Three years into the COVID-19 pandemic, staffing shortages continue to affect medical care facilities around the U.S., and long-term care is no exception. ValuePenguin health care expert Robin Townsend says this and other factors are putting the quality of long-term care at risk. "When staff is spread thin, they’re less equipped to meet a facility’s standard level of care," Townsend says. "Meanwhile, the cost of care will likely increase as the overall cost of living rises." Despite this, some states provide better long-term care than others. According to the latest ValuePenguin study — which analyzes data from the Centers for Medicare & Medicaid Services (CMS), U.S. Bureau of Labor Statistics (BLS), U.S. Census Bureau County Business Patterns and more to assess cost, accessibility and quality of care in each state — Arizona ranks highest for long-term care. Keep reading to find where long-term care is most affordable, and which health insurance programs can help lower the cost.
* Key findings
* Arizona ranks highest for long-term care
* The District of Columbia is the worst state for long-term care, despite providing high-quality care
* Most states provide less than 4 nurse staffing hours per resident daily
* Long-term care is most expensive in Alaska, District of Columbia
*Top expert tips to determine the right long-term care option
* Arizona is the best state for long-term care. ValuePenguin researchers used three overall metrics — cost, access to care and quality of care at each state’s nursing homes and assisted living facilities — with Arizona coming out on top. Idaho and Missouri rank second and third.
* The District of Columbia is the worst state for long-term care, even though it ranks among the highest for quality of care. The District of Columbia has a lower density of long-term care facilities and medical professionals than most states, and it’s among the most expensive states for long-term health care. However, those who can overcome these cost and access issues do well, as D.C. ranks in the top five in three of four quality-of-care metrics. Wyoming and New Hampshire are the second and third lowest-ranking states, respectively.
* Just 16 states provide four or more nurse staffing hours per resident daily. This comes amid the Biden administration’s February 2022 call to establish a minimum nursing home staffing requirement. According to a 2001 report to Congress that's still widely shared, the CMS recommended to Congress a minimum standard of 4.1 hours of nurse staffing hours per resident daily.
* In Alaska, a shared room at a nursing home costs an average of $378,140 annually or $1,036 a day — highest in the nation. Additionally, assisted living facilities in the state cost an average of $81,690 annually, second-highest in the U.S. And home health care aide workers make an average of $34,900 — fourth-highest in the nation.
* On the other hand, Texas and Missouri are the most affordable states for nursing homes and assisted living facilities, respectively. The annual average cost of a nursing home in Texas is $61,503. Meanwhile, Missouri ranks highest for assisted living facility affordability, with facilities in the state costing an average of $36,000 annually.
Arizona Ranks Highest for Long-Term Care
Arizona tops the list for long-term care, with quality and cost playing key roles. Particularly, the state ranks eighth for nursing home costs and 16th for assisted living costs. Arizona is also in the top 10 for several quality metrics, including its high average Quality of Patient Care Star Rating, a CMS rating system that measures Medicare claims and assessment data from home health agencies, and its low percentage of long-stay residents with an increased need for help with daily activities since admittance. The state also ranks among the top five for its density of assisted living facilities at 5.0. In other words, the rate of assisted living facilities in Arizona is five times the national rate.
Meanwhile, it’s 30th for average home health care aide wages, meaning the average aide salary is higher than most states. That ultimately leads to higher health care costs overall.
Cost of Care in the best States for Long Term Care
Average annual nursing home costs
Average annual assisted living facility costs
Average wages for home health care aides
Source: ValuePenguin analysis of American Council on Aging, SeniorLiving.org and U.S. Bureau of Labor Statistics (BLS) data
While Idaho ranks second overall, Missouri — the third-best state for long-term health care — ranks higher across the three cost metrics. In fact, Missouri has the most affordable nursing homes and assisted living facilities among the top three. Residents here pay an annual average of $63,145 for nursing homes and $36,000 annually for assisted living facilities. Missouri also ranks higher than Idaho in all but one accessibility metric. Notably, the density of nursing homes in Missouri is 3.52, while the density in Idaho is just 1.77.
Acessibility of Care in the Best States for Long-Term Care
Density of home health care aides
Density of medical professionals
Density of nursing homes
Density of assisted living facilities
Source: ValuePenguin analysis of BLS and U.S. Census Bureau County Business Patterns data
However, Idaho ranks above Missouri across all quality care metrics. Notably, health care facilities in Idaho provide the highest number of nursing staff hours per resident daily among the top three states at 4.41, compared with 4.04 in Arizona and 3.25 in Missouri. Missouri also has a higher percentage of long-stay residents whose need for help with daily activities has increased since admittance, and a higher number of outpatient emergency department visits per 1,000 long-stay resident days.
Quality of Care in the Best States for Long-Term Care
Average Quality of Patient Care Star Rating
Nursing staff hours per resident daily
Number of outpatient emergency department visits per 1,000 long-stay resident days
Percentage of long-stay residents whose need for help with daily activities has increased