Understanding Which States Have the Best Nursing Homes

According to Families for Better Care, state performance in long-term care can fluctuate significantly from year to year. Selecting the right care is critical, so for many, the question is: Which states have the best nursing homes? It's a complex query that requires looking at various metrics beyond simple rankings.

Quick Summary

Several states consistently appear at the top of nursing home quality rankings, including Hawaii, Minnesota, and Alaska, though different reports highlight unique strengths based on varying metrics like staffing levels or health outcomes. Factors such as state regulations, funding models, and facility-level oversight heavily influence the overall quality of care.

Key Points

• No Single 'Best': Different reports and rankings, like those from Medicare, U.S. News, and familiesforbettercare.com, use varying criteria, meaning there is no single consensus on which states have the absolute best nursing homes.

• Hawaii and Minnesota Often Top Lists: States like Hawaii, Minnesota, and Alaska consistently appear among the highest-ranking states in multiple nursing home quality studies due to strong performance in key metrics like staffing and health outcomes.

• Affordability vs. Quality Trade-off: Some analyses, like Beca Life's, reveal a surprising paradox where a state like Mississippi can have high percentages of top-rated facilities while also having low median household income, suggesting that cost doesn't always correlate with quality.

• Staffing is a Key Indicator: A facility's staffing levels, particularly the number of professional nursing hours per resident, are widely considered a crucial measure of quality and often correlate with better patient outcomes.

• Personal Research is Essential: State-level data is a starting point, but families should always conduct their own in-depth research on individual facilities using tools like Medicare's Care Compare, site visits, and ombudsman reports.

• Look Beyond the Overall Score: When evaluating a nursing home, focus on specific metrics that align with your loved one's needs, such as health outcomes, inspection results, and the ratio of nurses to residents.

Navigating Nursing Home Quality: A State-by-State Look

Choosing a nursing home is one of the most important decisions a family can make. To simplify this process, many turn to state-level rankings to gauge the overall landscape of care. However, simply knowing which states have the best nursing homes is only the first step. True quality is revealed by examining the metrics that matter most, from staffing and inspections to health outcomes and resident satisfaction. By synthesizing data from several authoritative reports, we can provide a clearer picture of which states lead the way in providing high-quality care for seniors.

The Problem with a Single 'Best' State

Before diving into the rankings, it's crucial to understand why no single report can perfectly capture nursing home quality. Different organizations use distinct methodologies, focusing on varying factors such as clinical data, resident reviews, or cost-to-quality ratios. This is why a state ranked highly in one study might not perform as well in another. For example, some analyses might emphasize staffing levels, while others focus on affordability or health inspection results. A truly informed decision requires a holistic perspective, using these rankings as a guide rather than a definitive statement.

Varying Methodologies Across Reports

• Medicare 5-Star Rating: The federal government's system uses a combination of health inspection results, staffing levels, and quality measures to rate facilities from one to five stars.
• Families For Better Care Report Card: This organization grades each state based on criteria like professional nurse staff hours, deficiencies, and occupancy rates, providing a letter grade system for an annual report.
• U.S. News & World Report: For their 'Best States' project, U.S. News often factors in metrics related to overall health care quality, which includes nursing home performance.
• Beca Life Senior Care Rankings: This 2025 report introduced some interesting findings, highlighting states like Mississippi for high 5-star facility percentages despite its lower median income.

Top-Performing States Based on Key Indicators

Combining data from various sources provides a more robust view of state performance. Certain states consistently appear in the top tiers across multiple reports, signaling a strong commitment to elder care. Here is a breakdown of states often highlighted for their high nursing home quality:

• Hawaii: Frequently cited as a top contender for its excellent health outcomes and high average federal 5-star ratings. Its high performance in healthcare quality, as noted by U.S. News, contributes to this reputation.
• Minnesota: Consistently ranks high in long-term care scorecards, excelling in both access and quality metrics. Its robust staffing levels and relatively low fine amounts for deficiencies are often praised.
• Alaska: Often scores well in average federal star ratings and consistently ranks among the top states in some reports. Despite its low population density, it shows strong average care scores.
• Utah: Noted for both nursing home quality and overall 'best state' metrics, Utah consistently places favorably in federal ratings and other reports.
• Washington: Consistently ranks in the top tier for long-term care services according to analyses like the LTSS State Scorecard.
• South Dakota: A Forbes analysis once ranked South Dakota highest for its percentage of positive nursing home ratings. This, combined with low costs, can make it an attractive option.

In-depth Comparison of High-Ranking States

This table provides a snapshot of how a few frequently top-ranked states compare based on different metrics. These figures can help inform your initial search, but remember that individual facility performance will always vary. Data sources and timeliness can also influence these snapshots, so it's always best to check the latest reports.

