Understanding Long-Term Care Facility Counts
When asking which state has the most long-term care facilities, the answer depends on which specific type of facility you are counting. The term "long-term care" is a broad umbrella covering everything from skilled nursing facilities (SNFs), often called nursing homes, to assisted living facilities (ALFs) and residential care communities. State-level data consistently shows different states leading the counts for different facility types, which is primarily a function of population size and local market dynamics.
The States with the Most Certified Nursing Facilities
According to recent data, Texas consistently has the highest number of certified nursing facilities in the United States. This is largely due to its massive and growing population, the second-largest in the nation. In early 2024, Texas reported over 1,180 certified nursing facilities. Close on its heels is California, which often ranks second for nursing home numbers. Other states like Ohio, Florida, and Illinois also consistently appear in the top rankings for nursing home counts.
The Assisted Living Facility Landscape
Assisted living facilities operate under a different licensing structure and serve a different demographic of seniors—those who need some assistance with daily activities but not the intense medical care provided in nursing homes. For this category, a different state takes the lead. California has the highest number of assisted living communities in the U.S., reflecting its large and aging population. Other states with significant numbers of ALFs include Michigan, Wisconsin, and Florida. This highlights the need to be specific when comparing senior care options.
Key Factors Influencing Facility Numbers
Several factors contribute to a state having a high number of long-term care facilities. The two most significant are population size and demographic trends, particularly the size of the elderly population. States with large overall populations will naturally have more facilities to meet demand. Additionally, states with a larger percentage of residents over 65, and those experiencing a faster growth in their senior demographic, will also see a higher number of care facilities.
Other influencing factors include:
- Market Dynamics and Economics: Economic conditions and the cost of living can impact the viability of opening and operating care facilities. States with favorable business climates for healthcare can see more development.
- State-Specific Regulations: State regulations regarding licensing, staffing, and care standards can influence the number of facilities and the type of care available.
- Rural vs. Urban Population: The geographic distribution of a state’s population plays a role. Densely populated states might have fewer but larger facilities, while states with large rural areas might have more, smaller facilities to cover the geographical spread.
Quantity vs. Quality: Beyond the Numbers
While knowing which state has the most long-term care facilities is informative, it is essential to remember that quantity does not guarantee quality. Some reports and scorecards, like those from the AARP or the Commonwealth Fund, rank states based on the quality of their long-term services and support systems, not just raw facility counts. These metrics often reveal a different picture. For example, states like Minnesota and Washington frequently rank high on quality measures, despite having fewer facilities than a populous state like Texas. This reflects a focus on integrated care, strong state policies, and higher-quality outcomes.
Making an Informed Decision
For families searching for care, the overall number of facilities in a state is far less important than the quality of the individual facilities being considered. Resources like Medicare's Care Compare tool, which provides facility-specific quality ratings, are invaluable.
Here are the key steps for making an informed decision:
- Assess Specific Needs: Determine the level of care required—skilled nursing, assisted living, or memory care.
- Research Local Options: Use online tools like Medicare's Care Compare to find and compare facilities in your desired area.
- Conduct In-Person Visits: Schedule tours and meet with staff at potential facilities.
- Check Regulatory and Quality Information: Review state inspection reports and quality ratings.
- Talk to Current Residents and Families: Gain firsthand insight into the facility's culture and standard of care.
Comparison of Top States by Facility Type
| Metric | Texas | California | Ohio |
|---|---|---|---|
| Certified Nursing Facilities | ~1,184 (as of mid-2024) | ~1,164 (as of mid-2024) | ~929 (as of mid-2024) |
| Assisted Living Facilities | ~1,300 (est.) | ~5,900 (est.) | ~600 (est.) |
| Overall Population | ~31 million | ~39 million | ~11 million |
| Care Quality Ranking | Lower on comprehensive scorecards | Higher on comprehensive scorecards | Mid-range depending on metric |
The National Context and Future of Care
Nationally, the number of certified nursing facilities has actually been declining over the last decade, partly due to a decrease in demand for traditional nursing home settings and a shift towards home- and community-based care. However, the demand for senior care in general continues to grow as the population ages. This dynamic market means that while one state may currently lead in sheer facility numbers, the landscape is always evolving. Understanding these trends, along with local specifics, is key for making the best decision for a loved one's care.
For more resources on choosing a long-term care facility, visit the National Institute on Aging: https://www.nia.nih.gov/health/assisted-living-and-nursing-homes/how-choose-nursing-home-or-other-long-term-care-facility.
Conclusion
While a definitive, simple answer to which state has the most long-term care facilities is elusive due to the different types of facilities, the data shows that Texas has the most certified nursing facilities, and California has the most assisted living facilities. These high counts are driven largely by population size. For families considering options, focusing on the quality and specifics of care is far more important than a state's total facility count.
