Finding the best nursing homes is a critical decision for families. While a single, definitive answer to "Which state has the best nursing homes?" is not possible due to varying criteria and data sources, several reports offer insight. These assessments, from organizations like U.S. News & World Report, AARP, and Families For Better Care, typically analyze data from the Centers for Medicare & Medicaid Services (CMS). By examining multiple sources, a clearer picture emerges of which states consistently perform well in overall elder care.
Leading States in Nursing Home Quality
Based on various assessments, a few states consistently earn top marks for their nursing home quality and overall long-term care services. These rankings are generally based on a combination of federal data, state-level initiatives, and specific quality measures.
Hawaii
Frequently cited in reports for its high standard of nursing home quality, Hawaii benefits from strong health care quality and favorable social and environmental factors that contribute to residents' well-being. A 2022 USA Today analysis found Hawaii with the highest average overall 5-star rating in the nation.
Minnesota
Minnesota is often ranked highly for its robust long-term services and support systems for older adults. In recent AARP scorecards, Minnesota has secured the top position for its overall long-term care services, scoring high in family caregiver support and community integration. The state is also home to world-class medical facilities like the Mayo Clinic, which contributes to a strong healthcare infrastructure.
Alaska
Despite its challenging geography, Alaska consistently shows strong nursing home performance, particularly in average staffing levels. The state is noted for its high average CMS star rating, a strong indicator of overall care quality. However, it is important to note that Alaska has a small number of facilities compared to larger states.
Washington
Ranking well in long-term care services according to the AARP, Washington is recognized for its support for family caregivers and overall elder care initiatives. It is a consistently high performer, alongside Minnesota, in long-term care and supports.
Utah
Utah has appeared in the top tier of several reports, recognized for strong nursing home quality and a supportive environment for senior living. The state's focus on affordability and low social isolation among seniors also contributes to its high marks.
How Nursing Home Quality is Measured
When evaluating nursing home quality, several key metrics are typically used by organizations like CMS. These measurements provide a more comprehensive view of care than any single rating.
- Health Inspections: These are on-site surveys conducted by state agencies to determine if facilities are in compliance with federal requirements.
- Staffing Levels: This measures the amount of nursing staff time available to residents per day, a crucial factor in resident care.
- Quality Measures: These metrics track various health outcomes for both short-term and long-term residents, including data on infections, pressure ulcers, and other conditions.
- Support for Home and Community-Based Services (HCBS): The AARP Scorecard also considers how well states support alternatives to institutional care, such as home health aides.
- Emergency Preparedness: Following the COVID-19 pandemic, many evaluations now include a state's preparedness for emergencies and natural disasters.
A Comparison of Nursing Home Metrics by State
Different organizations and reports use various methodologies and data points, leading to a range of state rankings. The table below compares the results from three recent, reliable sources.
| State | Families for Better Care Ranking (2019) | AARP Long-Term Services & Supports (LTSS) Scorecard Tier (2023) | CMS 5-Star Average Rating (2022) |
|---|---|---|---|
| Hawaii | 1 | Tier 2 (Rank 8) | 3.90 (Highest) |
| Minnesota | N/A | Tier 1 (Rank 1) | 3.2 (Above Avg) |
| Alaska | 3 | Tier 3 (Rank 26) | 3.80 (2nd Highest) |
| Delaware | 2 | Tier 3 (Rank 17) | 3.35 (Above Avg) |
| Utah | 5 | Tier 3 (Rank 29) | 3.34 (Above Avg) |
| Louisiana | 43 | Tier 4 (Rank 45) | 2.34 (Lowest) |
| Texas | 51 | Tier 3 (Rank 34) | 2.55 (Low) |
| Mississippi | N/A | Tier 5 (Rank 48) | 2.48 (Low) |
Note: N/A indicates the state's ranking was not specified in the Families for Better Care Report Card synopsis.
States that Consistently Rank Lower
On the other end of the spectrum, several states are consistently noted for having lower-rated nursing homes or long-term care systems. Reports from Families for Better Care have identified states like Texas, Illinois, New Mexico, Michigan, Oklahoma, Louisiana, and Indiana as performing poorly. AARP's Scorecard places a number of Southern states in its lowest tiers due to persistent issues with staffing, equity, and access. Factors contributing to these lower rankings include high staff turnover rates and less competitive wages for direct care workers.
Considerations Beyond State Rankings
While state-level data provides a useful overview, it is crucial to remember that quality can vary significantly from one facility to the next, even within the same state. A high state average does not guarantee a high-quality facility in every city. When choosing a nursing home, families should consider the following steps:
- Use the Official Medicare Tool: Medicare.gov's Care Compare tool provides detailed information and CMS 5-star ratings for every Medicare-certified facility in the country.
- Conduct On-Site Visits: The only way to truly assess a facility's culture, cleanliness, and staff-resident interactions is to see it in person.
- Ask About Staffing: Enquire about specific staffing ratios and staff turnover rates, which are key indicators of care quality.
- Check Inspection Reports: Review a facility's health inspection and complaint history, which are often available online or through your state's health department.
Conclusion
There is no single state that holds the undisputed title for "best nursing homes," as rankings differ depending on the specific criteria used. However, states like Hawaii, Minnesota, and Alaska frequently appear at the top of national assessments, while many Southern states consistently rank lower. Prospective residents and their families should use state rankings as a starting point, but always supplement this information with personal research using tools like Medicare's Care Compare to find the best possible facility for their individual needs. A holistic approach, combining national data with local investigation, is the most effective strategy for making an informed decision.
