A new report by the hospital bed manufacturer Opera ranks the states and Washington, DC, on which are the most challenging or most supportive to age in, with one of them being how many nursing homes per 100,000 residents.

Overall, the study said Vermont, Hawaii, Maine are the most challenging states for those 65 and over, while Louisiana, Texas, and Arkansas are the most supportive. The data in “The Elderly Care Report: The True State of Aging in America” is broken down into sections based on the aforementioned nursing home infrastructure, home health aide costs, healthcare affordability, and how long people live in each state, among other factors.

“Our report finds that Northeastern states such as Vermont and Maine face some of the highest care pressures, fueled by aging populations and costly home health services exceeding $100,000 in parts of the U.S., while states like Louisiana and Texas provide comparatively stronger affordability and service availability,” report authors said.

Key takeaways

The report pointed out the following as important to highlight:

• Seniors in Hawaii live longer than anywhere else in the U.S., but the state also faces some of the highest care costs and limited support infrastructure.

• Maine and Vermont have some of the oldest populations in the country, intensifying demand on local care systems.

• In Nebraska, nearly 22 percent of adults aged 65+ report struggling to pay off medical bills.

• Hiring a home health aide now costs over $100,000 per year in South Dakota, the highest in the country.

• Iowa has nearly five times as many nursing homes per senior as some states, highlighting major regional gaps in care infrastructure.

• Aging is a zip code lottery, with factors such as healthcare availability, infrastructure, and demand for services varying greatly by state.

Nursing Home Supply

On the issue of nursing homes and home health services per 100,000 seniors, the report said care capacity was assessed using provider data from the Centers for Medicare and Medicaid Services Care Compare database, normalized by each state’s population aged 65+. “By doing this, we compared infrastructure to demographic demand rather than focusing solely on total facility counts,” authors said.

Here are the top three states under this ranking system:

Significant to the nursing home data is that Midwestern states dominate in the availability of institutional care. “Iowa leads with 68.7 nursing homes per 100,000 seniors. South Dakota follows with 61.4 nursing homes per 100,000 seniors, showing that while home health aide costs are high, the capacity for care is strong in comparison. Kansas ranks third at 61.0 per 100,000, helping to show a regional pattern of more nursing homes per population in the Midwest,” the report said.

Strong infrastructure reduces the risk of demand outpacing available facilities, although affordability pressures may still limit access for some households, researchers added.

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