How do the U.S. States Compare on End-of-Life Care?
Facing the realities of end-of-life care is never easy to handle. From palliative to hospice to memory care, older Americans and their families have to navigate various stages of care and providers. Unfortunately, the cost, access, and quality differ in each state.
Fast Facts
Highest Ranked: Alabama and Mississippi | Lowest Ranked: Alaska and Washington
Cheapest Costs: Hawaii, Alabama | Most Expensive: Maine and Minnesota
Best Access to care: Kansas and Oklahoma | Worst Access: Hawaii and North Carolina
Best Quality: Delaware and Alabama | Worst: Montana and Wyoming
HealthCare.com looked at 28 metrics to determine which states ranked the highest for end-of-life care. Read below for our full findings and methodology.
| State | Rank | Score | Cost | Access | Quality |
|---|---|---|---|---|---|
| Alabama | 1 | 68.16 | 23.91 | 18.64 | 25.6 |
| Mississippi | 2 | 65.99 | 23.34 | 23.39 | 19.27 |
| Idaho | 3 | 65.57 | 18.69 | 26.2 | 20.68 |
| Louisiana | 4 | 64.75 | 22.95 | 22.11 | 19.68 |
| Utah | 5 | 63.2 | 17.5 | 21.85 | 23.85 |
| Arkansas | 6 | 62.53 | 21.24 | 20.44 | 20.85 |
| Oklahoma | 7 | 62.19 | 21.21 | 28.64 | 12.34 |
| Ohio | 8 | 60.87 | 18.2 | 24.48 | 18.18 |
| California | 9 | 60.06 | 20.21 | 17.92 | 21.93 |
| Florida | 10 | 60.02 | 19.04 | 16.21 | 24.77 |
| Delaware | 11 | 60.02 | 14.76 | 14.73 | 30.52 |
| Indiana | 12 | 59.03 | 15.76 | 24.91 | 18.35 |
| Colorado | 13 | 58.67 | 18.15 | 19.35 | 21.18 |
| Missouri | 14 | 58.32 | 18.27 | 23.95 | 16.1 |
| Iowa | 15 | 58.13 | 18.3 | 24.48 | 15.35 |
| Kansas | 16 | 58.02 | 15.47 | 28.7 | 13.84 |
| Nebraska | 17 | 57.4 | 15.96 | 22.33 | 19.1 |
| Rhode Island | 18 | 57.39 | 15.51 | 20.86 | 21.02 |
| Texas | 19 | 56.75 | 20.66 | 20.83 | 15.26 |
| New Mexico | 20 | 56.43 | 19.23 | 26.69 | 10.51 |
| Tennessee | 21 | 55.63 | 20.2 | 13.24 | 22.18 |
| South Dakota | 22 | 54.99 | 17.95 | 19.78 | 17.26 |
| Arizona | 23 | 54.58 | 18.15 | 19.33 | 17.1 |
| Pennsylvania | 24 | 54.34 | 18.08 | 18.83 | 17.43 |
| Georgia | 25 | 53.99 | 20.73 | 12.91 | 20.35 |
| Nevada | 26 | 53.89 | 20.09 | 14.95 | 18.85 |
| Michigan | 27 | 53.87 | 15.57 | 21.2 | 17.1 |
| North Dakota | 28 | 53.24 | 14.61 | 17.37 | 21.27 |
| South Carolina | 29 | 53.03 | 20.25 | 12.6 | 20.18 |
| Massachusetts | 30 | 51.83 | 14.81 | 16 | 21.02 |
| Minnesota | 31 | 50.25 | 11.91 | 26.25 | 12.09 |
| Maryland | 32 | 50.21 | 19.52 | 12.25 | 18.43 |
| Kentucky | 33 | 49.86 | 20.04 | 11.13 | 18.68 |
| Vermont | 34 | 49.35 | 13.65 | 19.27 | 16.43 |
| New Jersey | 35 | 49.09 | 14.08 | 10.99 | 24.02 |
| Hawaii | 36 | 48.65 | 26.34 | 5.55 | 16.76 |
| Connecticut | 37 | 48.12 | 13.95 | 15.49 | 18.68 |
| Maine | 38 | 48.02 | 11.5 | 20.01 | 16.51 |
| New Hampshire | 39 | 47.47 | 13.37 | 15 | 19.1 |
| Wisconsin | 40 | 46.92 | 14.32 | 15.83 | 16.76 |
| West Virginia | 41 | 46.69 | 17.11 | 14.74 | 14.85 |
| Illinois | 42 | 46.67 | 14.6 | 15.22 | 16.85 |
| Montana | 43 | 45.92 | 20.36 | 19.3 | 6.26 |
| North Carolina | 44 | 45.91 | 20.23 | 8.09 | 17.6 |
| Virginia | 45 | 43.95 | 16.97 | 9.22 | 17.76 |
| Oregon | 46 | 42.85 | 15.73 | 11.78 | 15.35 |
| New York | 47 | 41.42 | 14.54 | 9.2 | 17.68 |
| Wyoming | 48 | 40.53 | 16.95 | 15.99 | 7.59 |
| Washington | 49 | 39.02 | 13.12 | 8.39 | 17.51 |
| Alaska | 50 | 38.46 | 12.54 | 15.83 | 10.09 |
End-of-Life Care: Rankings
Metric Breakdown
COST
Funeral Costs
- Highest: Hawaii
- Lowest: Mississippi
Home Health Aides
- Cheapest: Lousiana
- Most Expensive: Minnesota
Cremation Costs
- Cheapest: Alabama
- Most Expensive: South Dakota
Nursing Home Care for a Private Room
- Cheapest: Missouri
- Most Expensive: Alaska
Total Medicaid Payments for Older Americans Living with Alzheimer’s
- Highest: Rhode Island
- Lowest: Arizona
End-of-Life Medical Costs
- Highest: Hawaii
- Lowest: Mississippi
Prescription Drug Prices Per Capita