Feature	Minnesota	Hawaii	Utah	Mississippi (2025 Beca Life)
Staffing Hours	Ranks high in nurse staffing hours per resident	Strong staffing often cited	Ranks high in specific staffing metrics	Varies, but 5-star facilities are common
Health Outcomes	High percentage of residents with functional improvement	Excellent health outcomes overall, low COVID death rates	Favorable rates for worsening health indicators	Varies, but some strong metrics noted
Cost of Care	Higher average annual cost	Generally higher due to location	Relatively lower annual cost	Much lower average annual cost
Primary Ranking Source	LTSS Scorecard, SmartAsset	U.S. News, Families For Better Care	U.S. News, SmartAsset	Beca Life Rankings

How to Evaluate Nursing Home Quality Personally

Ultimately, state rankings are just a starting point. Your personal research into specific facilities is the most important step. Here is a numbered list of actions you can take:

1. Use Medicare's Website: Utilize the Medicare.gov website to research specific facilities and their 5-star ratings. This tool also provides detailed health inspection results and quality measures. The website's search function is very robust and can be used to compare facilities side-by-side. You can start your search here: https://www.medicare.gov/care-compare/.
2. Conduct a Site Visit: Nothing replaces an in-person visit. Go during different times of the day to observe staff interactions, cleanliness, and the general atmosphere. Unannounced visits are often the most revealing.
3. Interview Staff and Residents: Ask staff about turnover rates and training protocols. Talk to residents about their daily experiences, the food, and the level of care they receive.
4. Review the Ombudsman Report: Every state has a long-term care ombudsman program that advocates for residents. Requesting their reports on a facility can uncover past issues and complaints.
5. Check for Deficiencies: Look at the frequency and severity of deficiencies cited during state inspections. A history of repeated, severe deficiencies is a major red flag. This information is available via Medicare.gov.
6. Consider Resident-to-Staff Ratio: While overall staffing is important, a high resident-to-staff ratio for nurses and aides is a strong indicator of better care and more personal attention.

Conclusion: Finding the Right Care for Your Needs

Determining which states have the best nursing homes is not as simple as checking a single list. While states like Hawaii and Minnesota often lead in overall quality metrics, the best fit for an individual will depend on their specific needs, location, and budget. Use state rankings as a tool for narrowing down potential areas, but always prioritize thorough, hands-on research into specific facilities. By focusing on factors like staffing, health outcomes, and resident satisfaction, you can ensure your loved one receives the compassionate, high-quality care they deserve.

What Factors Influence a State's Nursing Home Rankings?

State rankings are influenced by a variety of factors, including regulatory oversight, Medicaid funding rates, and the demographic needs of the state's senior population. States with higher funding and stricter regulations often perform better overall. Regional differences, such as cost of living, also play a role in staffing and resource allocation.

Frequently Asked Questions

Which states have the best nursing homes according to Medicare's 5-star rating?

Medicare's 5-star ratings change regularly based on updated data. However, states like Hawaii, Alaska, and Utah have frequently been noted for having high average scores across their facilities in past analyses.

Are wealthier states guaranteed to have better nursing homes?

No, this is not always the case. Some reports, like Beca Life's 2025 Senior Care Rankings, have shown that some of the highest-rated states for nursing home quality are among the nation's poorest by median household income, demonstrating that other factors are at play.

What is the most important factor to consider when evaluating a state's nursing home quality?

Staffing levels are often cited as one of the most critical factors influencing nursing home quality. Adequate nurse and caregiver staffing directly impacts the amount of personalized care and attention residents receive.

Where can I find the most up-to-date nursing home rankings?

You can find up-to-date rankings and quality data from several sources, including the Medicare.gov website (Care Compare tool), Families For Better Care, U.S. News & World Report, and other healthcare publications.

Do nursing home costs correlate with quality?

Not necessarily. While some high-cost states may have excellent facilities, reports have shown that high-quality care can be found in states with much lower average costs. Cost is an important factor to consider alongside other quality indicators.

What are some of the lowest-ranking states for nursing home care?

Different reports list various states at the bottom of their rankings. Historically, states like Texas, Louisiana, and Illinois have appeared among the lower-tier rankings in reports from Families For Better Care and USA Today due to factors like high deficiencies or lower federal star ratings.

Besides state rankings, what other research should I do?

State rankings are a good starting point, but you should also conduct personal research. This includes visiting facilities, speaking with staff and residents, and reviewing ombudsman reports and Medicare.gov's detailed inspection data.