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States with the highest long-term care costs

States with the highest long-term care costs
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States with the highest long-term care costs

Long-term care costs can prove insurmountable for many families, with average prices fluctuating wildly across state lines. The recently released Genworth Cost of Care Survey 2018, conducted by CareScout in June 2018, shows exactly how much such care costs vary from state to state and reveals trends from 2004 to 2018. The study also explains why the price of care has increased.

The study goes in-depth across 440 regions with 15,550 completed surveys, and demonstrates that even in states where costs for long-term care are relatively low, they’re rarely cheap. Nationally, people spend on average $4,000 a month for assisted-care facilities, more than $8,000 a month for a private room in a nursing home (or $7,441 for a semi-private room), and in excess of $4,000 for a home health aide. Each one of those metrics is expected to cost well more than double those amounts by 2048, when many millennials will be making tough decisions about elderly loved ones.

Stacker created a ranking for each state based on this information, assigning a cost index on a scale of one to 100 based on costs compared to other states. Each component of the ranking—including homemaker services, home health aide, adult day health care, assisted living/private bedroom, nursing home/semi-private room, and nursing home/private room—was given equal weighting. The higher the index score, the higher the long-term care costs.

It’s important to note that nursing home (semi-private and private) scores excluded Alaska in their calculations, as costs are about twice as high there as the next most expensive state.

Read on to find out where your state ranks regarding its long-term care costs.

ALSO: How much does your state spend on health care?

#50. Louisiana
2/JamesDeMers // Pixabay

#50. Louisiana

- Cost index: 9.8
- Homemaker services: $36,608 (#50 most expensive among all states, 2.7% 5-year annual growth)
- Home health aide: $36,608 (#50 most expensive, 1.3% growth)
- Adult day health care: $16,380 (#39 most expensive, 2% growth)
- Assisted living/private bedroom: $42,600 (#36 most expensive, 2.4% growth)
- Nursing home/semi-private bedroom: $62,780 (#47 most expensive, 2.8% growth)
- Nursing home/private bedroom: $66,503 (#49 most expensive, 2.7% growth)

Louisiana is about to face penalties at the majority of its nursing homes. A new Medicare program will penalize facilities based on the number of times patients were readmitted for care. In Louisiana, that’s about 85% of the skilled nursing homes.

#49. Alabama
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#49. Alabama

- Cost index: 10.8
- Homemaker services: $38,896 (#47 most expensive among all states, 1.2% 5-year annual growth)
- Home health aide: $38,896 (#47 most expensive, 1.2% growth)
- Adult day health care: $9,100 (#48 most expensive, 7% growth)
- Assisted living/private bedroom: $39,252 (#47 most expensive, 4.7% growth)
- Nursing home/semi-private bedroom: $75,347 (#41 most expensive, 2.8% growth)
- Nursing home/private bedroom: $79,935 (#43 most expensive, 2.8% growth)

When the opportunity to expand Medicaid came up, Alabama was one of 14 states that decided against it. A new study shows that may have been a bad idea and will potentially cost the state an $11 billion economic boost over the next four years, according to a recent study.

#48. Mississippi
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#48. Mississippi

- Cost index: 13.5
- Homemaker services: $38,896 (#47 most expensive among all states, 0.3% 5-year annual growth)
- Home health aide: $38,896 (#47 most expensive, 0% decrease)
- Adult day health care: $9,100 (#48 most expensive, 11.1% decrease)
- Assisted living/private bedroom: $41,910 (#42 most expensive, 3.1% growth)
- Nursing home/semi-private bedroom: $80,300 (#35 most expensive, 1.9% growth)
- Nursing home/private bedroom: $85,045 (#38 most expensive, 2.4% growth)

In Mississippi, Medicaid only covers seniors and the disabled for long-term care if they are below income limits set according to the federal poverty level. To qualify, they have to make less than $6,000 per year. But state leaders are considering a limited expansion of the program, and public opinion polls show that 60% of Mississippi residents are in favor of it.

#47. Arkansas
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#47. Arkansas

- Cost index: 17.5
- Homemaker services: $41,184 (#45 most expensive among all states, 1.2% 5-year annual growth)
- Home health aide: $43,312 (#46 most expensive, 2.2% growth)
- Adult day health care: $20,800 (#18 most expensive, 4.6% growth)
- Assisted living/private bedroom: $36,443 (#49 most expensive, 1.2% growth)
- Nursing home/semi-private bedroom: $64,240 (#46 most expensive, 3.3% growth)
- Nursing home/private bedroom: $71,832 (#46 most expensive, 3.6% growth)

Costs in Arkansas may be among the lowest of all the states, but there may be internal problems at the state agency that licenses and inspects long-term care facilities. At the end of January, the director of the Office of Long Term Care quit over conflicts with her boss. She did say that the department’s work won’t suffer because of it.

