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Ranking U.S. States on End-of-Life Care: The Best & Worst States Revealed

How does your state rank when it comes to end-of-life care? In this blog, we break down the 2024 State-by-State Scorecard on Palliative Care released by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center.

6/30/20254 min read

Which U.S. States Are Best at Dying? A Look at Palliative Care Rankings

A few weeks ago, we explored which countries do death best, based on a global survey from Duke University. That video sparked a wave of interest, with many people asking: “Do they break it down by regions or states?” While Duke’s report didn’t go that far (and even said so), it raised a great question — how do different states within a country rank when it comes to end-of-life care?

So, over the next few weeks, we’ll be diving into the internal data of several countries — beginning with the United States, which, if you recall, came in 43rd globally in that original report.

Today’s post looks at how U.S. states compare when it comes to palliative care access and infrastructure. Spoiler: it's a mixed bag.

What Is Palliative Care and Who Tracks It?

Every few years, the Center to Advance Palliative Care (CAPC) — based at the Icahn School of Medicine at Mount Sinai in New York — collaborates with the National Palliative Care Research Center (NPCRC) to produce a comprehensive report titled:

“America’s Readiness to Meet the Needs of People with Serious Illness: A State-by-State Look at Palliative Care Capacity”

We’re using their 2024 Scorecard for this analysis. You can view the full report here.

Palliative care is not just for the dying — it’s also for those living with serious illness. But most frequently, it’s used by people with terminal diagnoses or those in advanced age. The scorecard evaluates each state on a 5-point scale based on:

  • Availability of specialty-trained palliative care professionals

  • Payment structures for services

  • Public awareness and access mechanisms

  • Basic education in palliative care for clinicians

  • Support for caregivers and functional needs

These are basic standards for any modern healthcare system. Not asking for miracles here.

Important Note: Voluntary Assisted Dying (VAD) laws are not included in the rankings. CAPC intentionally left this out to avoid politicizing the scorecard or conflating different end-of-life options. VAD is a separate issue. High-quality palliative care should always be available — regardless of your stance on VAD.

How Did the States Rank?

Before you scroll — take a moment to guess: How do you think your state scored out of 5? Done? Great. Here’s what the report found:

🌟 4.5 Stars (Top Ranking):

  • Massachusetts

  • Oregon

🌟 4 Stars:

  • California

  • Connecticut

  • Illinois

  • Maryland

  • New Jersey

  • Ohio

🌟 3.5 Stars:

  • Alaska

  • Colorado

  • Delaware

  • Kentucky

  • Maine

  • Minnesota

  • New Mexico

  • New York

  • Pennsylvania

  • Vermont

  • Virginia

🌟 3 Stars:

  • Florida

  • Hawaii

  • Michigan

  • Montana

  • Nebraska

  • New Hampshire

  • Rhode Island

  • Washington

⚠️ 2.5 Stars:

  • Alabama

  • Arizona

  • Indiana

  • Iowa

  • Kansas

  • Nevada

  • North Carolina

  • North Dakota

  • Texas

  • West Virginia

  • Wisconsin

⚠️ 2 Stars:

  • District of Columbia

  • Georgia

  • Louisiana

  • Mississippi

  • South Carolina

  • South Dakota

  • Tennessee

  • Utah

⚠️ 1.5 Stars:

  • Idaho

  • Missouri

  • Oklahoma

🚨 1 Star (Lowest Ranking):

  • Arkansas

  • Wyoming

If your jaw dropped, you’re not alone. We were surprised by New York’s middle-of-the-pack placement and Alabama not coming in last — shocking, right? You can view the full score breakdown here.

What’s Happening With U.S. Hospitals?

One part of the report that stood out: the U.S. is rapidly losing hospitals. In fact, nearly every state has fewer hospitals in 2024 than it did in 2019. For example:

  • Alabama: 56 → 28 hospitals

  • Illinois: 103 → 79

  • North Carolina: 74 → 52

This decline is mostly due to rural hospital closures, largely because insurance companies pay them far less than urban hospitals for the same services. That’s a big problem — especially since rural hospitals are already less likely to offer palliative care.

On the flip side, the number of hospitals with palliative care teams has improved overall, which is good news. In some states, 100% of hospitals now have palliative care programs, including:

  • Alaska

  • Delaware

  • Maryland

  • New Hampshire

  • North Dakota

  • Rhode Island

  • Utah

  • Vermont

Other states like Ohio and New Jersey are close behind.

Full data on hospital coverage is here.

Who’s Doing the Heavy Lifting? Hospital Types Matter

Let’s break it down by hospital type:

🏥 For-Profit Hospitals

  • Goal: Generate profit for investors

  • Funding: Primarily through insurance/patient payments

  • Palliative Care Access: 49%

🏥 Nonprofit Hospitals

  • Goal: Reinvest profits into services

  • Funding: Insurance + major donations/philanthropy

  • Palliative Care Access: Highest among all types

🏥 Public Hospitals

  • Goal: Serve vulnerable populations

  • Funding: Mix of insurance, government subsidies, and grants

  • Access: Variable, but often a safety net

The report confirms: for-profit and rural hospitals are least likely to offer palliative care. That’s a major equity issue.

The Workforce Problem

According to the scorecard, the U.S. has only 19,920 certified hospice/palliative care clinicians, with just 2.86 prescribers per 100,000 people. That’s alarmingly low.

Why? Palliative care isn’t a highly paid or “glamorous” specialty. But there is a positive trend: the CAPC is pushing for basic palliative care training for all healthcare professionals — not just specialists.

  • 22 states now require continuing education in end-of-life care for medical licensure.

  • 136,000+ professionals have completed CAPC’s online training in communication, pain management, dementia care, and more.

This wider education approach is working — and it’s key to reducing the over-medicalization of dying and helping healthcare workers handle death better.

Final Thoughts

America’s end-of-life care picture is complicated. Some states are doing well, others are drastically underperforming. But the direction is hopeful, thanks to organizations like CAPC pushing for progress.

What should you do?

  • Don’t wait until you're dying to make plans.

  • Learn what’s available in your state.

  • Have conversations with your loved ones.

  • Make your wishes known in advance.

We’ll be covering Australia’s state-by-state rankings next, so be sure to check back or subscribe on YouTube for updates.

Until then — go talk death.

Resources:


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