Ledany discussed two consequences that family caregivers face: the negative impact of treatment on caregivers’ health, and the frequent neglect of their own well-being.
“One of the problems is that family caregivers do not perceive and define themselves as such and are not aware of their own need for help. Furthermore, they might be ashamed to ask for it,” Ledany said in the interview.
Research indicates that caregiving stress is not only emotional but also biological. Chronic stress has been shown to accelerate the shortening of telomeres – protective caps at the ends of chromosomes that help maintain cellular health. Telomeres naturally erode over time, and so prolonged emotional and physical strain may hasten this process, providing biological evidence of how sustained caregiving stress can directly affect long-term health.
Ledany identified the various roles of a caretaker as “help at home,” “escorting outside home,” “care management,” “emotional support,” and “decision-making”. In practice, these roles translate into coordinating appointments and transportation, filling out medical and insurance forms, attending consultations, and providing support in moments of emotional distress. Many caregivers assume additional responsibilities, such as including monitoring, virtual visits, home hospice care, and the administration of medication.
Against this backdrop, Raanani began to institute structural changes within the Hematology and Hemato-Oncology Department at the Davidoff Center.
“We gave this situation a name and a place, including a dedicated tab in the computerized medical record. It may sound technical, but it represents a conceptual shift. The son or daughter, the spouse, exists in the system, not only the patient,” she said.
Following this more technical alteration, Raanani focused on providing regular support groups that offer safe spaces for caregivers where they can emotionally process their journey away from the cancer patients.
Along with social worker Orit Horn and nurse Maly Rubinstein, Raanani established a support group for family caregivers who had patients in the Hematology and Hemato-Oncology division. The group expands on support practices already in place in the department.
“We said that the special thing is that it’s not just a group,” Raanani added. “It’s a group that is under the doctor’s prescription; part of the treatment that we give to our patients is also a support group for their family caregivers.”
For a two-year period ending in December 2025, the group included 50 members, with weekly meetings typically ranging from 10 to 20 participants.
Dr. Dubi Levin, a physician and caregiver for his wife, attended meetings regularly for two years.
“Compassion, compassion, compassion, and compassion; they taught me compassion,” he said in an interview. “By being with other people, you learn sometimes that your problem is big, but not as big as you think. And then by being in a group, you get help. People tell you about what to do with administration. People tell you which psychology to choose.”
Levin reflected on how the support group reshaped his relationship with his wife, helping him to better navigate and respond to the emotional challenges they faced.
“It’s very hard listening to a cancer patient because it’s not a complaint; it’s fear. Most people are hearing complaints; I hear fear. And you have to understand that your spouse, your daughter, your whatever, [they] fear. They are terrorized.
“I am in love with [my wife] because I understood her, and I had compassion. When you have a cancer patient, you can look at [him/her] as a complainer, and you can look at [him/her] as one that is in need of love. We learned in the group that the patient needs love,” Levin said.
Additionally, Levin credited the efforts of Horn and Rubinstein, emphasizing their valuable insight and successful management of the group.
“This is what the group does if you have people like Orit and Maly because they were amazing company,” Levin said. “We looked at them [as] company, and [through] every word they gave life to the [patients’ families].”
Following this initial trial run, on January 16 a new support group was launched, structured as a 10-session program.
“[Horn and Rubinstein] felt [the first support group was] too long,” Raanani said. “Family caregivers of patients who died were together with new family caregivers of patients who just arrived. [Now], when [the 10 sessions] end, a new group will start, etc.”
The revised format aims to preserve the group’s supportive effect while better matching caregivers’ stages of experiencing illness and loss.
“The caregiver programming they have started in Beilinson [hospital], doing this group – it’s amazing,” Levin said. “[It] is the best exchange value for the hospital and for humanity because you’ve got a cancer patient with three, four, or five people [in] the family. You don’t have [just] the patient.”
In may 2025, Raanani was invited to speak to a small committee in the Knesset, with the goal of garnering attention for the project. She also spoke with President Isaac Herzog, further bringing her department’s efforts into the spotlight.
“This recognition brings the issue into a broader discourse and signals to the system that there is a blind spot that needs to be corrected. Our aspiration is to expand the model to all hospital departments.
“I see that today we’re in a much better place than when we started two years ago,” Raanani said. “There [used to be] total ignorance. I have a feeling [that] the more we publish it, the more people [will] know about it.”
For Raanani, that growing awareness reflects a simple principle: “By empowering the family caregiver, we help prevent the drowning of the patient.”