Best and Worst States for Long-Term Care

The future of long-term care (LTC) is uncertain, but growing demand isn’t. Experts predict the number of people needing long-term care will double to 14 million by 2065.

As part of the Biden Administration’s $2 trillion infrastructure plan, the president proposed spending $400 billion over eight years on home and community-based services.

States are also joining in. 

Washington is the first state to act, which recently introduced the Long-Term Care Trust Act to begin in 2022. Starting January 2025, each person who is eligible to receive the benefit can access services and supports costing up to $36,500. This act is planned to help with extended hospital stays, rehabilitation, and assisted living by implementing a tax on employee wages. 

MedicareGuide looked at cost, access, and quality factors for adults over 65 to determine the top states for long-term care.

We compared all 50 states and Washington, D.C., to determine how they rank across cost, access, and quality measures. 

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We found LTC varies significantly by state. So, where you and your loved ones live matters. 

We conclude with insight from Jeff Smedsrud, a healthcare expert, on long-term care, its future, and what Americans can expect when they use it. 

Please read below for our findings and methodology.

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Best States for Long-Term Care: Countdown

Expert Analysis

• Why isn’t most long-term care (LTC) included in Medicare?
• How has the Biden Administration addressed ways to improve LTC throughout the nation?
• How much should Americans anticipate setting aside as they age?
• What are some of the most expensive costs?
• What does long-term care insurance typically cover?
• Is long-term care insurance right for everyone? When is the best time to buy it?
• What does the future look like for the next generations needing LTC?
• How can families prepare for long-term care costs?
  

Why isn’t most long-term care (LTC) included in Medicare?

Medicare pays for care that‘s considered skilled, which means it requires the skills of a licensed or trained medical professional. If someone can provide the care without professional training and licensing, Medicare considers the care as unskilled and will not pay for it. Often referred to as custodial care, LTC is a range of services and support to meet health or personal care needs over an extended time period. 

However, Medicare does cover home health care for older adults with severe disabilities who are homebound and need skilled services from nurses and therapists. It won’t cover 24-hour care, homemakers, or routine care from personal aides. 

How has the Biden Administration addressed ways to improve LTC throughout the nation?

As part of the Biden Administration’s proposed infrastructure bill, $400 billion is proposed to be spent over eight years on home and community-based services. The proposal is in its early stages and doesn’t provide details on where to allocate funding. Whether it goes towards strengthening the workforce, eliminating waitlists, addressing inequities of the current system, or expanding services is unclear.

How much should Americans anticipate setting aside as they age?

Men who turn 65 will spend more than $140,000 on long-term and home health care. Women will spend even more ($176,000), according to our recent analysis on LTC projections. Men will need just over two years of long-term care; women will need just over three.

What are some of the most expensive costs?

Costs depend on the type of care you need, how long you need it for, which provider you use and where you live. Prices also vary depending on when you need help from service providers. Home health care services are typically more expensive on evenings, weekends, and holidays. Some of the most expensive costs include nursing home care, memory care, home health aides, assisted living, and adult day healthcare services. 

What does long-term care insurance typically cover?

Long-term care insurance doesn’t cover medical care. But it may cover the cost of staying in a nursing home, assisted living facility, adult day care, or in-home care. Benefits include nursing care, physical, occupational, or speech therapy, and help with day-to-day activities like eating and bathing. 

Additionally, it pays for care due to chronic illness, disability, or injury.

Is long-term care insurance right for everyone? When is the best time to buy it?

Long-Term Care Insurance (LTCI) may be ideal if you don’t have a family to care for you (which can be an enormous task), are able to pay out-of-pocket costs for care, or qualify for Medicaid.  

If you’re looking at LTCI, consider buying it earlier, say in your 50s, so your monthly premiums cost less. The later you purchase, the more it’ll cost you when you do enroll. 

What does the future look like for the next generations needing LTC?

More people will rely on long-term care. For example, by 2065, the number of people who will need help with activities of daily life bathing or eating will double from seven to 14 million. 

By 2065, the Social Security Administration projects 95 million people will be 65 and up. With the growing number of elderly will come growing numbers of people with disabilities. In 2065, 15% of Americans age 65+ will live with at least two disabilities. As a result, the number of people using long-term care services for help with what the government terms Activities of Daily Life (ADL) like bathing and eating will double from 7 to over 14 million Americans in 2065.

The 65+ population is projected to expand from roughly 57 million today to over 80 million in 2050. Many of the elderly will be in the 85 plus bracket, the group that requires the most long-term care. 

How can families prepare for long-term care costs?

There’s a common misconception that Medicaid and Medicare delivers a lot of LTC benefits. Unfortunately, individuals or their families bear most of the costs. Saving for retirement is important, but you should also save for long-term medical expenses. You can start doing this with a Health Savings Account, which shelters funds in a tax-free environment until age 65. 

Only a select number of Americans can afford long-term care insurance. Most people get help from their spouses, children, or siblings. But that may change over time. States are studying public long-term care insurance while others have held referendums asking the public’s support of the idea.  

Methodology

In order to determine the best and worst states for long-term care, MedicareGuide compared the 50 states and the District of Columbia across three key categories: 1) Cost, 2) Access and 3) Quality.

We evaluated those categories using 27 relevant metrics, which are detailed below. Each metric was graded on a 100-point scale, with a score of 100 representing the best elderly healthcare at the most affordable cost.

Lastly, we determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Cost – Total Points: 33.33

• Annual Nursing Home Costs: Full Weight
• Total Medicaid Payments for Those Living with Alzheimer’s or Other Dementias: Full Weight
• Annual Home Care Private Pay Costs: Full Weight
• Community and Assisted Living Costs Per Month: Full Weight
• Homemaker Services Per Month: Full Weight
• Home Health Aide Costs Per Month: Full Weight
• Adult Daycare Costs Per Month: Full Weight
• Cares Fund Legislation: Full Weight

Access – Total Points: 33.33

• Adult Day Services Total Licensed Capacity: Full Weight
• Home Health Aides Per Capita: Full Weight
• Nurse Staffing Hours Per Resident Per Day: Full Weight
• Medicaid Expenditures Per Resident: Full Weight
• Skilled Nursing Facilites Per Capita: Full Weight
• Certified Geritricians Per Capita: Full Weight
• Nursing/Assisted Living Homes Per Capita: Full Weight

Quality – Total Points: 33.33

• Short Stay Residents Who Made Improvements in Function: Full Weight
• Short Stay Residents Who Were Rehospitalized After a Nursing Home Admission: Full  Weight
• High Risk Long Stay Residents with Pressure Ulcers: Full Weight
• Long Stay Residents Whose Need for Help with Daily Activities Has Increased: Full Weight
• Covid-19 Death Rate Over 85: Full Weight
• Long Stay Residents Assessed And Appropriately Given The Pneumococcal Vaccine: Full Weight
• Got Better At Walking Or Moving Around While In Home Healthcare: Full Weight
• Long Stay Residents Who Lose Too Much Weight: Full Weight
• Number Of Hospitalizations Per 1000 Long-stay Resident Days: Full Weight
• Support For Family Caregivers: Double Weight

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, U.S. Bureau of Labor Statistics, Center for Medicare & Medicaid Services (CMS), Genworth, AARP, American Geriatrics Society, Alzheimer’s Association, SNFdata Resources and MedicareGuide research.