Ranking the States for End-of-Life Care

Healthcare Writer

Updated on May 31st, 2024

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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.

StateRankScoreCostAccessQuality
Alabama168.1623.9118.6425.6
Mississippi265.9923.3423.3919.27
Idaho365.5718.6926.220.68
Louisiana464.7522.9522.1119.68
Utah563.217.521.8523.85
Arkansas662.5321.2420.4420.85
Oklahoma762.1921.2128.6412.34
Ohio860.8718.224.4818.18
California960.0620.2117.9221.93
Florida1060.0219.0416.2124.77
Delaware1160.0214.7614.7330.52
Indiana1259.0315.7624.9118.35
Colorado1358.6718.1519.3521.18
Missouri1458.3218.2723.9516.1
Iowa1558.1318.324.4815.35
Kansas1658.0215.4728.713.84
Nebraska1757.415.9622.3319.1
Rhode Island1857.3915.5120.8621.02
Texas1956.7520.6620.8315.26
New Mexico2056.4319.2326.6910.51
Tennessee2155.6320.213.2422.18
South Dakota2254.9917.9519.7817.26
Arizona2354.5818.1519.3317.1
Pennsylvania2454.3418.0818.8317.43
Georgia2553.9920.7312.9120.35
Nevada2653.8920.0914.9518.85
Michigan2753.8715.5721.217.1
North Dakota2853.2414.6117.3721.27
South Carolina2953.0320.2512.620.18
Massachusetts3051.8314.811621.02
Minnesota3150.2511.9126.2512.09
Maryland3250.2119.5212.2518.43
Kentucky3349.8620.0411.1318.68
Vermont3449.3513.6519.2716.43
New Jersey3549.0914.0810.9924.02
Hawaii3648.6526.345.5516.76
Connecticut3748.1213.9515.4918.68
Maine3848.0211.520.0116.51
New Hampshire3947.4713.371519.1
Wisconsin4046.9214.3215.8316.76
West Virginia4146.6917.1114.7414.85
Illinois4246.6714.615.2216.85
Montana4345.9220.3619.36.26
North Carolina4445.9120.238.0917.6
Virginia4543.9516.979.2217.76
Oregon4642.8515.7311.7815.35
New York4741.4214.549.217.68
Wyoming4840.5316.9515.997.59
Washington4939.0213.128.3917.51
Alaska5038.4612.5415.8310.09

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

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  • 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

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  • 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.

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