While end-of-life planning requires many important decisions, one thing you may not consider is whether you’re in the right city. Where you spend your last days can make a difference in your own quality of life, and benefit your loved ones after your death.
“Across the board, we’re changing how we look at death and dying and burial,” says Elizabeth Fournier, author of “The Green Burial Guidebook” and owner and operator of Cornerstone Funeral Services in Boring, Oregon, in the Portland metro area. But location really does matter when it comes to finding quality hospice, palliative, and health care, as well as funeral services, and how easy it will be for your loved ones to settle your estate.
With that in mind, we crunched the numbers on the 100 largest metro areas in the United States to find and rank the best and worst cities to die in 2023.
How we ranked the cities
We weighed several factors that contribute to a good death, including the quality and availability of end-of-life care and the cost and availability of funeral services. This index incorporates the following seven factors.
Funeral costs: The median cost of a funeral among these metros was $7,848, but it varied by region from as low as $6,888 to as high as $8,500.
Funeral services: We calculated the ratio of funeral homes and other funeral service establishments to 100,000 residents in each metro area. A higher number means more options, and the average was just under four per 100,000.
Green burial cemeteries: The number of green burial cemeteries in the city, for people looking for a more sustainable option. Many cities have no green burial options, while one city, Portland, Oregon, has six green cemeteries.
4- or 5-star hospitals per 100,000 residents: The number of highly rated hospitals (according to Medicare) [1] , for every 100,000 people living in a city, as a measure of the quality and availability of local health care. The average was 0.48 per 100,000.
4- or 5-star hospices: The number of hospice care providers serving the city that received high ratings in a family caregiver survey. Hospices provide care for people who are terminally ill and have up to six months to live.
Palliative care providers: The number of palliative care providers within a 25-mile radius of the city’s geographic center. Palliative care is a specialized form of medical care that focuses on relieving a patient’s pain and other symptoms of a serious illness, regardless of the diagnosis or stage of the disease. It’s meant to improve quality of life for patients and families, and is provided alongside other care.
Probate shortcuts: Most states have simplified procedures for settling your estate as long as it’s worth less than a certain value. A higher value is better: It means more estates in that state can avoid the formal probate process. The average threshold value was $66,000.
For more details on these metrics and how we calculated our rankings, see the methodology section below.
The best cities to die in 2023
1. Portland, Oregon
Funeral cost: $7,225
Funeral services: 2.57 per 100,000
Green burial options: 6
Hospitals: 0.44 per 100,000
Hospices: 11
Palliative care: 5
Probate shortcut: $75,000
The Portland-Vancouver (Washington)-Hillsboro metropolitan area is 2023’s best city to die. Suiting its reputation as one of the most environmentally conscious cities in the United States, Portland leads all other major American cities in green burial options, with more than twice as many as the next-closest city. Portland also has some of the most affordable prices for funeral services.
2. Pittsburgh, Pennsylvania
Funeral costs: $8,093
Funeral services: 9.93 per 100,000
Green burial options: 1
Hospitals: 0.42 per 100,000
Hospices: 21
Palliative care: 9
Probate shortcut: $50,000
With nearly 10 funeral service providers for every 100,000 residents, the Pittsburgh metro area has the second-biggest selection of funeral options among the 100 cities in our study. Pittsburgh also scored highly in the availability and quality of hospice and palliative care.
3. Los Angeles, California
Funeral costs: $7,225
Funeral services: 1.47 per 100,000
Green burial options: 2
Hospitals: 0.19 per 100,000
Hospices: 6
Palliative care: 8
Probate shortcut: $166,250
The Los Angeles-Long Beach-Anaheim metro area, home to the famed Hollywood Forever Cemetery, placed third in our rankings, thanks in large part to the generous probate laws in California. Los Angeles also boasts affordable funeral costs and a good number of palliative care providers, making up for fewer funeral providers than expected for a city of its size.
4. Phoenix, Arizona
Funeral costs: $6,888
Funeral services: 1.69 per 100,000
Green burial options options: 0
Hospitals: 0.15 per 100,000
Hospices: 16
Palliative care: 10
Probate shortcut: $100,000
If you die in the Phoenix-Mesa-Chandler metro area, you’ll pay some of the lowest funeral costs in the country. Phoenix has plentiful palliative care providers, but there aren’t as many funeral service providers as you’d hope to find on a per capita basis.
5. San Francisco, California
Funeral costs: $7,225
Funeral services: 1.76 per 100,000
Green burial options: 1
Hospitals: 0.21 per 100,000
Hospices: 1
Palliative care: 8. Probate shortcut: $166,250
One of three California metro areas in the top 10, San Francisco-Oakland-Berkeley residents benefit from the state’s generous estate laws. San Francisco also has a good selection of palliative care providers.
