Advancing into old age brings to the forefront a variety of lifestyle and financial considerations, including the possibility of transitioning to a full-time nursing home. Whether you are thinking about nursing home care for yourself or for a parent or loved one, there are many factors to weigh and expenses to navigate. You want to make sure, after all, that the facility you choose will be comfortable, clean, well-run and affordable.
SmartAsset analyzed data to find the states in the U.S. where the nursing home care is the best. Specifically, we looked at the following metrics: nursing homes per 10,000 seniors, nurse staffing hours per resident per day, average fine amount incurred by nursing homes, percentage of long-stay residents with depressive symptoms, percentage of long-stay residents with worsening health, percentage of short-stay residents with improvements in function, percentage of short-stay residents assessed and given the flu vaccine appropriately and average cost of nursing home care. For details on our data sources and how we put all the information together to create our final rankings, check out the Data and Methodology section below.
- Good care in the South and in the Midwest. Four of the top 11 states in our study are in the South – Arkansas, Mississippi, Louisiana and Alabama. The Midwest also has four representatives in the top 11 – North Dakota, Minnesota, Nebraska and Missouri. There is no Northeastern representation at the top of the list.
- Nursing care is expensive. Even in the least expensive states, nursing home care will run more than $50,000 per year. Make sure you plan your finances accordingly if you think full-time care may be in the future for you or a loved one. The state with the highest cost of nursing home care in our study is Alaska. According to Genworth Cost of Care Survey data, the average annual cost of nursing home care in the state is $351,495 – more than six times the cost in Oklahoma, the state in our study with the lowest average annual cost.
Arkansas leads the way in our study on the best states for nursing home care. Most notably it has the fifth-least expensive average cost of nursing home care in the country, at $64,240. It also ranks 10th overall in terms of nursing homes per 10,000 seniors, at 4.63. The average fine amount for a facility in Arkansas is $16,180, which ranks right in the middle of the study.
2. North Dakota
North Dakota is the second-best state for nursing home care. This state leads the study in its percentage of short-stay residents showing improvement in function, at a rate of 78.14%, according to Medicare data. North Dakota also ranks fifth for the number of nursing homes per 10,000 seniors, at 7.10. Though the state ranks in the top 10 for some other metrics, including daily nurse staffing hours per resident and low average fine amount, one metric where North Dakota doesn’t place as well is the average cost of nursing home care. Its average cost of $132,320 is the fifth-most expensive amount in the study.
Mississippi, coming in third place, has the sixth-highest rate of short-stay residents assessed and given the flu shot appropriately, at 88.65%. It also ranks in the top 10 of the study for two other metrics, with an average fine amount of just $6,231 and the relatively low 1.49% of long-stay residents showing depressive symptoms. The average cost of nursing home care in Mississippi is $80,300.
Minnesota is the No. 4 state in our study on the best states for nursing home care. The state ranks eighth in the study for the average fine amount, at $5,658. It ranks seventh in terms of percentage of short-stay residents showing functional improvement, at 74.34%. The average cost of nursing home care in Minnesota, however, ranks in the bottom half of the study at $109,500. Residents in Minnesota who are seeking nursing home care may also be interested in learning more about how to create a living trust in the state.
California, ranks well in terms of the efficacy of its nursing homes. It has the lowest rate in the study of depressive symptoms for long-stay residents, at just 0.73%. It has the second-lowest rate of long-stay residents with worsening health at 13.83%, and it has the seventh-highest rate of short-stay residents assessed and given the flu shot appropriately, at 88.42%. The cost and concentration metrics, though, aren’t as strong. California ranks 31st overall in terms of cost with an average of $100,375 per year and in the bottom 10 of the study for nursing homes per 10,000 seniors, at 2.17. Residents seeking nursing home care may want to become familiar with inheritance laws in California.
Nebraska, coming in at No. 6, has the fourth-highest number in our study of nursing homes per 10,000 seniors, at 7.15. It also has the fifth-highest rate of short-stay residents showing improvements in function, at 76.01%. Nebraska has a top-20 rate for cost. The average cost of nursing home care in the state is $82,855 per year.
