Ranking the States for End-of-Life Care

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

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.