6. Houston, Texas
Funeral costs: $7,334
Funeral services: 2.48 per 100,000
Green burial options: 0
Hospitals: 0.17 per 100,000
Hospices: 28
Palliative care: 6
Probate shortcut: $75,000
Hospices are plentiful in the Houston-The Woodlands-Sugar Land metro area, with a study-leading 28 highly rated hospices. And like other top cities to die, it has relatively low funeral costs.
7. Dallas, Texas
Funeral costs: $7,334
Funeral services: 2.29 per 100,000
Green burial options: 1
Hospitals: 0.23 per 100,000
Hospices: 19
Palliative care: 7
Probate shortcut: $75,000
The Dallas-Fort Worth-Arlington metro area scored well in the same areas as Houston: Affordable funerals and plentiful hospices, helping make up for a low density of funeral service providers.
8. Riverside, California
Funeral costs: $7,225
Funeral services: 1.81 per 100,000
Green burial options: 1
Hospitals: 0.09 per 100,000
Hospices: 5
Palliative care: 6
Probate shortcut: $166,250
Residents of the Riverside-San Bernardino-Ontario metro area benefit from California’s generous estate laws and affordable funeral costs. On the other hand, the funeral industry in Riverside isn’t very large, and there are only a few highly rated hospitals.
9. Salt Lake City, Utah
Funeral costs: $6,888
Funeral services: 2.41 per 100,000
Green burial options: 0
Hospitals: 0.80 per 100,000
Hospices: 6
Palliative care: 2
Probate shortcut: $100,000
Salt Lake City is high on our list thanks to low funeral costs and a good selection of highly rated hospitals for a city of its size. The city lacks a high number of funeral service providers, though.
10. Boise City, Idaho
Funeral costs: $6,888
Funeral services: 1.6 per 100,000
Green burial options: 0
Hospitals: 0.53 per 100,000
Hospices: 6
Palliative care: 5
Probate shortcut: $100,000
Like Salt Lake City, Boise City has low funeral costs. Idaho also has a relatively high probate shortcut level, helping it make the top 10 in our list despite a relative lack of funeral service providers.
The worst cities to die
1. Rochester, New York
Funeral costs: $8,093
Funeral services: 1.29 per 100,000
Green burial options: 3
Hospitals: 0 per 100,000
Hospices: 2
Palliative care: 0
Probate shortcut: $50,000
The Rochester metro area is the worst city to die in for 2023. The city on the southern shore of Lake Ontario doesn’t have a single hospital that received at least a 4-star rating from Medicare, and no palliative care programs listed with the National Hospice and Palliative Care Organization. Rochester also has the second-lowest number of funeral services per 100,000 people, second only to Honolulu. To top it off, there aren’t many highly rated hospices serving the city. Rochester has the second-highest number of green burial options in our study, but it wasn’t enough to make up for the other factors.
2. North Port, Florida
Funeral costs: $7,800
Funeral services: 3.03 per 100,000
Green burial options: 0
Hospitals: 0.24 per 100,000
Hospices: 0
Palliative care: 0
Probate shortcut: $75,000
The first of four Florida cities in the bottom five, the North Port-Sarasota-Bradenton metro area ranks this low because it has no highly rated hospice or palliative care providers.
3. Tampa, Florida
Funeral costs: $7,800
Funeral services: 2.42 per 100,000
Green burial options: 0
Hospitals: 0.29 per 100,000
Hospices: 0
Palliative care: 1
Probate shortcut: $75,000
Like North Port, the Tampa-St. Petersburg-Clearwater metro area lacks highly rated hospices. But it does have a good palliative care option and a slightly larger selection of hospitals.
4. Miami, Florida
Funeral costs: $7,800
Funeral services: 2.59 per 100,000
Green burial options: 0
Hospitals: 0.08 per 100,000
Hospices: 0
Palliative care: 3
Probate shortcut: $75,000
The third Florida city in our bottom five is the Miami-Fort Lauderdale-Pompano Beach metro area, which also lacks a highly rated hospice provider. It does have more palliative care providers than the other two Florida cities, and Florida residents have a fairly generous probate shortcut law.
5. Cape Coral, Florida
Funeral costs: $7,800
Funeral services: 2.53 per 100,000
Green burial options: 0
Hospitals: 0.4 per 100,000
Hospices: 0
Palliative care: 0
Probate shortcut: $75,000
The fifth-worst city to die is another Florida metro area: Cape Coral-Fort Myers. Like its fellow Florida cities, it lacks a highly rated hospice provider, and it’s a difficult place to find palliative care. But at the very least, Cape Coral and Fort Myers have more hospital options than the other cities in the bottom five.
The full ranking of the best & worst cities to die
You can find all 100 metro areas in the study in the table below, along with how they scored in our rating system, and the data we used to create the rankings. Use the search bar to see how your city ranked.
How to make end-of-life planning easier
Knowing where to die is only part of end-of-life planning. No matter your age and health status, it’s a good idea to document what kind of health treatment you want to receive if you become incapacitated and unable to make these decisions on your own. You can delegate these decisions by creating a living will or advance directive. You should also name a health care power of attorney to make medical decisions for you and a durable power of attorney to make financial decisions for you.