Louisiana has the fourth-lowest average cost for nursing home care in our study – $62,780. It also has the seventh-lowest average fine amount that nursing homes in the state incur, at $4,998. Louisiana has top-10 percentages for two of our performance metrics – just 1.10% of long-stay residents report depressive symptoms and only 15.61% of long-stay residents show worsening health. As an added bonus, Louisiana has no state inheritance or estate taxes.
The average cost of nursing home care in Missouri, which takes the No. 8 spot in our study, is just $60,225. That’s the third-lowest amount for this metric overall. There are 5.19 nursing homes per 10,000 seniors in Missouri, the seventh-highest amount in our study. Missouri also has the fourth-lowest percentage of worsening health for short-stay residents, at just 14.86%. Missouri is one of the cheapest states to buy a home, which may be ideal for those who are considering relocating in order to be closer to a parent or loved one who is staying in a nursing home.
Utah comes in at No. 9 on our list of the top 11 states for nursing home care. It has the eighth-lowest average cost of nursing home care in this study – $73,000 per year. Utah also has the sixth-lowest rate of worsening health in long-stay residents, at 15.51%, and the 10th-highest rate of short-stay residents being assessed and given flu vaccines, at 86.57%.
10. Alabama (tie)
Tied for 10th place (with Arizona) is Alabama, where a year of nursing home care costs $75,347 on average, the 10th-lowest rate in this study. Residents who are considering paying for nursing home care and who also may have concerns about estate planning can seek the guidance of a professional advisor to help them navigate inheritance laws in the state. Alabama finishes in the top five of both of our metrics measuring performance for long-stay residents. Only 1.08% of long-stay residents show depressive symptoms, and only 14.62% show worsening health.
10. Arizona (tie)
Arizona has the fourth-lowest average fine amount on this study, $2,582. The state leads the study when it comes to the percentage of short-stay residents getting assessed and given the flu vaccine appropriately, at 91.25%. The average cost of nursing care is $77,928 per year, a top-15 rate.
Data and Methodology
To find the best states in the nation for nursing home care, SmartAsset analyzed all 50 states plus Washington, D.C. across the following eight metrics:
- Nursing homes per 10,000 seniors. Data comes from the Census Bureau’s 2017 1-year American Community Survey and from data.medicare.gov.
- Nurse staffing hours per resident per day. Data comes from data.medicare.gov.
- Average fine amount incurred for care violations. Data comes from data.medicare.gov.
- Percentage of long-stay residents with depressive symptoms. This measures the percentage of residents staying longer than 100 days who have had symptoms of depression during a two-week period preceding their assessment. Data comes from data.medicare.gov.
- Percentage of long-stay residents with worsening health. This measures the percentage of residents staying longer than 100 days who experienced a decline in independence of locomotion during the 12-month target period. Data comes from data.medicare.gov.
- Percentage of short-stay residents with improvements in function. This measures the percentage of residents who were discharged after staying less than or equal to 100 days and who gained more independence in transfer, locomotion and walking during their episodes of care. Data comes from data.medicare.gov.
- Percentage of short-stay residents assessed and given flu vaccine appropriately. Data comes from data.medicare.gov.
- Median cost of nursing home care. Data comes from the Genworth Cost of Care Survey and is for 2018.
First, we ranked each state in each metric. We then took an average of each state’s ranking, giving full weight to all metrics except for the measurements of depressive symptoms, worsening health and improvements in function and flu shots, each of which were given a half weight. We used this average ranking to determine our final rankings. The state with the highest average ranking received a score of 100, and the state with the worst average ranking received a score of 0.
Tips for Managing Your Money
- Expert advice to help you get quality care. A financial advisor can help you plan for how to pay for nursing home care for yourself or a family member. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.
- Save now to prepare for costs later. You can put away money for your future nursing home care by using a workplace retirement plan. See how much money you’ll have when you retire with SmartAsset’s 401(k) calculator.
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