While roughly 90% of Americans agree that discussing end-of-life care with their loved ones is important, only 27% actually follow through with conversations focused on planning, according to research from public engagement initiative The Conversation Project.
Although many have ramped up community outreach efforts, that aversion to thinking about death has been a roadblock for hospice providers in some parts of the country.
A new study by Dallas-based life insurance technology company Bestow Inc. has identified several states states where end of life is on people’s minds, however.
Bestow was founded in 2016 by Jonathan Abelmann and Melbourne O’Banion. As an early-stage venture, the company has raised about $17.5 million to date, according to online investment tracker Crunchbase. That includes a $15 million Series A round that closed in May 2018, led by Valar Ventures.
Overall, Wisconsin is the state most concerned about end-of-life issues, with New York as a close second, according to the Bestow study. New Hampshire, South Dakota and Ohio make up the rest of the top five, in order.
The states least concerned about end-of-life issues: Nevada, California, Wyoming, Utah and Alaska.
As a state with a large senior citizen population, California’s inclusion in that group is somewhat surprising, Jackie Morales, chief insurance officer at Bestow, told Home Health Care News.
“We found that population size has little to no bearing on concern or awareness toward end-of-life issues, which surprised us,” Morales said. “One would imagine that states like California or Florida, two states that boast some of the highest senior citizen populations in the U.S., would rank at the top of our list for end-of-life issues. However, it turned out that states in the Midwest, such as Wisconsin, South Dakota, and Ohio are more concerned about these issues.”
To determine which states are thinking the most about end-of-life issues, Bestow evaluated the prevalence of certain targeted online search terms, including “palliative care,” “estate planning,” “end-of-life care,” “home care,” “caregiver,” “assisted living” and others.
The term “home care,” ranked the highest in northeastern states such as New York, Pennsylvania and Connecticut. In fact, it was the most-searched targeted in New York and Pennsylvania.
New York’s interest in home care could, perhaps, be explained by the fact home health aides and personal care aides are among the state’s largest occupational group, according to Bestow.
Nationally, home care employment is expected to grow by more than 40% between 2016 to 2026, according to the U.S. Bureau of Labor Statistics.
“We found that a state’s interest in a given end-of-life topic was based on a health care-related issue unique to that area,” Morales said. “For instance, Wisconsin, the state we deemed the most concerned about end-of-life issues, ranked the highest for the term ‘caregiver.’ This is most likely due to the fact that Wisconsin has had an ongoing challenge in finding and retaining qualified caregivers, which has impacted its ability to keep pace with patient demand.”
While Alaska checked in toward the bottom of Bestow’s study, it was No. 1 in terms of hospice admissions growth from the second quarter of 2017 to the same period in 2018. Specifically, the state’s hospice admissions jumped by more than 17%, far outpacing Wisconsin 6.5% growth, according to the latest quarterly data from Atlanta-based metrics firm Excel Health.
Alaska, Delaware and South Dakota all saw double-digit hospice admissions growth from Q2 2017 to Q2 2018, while Maine, North Dakota, Nebraska, Hawaii, New York and Rhode Island all experience negative growth.
Elevating the end-of-life care discussion and raising hospice awareness has also been a priority for federal lawmakers.
The U.S. House of Representatives in July passed the Palliative Care and Hospice Education Training Act (PCHETA), a bipartisan piece of legislation designed to expand and strengthen end-of-life care through outreach and training programs.
PCHETA was received in the Senate on July 24, read twice, and referred to the Committee on Health, Education, Labor and Pensions.
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