Vermont, Utah Ranked ‘Best Places to Die’ by Policygenius

Facing mortality is never easy, but patients and families may see fewer hardships in some geographies. Some signs point to Vermont and Utah as states in which people were more likely to have a better end-of-life experience, whereas families in New Jersey or New York may encounter more difficulties.

A recent analysis by the insurance marketplace firm Policygenius ranked factors associated with a loved one’s death in each state and the District of Columbia. The organization based its findings on indicators such as the number of people who passed away in their homes, the availability of palliative care, access to green burials and funeral costs. 

The analysis also took into account the ratio of Medicare-certified health care providers to eligible patients, as well as probate processes.

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The report concluded that Vermont was “the best place to die” in the United States.

“[Vermont] ranked fifth for the density of funeral homes and related services, including cemeteries and crematoriums, and third for green burial options,” the report indicated. “However, the average funeral costs are more expensive than 86% of the country, which makes sense given Vermont’s higher than average cost of living.”

Policygenius also cited the availability of palliative care in the state, though throughout its nationwide comparison it zeroed in on the hospital setting rather than community-based services. About 38% percent of decedents in Vermont died in their homes rather than a facility, the report found.

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Utah ranked second according to the analysis. At 42%, the state had the highest proportion of decedents who reached the end of life in their residences. Utah fell short of the top spot due to its low concentration of funeral homes.

Incidentally, as of 2018 Utah also had the highest rate of hospice utilization among Medicare decedents at 60.5%, compared to that year’s national average of 50.3%, according to the National Hospice & Palliative Care Organization (NHPCO).

Other states in the Policygenius top 10 included Idaho, Ohio, South Dakota, Maine, New Hampshire and Washington, with Illinois and Colorado tied for number seven.

The analysis cited data for each metric ranging from 2018 to early 2022, depending on the individual indicator. For deaths at home, for example, the report included numbers from 2018 to 2021. Whereas the probate data was based on information from early 2022.

For the lowest-ranking states — New York and New Jersey — the deciding factors were high funeral costs and smaller percentages of in-home deaths, 29.7% and 29.9%, respectively.

The analysis did note that New Jersey had made strides in recent years in terms of making palliative care more available.

“On the bright side, New Jersey excels in palliative care, ranking 9th for this data point,” Policygenius indicated. “In 2019, the state enacted a palliative care law, aimed at identifying patients who could benefit from these services and making information more readily available to them.”

Among the other states the report deemed “worst places to die” were Hawaii, Texas, Alaska and Florida.

Nationwide, the burden on bereaved families is severe, other research has found.

Families spend as many as 500 hours over as long as 13 months completing administrative tasks related to their loved one’s death, a recent report from the bereavement care technology company Empathy found.

The average cost to the bereaved exceeds $12,000, according to that report. These factors also cause stress that can complicate grief, as well as adversely affect family members’ health and job performance.

“Grief is made harder by logistics and logistics are made harder by grief,” Ron Gura, co-founder and CEO of the bereavement care tech platform Empathy, told Hospice News. “If you need to get up in the morning and call Amazon to delete your partner’s name, call the [U.S. Department of Veterans Affairs], arrange a ceremony, work with Social Security, IRAs, pensions, property brokers, probate court, it just makes things worse.”

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