Despite rapid population aging in Korea, home-based hospice care continues to exhibit low levels of service provision and utilization, and empirical research on regional disparities remains limited. Using national hospice data, regional aging indicators, and place-of-death statistics(2016–2024), four hypotheses were tested regarding supply levels, growth trends, spatial aging clusters, and demand–supply mismatches. Home-based hospice had the lowest supply among all service types (39 institutions nationwide) and showed no growth after 2019. High-aging regions—Jeonnam, Gyeongbuk, Gangwon, and Jeonbuk—formed a high–high spatial cluster, yet these areas had limited access to home-based services. A mismatch between high potential demand and available supply was confirmed, although detailed local analysis was constrained by data limitations. Korea’s hospice system remains hospital-centered, and home-based services are insufficiently aligned with regional demographic needs. Strengthening community-based hospice models and improving spatial equity are necessary to expand access to end-of-life care.