Does it matter where you die?

According to the Economist Intelligence Unit (EIU), some places are better than others when it comes to the quality of death.

The Quality of Death Index

The EIU first published its Quality of Death Index in 2010 and released an updated index again in 2015. The index measures different factors across five key categories:

• Palliative and health-care environment
• Human resources
• Affordability of care
• Quality of care
• Community engagement

According to the report, the index “sparked a series of policy debates over the provision of palliative care around the world.” The index is helpful because it causes us to think about the state of our palliative care, and ways in which we can improve care for patients who are facing death.

History of Hospice

Before we dive into the rankings, let’s get some history. Hospice and palliative care are both relatively new concepts. They got their start around the 1960s, and the book On Death and Dying by Elisabeth Kübler-Ross played a huge role in shaping our views on hospice care.

Because hospice and palliative care are still relatively new, they’re constantly evolving. The Quality of Death Index states that “everyone hopes for a good death, or rather, ‘a good life to the very end’, but until recently there was little dedicated effort and investment to provide the resources and education that would make that possible.”

Today we’re seeing a bigger push to put more emphasis on spirituality, dignity, and personal engagement. Often this means removing the patient from a hospital or clinical setting and bringing them into a more personal setting.

How the Rankings Work

The Quality of Death Index involves widespread research and interviews with more than 120 palliative care experts across the world. As we mentioned before, it includes a variety of factors (more than 80) across the five core categories.

Their main findings concluded:

• Income is a big factor when it comes to quality of care.
• Culture also plays a role in quality of care. The study indicates a shift is needed in our mindset from “curative care” to more palliative care and treatment of death as a natural process.
• Even wealthy industrial nations are struggling to provide acceptable palliative care programs for their citizens.

So where do we rank? Let’s take a look at the best (and worst) places to die.

Best Ranked

The countries that received the top ten scores for quality of death were:

1. U.K.
2. Australia
3. New Zealand
4. Ireland
5. Belgium
6. Taiwan
7. Germany
8. Netherlands
9. U.S.
10. France

The United States scored an 80.8 out of 100, putting them 9th on the list of best countries with palliative care. The biggest factor that hurt America’s score was the high cost of care — ranking 18th overall in affordability — making palliative and hospice care a limited option for many.

The U.K. — for the second time in a row — took the number one spot for quality of death care. According to the report, the U.K excelled in areas that “reflects the attention paid to palliative care in both public and non-profit sectors. With a strong hospice movement — much of it supported by charitable funding — palliative and end-of-life care are both part of a national strategy that is leading to more services being provided in National Health Service hospitals, as the country works to integrate hospice care more deeply into the healthcare system.”

Worst Ranked

On the other side of the rankings, these are the countries that received the lowest scores (out of all 80 countries sampled) in overall death care quality. They were:

71. China
72. Botswana
73. Iran
74. Guatemala
75. Dominican Republic
76. Myanmar
77. Nigeria
78. Philippines
79. Bangladesh
80. Iraq

There are a variety of factors that contributed to low rankings on the study. They include lack of funding, lack of infrastructure, rapidly aging population groups, and lack of qualified medical staff. But it isn’t all bad news. The study did note that “although many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure, some countries with lower income levels prove to be exceptions, demonstrating the power of innovation and individual initiative.”

Feel free to read the full Quality of Death Index report here.

Your Funeral Home and Hospice

As communities look to improve palliative and hospice care for families, your funeral home can be a valuable partner. Hospice and funeral homes can work together to provide more personalized care and hospice caregivers can help establish trust between your funeral home and families. Check out our article on how to start connecting with hospice programs in your community to learn more.