- Cheapest: Hawaii
- Most Expensive: Tennessee
Memory Care
- Cheapest: Missouri
- Most Expensive: Delaware
Adult Day Care
- Cheapest: Alabama
- Most Expensive: Maine
ACCESS
Skilled Nursing Facilities Per Capita
- Most: North Dakota
- Least: New York
Home Health Aids Per Capita
- Most: New York
- Least: Florida
Percentage of Medicare Decedents that were in Hospice at Time of Death
- Highest: Utah
- Lowest Alaska
Pharmacies Per 10K Residents
- Most: North Dakota
- Least: Oklahoma
Total Hospital Beds Per Capita
- Most: South Dakota
- Least: Oregon
Healthcare Social Worker Employment per 1,000 Jobs
- Most: Massachusetts
- Least: Utah
Home Health Agencies Per Capita
- Most: Texas
- Least: New Jersey
Hospice Agencies Per Capita
- Most: Utah
- Least: Florida
Geriatricians Per Capita
- Most: Hawaii
- Least: Montana
QUALITY
Outcomes While in Home Healthcare
- Best: Mississippi
- Worst: Alaska
Fall Deaths Per 100,000 Residents
- Most: Wisconsin
- Least: Alabama
Medicare Hospice Utilization by State: Average Reimbursement Per Patient
- Best: California
- Worst: Alaska
Quality Ratings for Nursing Homes
- Best: Hawaii
- Worst: Louisiana
Hospice Score
- Best: North Dakota
- Worst: Wyoming
Palliative Care Score
- Best: *Tie* Delaware, New Hampshire, Rhode Island, Vermont
- Worst: Mississippi
Medicare Spending Per Beneficiary Score
- Best: New Jersey
- Worst: Wisconsin
Home Healthcare Score
- Best: Alabama
- Worst: Montana
End-of-Life Care: Countdown
Methodology
To determine how the 50 U.S. States rank for End-of-Life Care, HealthCare.com compared the 28 metrics across three key categories: 1) Cost, 2) Access, and 3) Quality.
We analyzed those categories using 28 relevant metrics, which are detailed below. Each metric was graded on a 100-point scale, with a score of 100 representing the best end-of-life care at the most affordable cost.
Lastly, we determined 50 states’ weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.
Cost – Total Points: 33.33
- Funeral Costs: Full Weight
- Home Health Aides: Full Weight
- Cremation Costs: Full Weight
- Nursing Home Care for a Private Room: Full Weight
- Total Medicaid Payments for Older Americans Living with Alzheimer’s: Full Weight
- End-of-Life Medical Costs: Full Weight
- Prescription Drug Prices Per Capita: Full Weight
- Memory Care: Full Weight
- Adult Day Care: Full Weight
ACCESS
- Skilled Nursing Facilities Per Capita: Full Weight
- Home Health Aids Per Capita: Full Weight
- Percentage of Medicare Decedents that were in Hospice at Time of Death: Full Weight
- Pharmacies Per 10K Residents: Full Weight
- Total Hosptial Beds Per Capita: Full Weight
- Healthcare Social Worker Employment per 1,000 Jobs: Full Weight
- Home Health Agencies Per Capita: Full Weight
- Hospice Agencies Per Capita: Full Weight
- Geriatricians Per Capita: Full Weight
- States with Legal Physician-Assisted Suicide Laws: Full Weight
QUALITY
- Outcomes While in Home Healthcare: Full Weight
- Fall Deaths Per 100,000 Residents: Full Weight
- Medicare Hospice Utilization by State:
- Average Reimbursement per Patient: Full Weight
- Quality Ratings for Nursing Homes: Full Weight
- Hospice Score: Full Weight
- Palliative Care Score: Full Weight
- Medicare Spending Per Beneficiary Score: Full Weight
- Home Healthcare Score: Full Weight
Sources: Data used to create this ranking were collected from the Genworth Cost of Care Survey, National Funeral Directors Association (NFDA), Centers for Medicare & Medicaid Services (CMS), SeniorLiving.org, Alzheimer’s Association, Kaiser Family Foundation (KFF), Bureau of Labor Statistics (BLS), Center to Advance Palliative Care (CAPC), American Association of Retired Persons (AARP), American Geriatrics Society (AGS), Alliance for Home Health Quality and Innovation (AHHQI), Centers for Disease Control and Prevention (CDC) and HealthCare.com research.