When deciding how to pass on your estate, the first step is to list what assets the estate will actually include, including your real estate, bank accounts, retirement accounts, investment accounts, life insurance policies, digital assets like email passwords, and your debts. Your estate planning documents, like your will and possibly a trust, will determine who gets those assets.
You should also document your wishes for your final arrangements, and like your will, find someone to carry out those wishes. Don’t forget to set aside enough money for your family to carry out your plans. If you want your ashes to be scattered from the top of Mount Etna, at least make sure your family can afford a flight to Italy.
“Don’t put a burden on people,” Fournier says. “The fact that you’re dying is [already] a burden, because they’re not going to have you in their life.”
Many people buy life insurance to help their loved ones afford these expenses. Burial insurance is a specific type of insurance meant to cover funeral expenses, but the benefits can be limited compared to a term life policy.
Physician-assisted death
Supporters of “death with dignity” laws say people with terminal illnesses coping with pain should be allowed to choose when they die with the help of a physician. Ten states, plus Washington, D.C., have laws allowing doctors to prescribe lethal drugs to terminally ill patients. [2] Advocates for these policies say they allow people living with an illness to die peacefully rather than living with uncontrolled pain. Four of our top 10 cities are in states that have medically assisted suicide laws on the books: Portland, Oregon; and Los Angeles, San Francisco, and Riverside, California. These laws are extremely controversial and aren't widespread, so we didn’t consider these laws in our rankings.
The growth of green burial
The availability of green funeral options pushed Portland to the top of our list. Fournier, the author of “The Green Burial Guidebook,” says she’s seen interest in green burials grow.
Green burial options eschew features of traditional burial, like the use of embalming fluids and concrete burial vaults, in favor of more eco-friendly alternatives, like a biodegradable shroud or a wooden coffin that degrades over time. Fournier says there are three reasons green burial is so common in Portland: 1) There’s an outdoorsy, environmentally conscious population. 2) The city’s motto: “Keep Portland weird.” “If people can do something unique that their neighbor isn’t doing, they get excited about it,” she says. 3) Oregon allows burial to take place without a funeral director, and in many cases on private property, [3] opening up a wider range of burial options. There is growing interest in green funeral options. A 2022 survey from the National Funeral Directors Association found that 60.5% of consumers were interested in green funeral options because of their potential environmental benefits or cost savings, up from 55.7% in 2021. [4]
Traditional funeral services take up a significant amount of land and every year in America, burials consume 30 million feet of casket wood, 90,000 tons of steel, 1.6 million tons of concrete for burial vaults, and 800,000 gallons of embalming fluid. [5] Cremation releases gasses like carbon dioxide into the atmosphere. In addition to consuming fewer resources, green burial is often cheaper. People who live eco-friendly lifestyles tend to want eco-friendly deaths, Fournier says.
“Going out green and giving themselves to the planet as their last big environmental act seems like the right choice,” she says.
Methodology
First, we took the 100 largest metro areas in the country by population. For each metro area and for each of the categories listed below, we turned each data point into a percentile. These percentiles helped us adjust the values to a common scale that still accounted for the difference in the range of values and allowed us to give them equal weight. For each category, each city received a score ranging from 1 to 100, with the exception of the funeral cost, for which cities received a negative score ranging from 0 to -100, with lower (more negative scores) representing higher funeral costs. We added up all seven categories and ranked the totals to get the best and worst cities to die.
Funeral costs in 2021: All figures are regional and include burial. They come from the 2021 National Funeral Directors Association Member General Price List Study (the most recent version of the study available) [6]
Funeral providers per 100,000 people in 2020: We divided the number of funeral homes and funeral service establishments in each metro area by the population and multiplied by 100,000. Data for funeral homes and population comes from the U.S. Census, and is the most recent data available. [7]
Green burial options: We tallied the number of green burial options in each metro area, based on a list from New Hampshire Funeral Resources & Education. [8]
4- or 5-star hospitals per 100,000 people: For each city, we looked up the number of hospitals that received at least a 4-star rating from Medicare within a 25-mile radius using the provider search tool on the Medicare website. The rating summarizes measures across five areas: mortality, safety of care, readmission, patient experience, and timely and effective care. We divided the number of hospitals by the population and multiplied by 100,000. [9]
4- or 5-star hospices: Using the provider search tool on the Medicare website, we looked up the number of hospices serving each city that received at least a 4-star rating in the family caregiver survey, which asks whether family or friends of a patient would recommend the hospice to others. [10]
Availability of palliative care: For each city, we looked up the number of palliative care providers in a 25-mile radius using the provider search tool from the National Hospice and Palliative Care Organization. [11]
Probate shortcut 2022: We assessed estate value limits from state code, which are compiled in the Policygenius guide to small estate affidavits.
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Image: Ariel Davis