#46. Texas
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#46. Texas

- Cost index: 17.7
- Homemaker services: $45,760 (#33 most expensive among all states, 2.2% 5-year annual growth)
- Home health aide: $45,760 (#39 most expensive, 2.1% growth)
- Adult day health care: $9,100 (#48 most expensive, 1.2% growth)
- Assisted living/private bedroom: $45,540 (#32 most expensive, 2.6% growth)
- Nursing home/semi-private bedroom: $57,579 (#49 most expensive, 3.9% growth)
- Nursing home/private bedroom: $78,475 (#44 most expensive, 5.1% growth)

Despite staffing challenges caused by low wages and heavy turnover, long-term care facilities in Texas seem to be doing fairly well meeting goals of the American Health Care Association and National Center for Assisted Living’s Quality Initiative Recognition Program. Two facilities were honored recently for meeting at least four major goals.

#45. Oklahoma
7/filmDASH_OKC // Pixabay

#45. Oklahoma

- Cost index: 18.8
- Homemaker services: $45,760 (#33 most expensive among all states, 2.1% 5-year annual growth)
- Home health aide: $49,718 (#32 most expensive, 2.8% growth)
- Adult day health care: $15,600 (#42 most expensive, 0% decrease)
- Assisted living/private bedroom: $39,900 (#45 most expensive, 2.3% growth)
- Nursing home/semi-private bedroom: $55,663 (#50 most expensive, 2.5% growth)
- Nursing home/private bedroom: $63,510 (#50 most expensive, 2.8% growth)

Oklahoma’s new governor opposed Medicaid expansion on the campaign trail, but he may have had a change of heart. Gov. Kevin Stitt recently said that he’s open to negotiating a version of it. The solution may be a waiver that allows the state to create its own expansion plan.

#44. Georgia
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#44. Georgia

- Cost index: 20.8
- Homemaker services: $43,472 (#41 most expensive among all states, 2.3% 5-year annual growth)
- Home health aide: $45,760 (#39 most expensive, 2.7% growth)
- Adult day health care: $15,600 (#42 most expensive, 0.5% decrease)
- Assisted living/private bedroom: $37,200 (#48 most expensive, 2.8% growth)
- Nursing home/semi-private bedroom: $76,103 (#40 most expensive, 3.8% growth)
- Nursing home/private bedroom: $81,213 (#41 most expensive, 3.8% growth)

By 2050, the number of Georgia citizens over the age of 85 is expected to quadruple. Luckily for the state, though, long-term care costs aren’t too bad, and fewer people than the national average are seeking out care. Medicaid currently pays for 76% of the state’s nursing home care and 13% of home-based care.

#43. Missouri
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#43. Missouri

- Cost index: 20.9
- Homemaker services: $45,760 (#33 most expensive among all states, 3.3% 5-year annual growth)
- Home health aide: $48,048 (#34 most expensive, 3.1% growth)
- Adult day health care: $21,840 (#14 most expensive, 3.7% growth)
- Assisted living/private bedroom: $34,128 (#50 most expensive, 4.5% growth)
- Nursing home/semi-private bedroom: $60,225 (#48 most expensive, 2.7% growth)
- Nursing home/private bedroom: $66,521 (#48 most expensive, 2.8% growth)

Missouri may be on the lower end of long-term-care costs, but that didn’t stop the state from cutting key funding for senior care. Now advocates for the aging will seek new protections, returned funding, and the ability to retain current programs during this year’s legislative session.

#42. South Carolina
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#42. South Carolina

- Cost index: 23.7
- Homemaker services: $43,472 (#41 most expensive among all states, 2.3% 5-year annual growth)
- Home health aide: $45,760 (#39 most expensive, 2.1% growth)
- Adult day health care: $15,595 (#45 most expensive, 3.7% growth)
- Assisted living/private bedroom: $42,000 (#38 most expensive, 3.1% growth)
- Nursing home/semi-private bedroom: $77,015 (#38 most expensive, 2.2% growth)
- Nursing home/private bedroom: $86,505 (#37 most expensive, 3.4% growth)

Because of the high cost of long-term-care, many South Carolina residents purchased long-term care health insurance—and now they’re suffering for it. Premium rates have increased just as quickly as facility costs have, and they are pricing people out. Many paying for insurance are likely to be forced off their plans because of the prohibitive premiums.

#41. North Carolina
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#41. North Carolina

- Cost index: 24.9
- Homemaker services: $42,328 (#44 most expensive among all states, 1.7% 5-year annual growth)
- Home health aide: $45,188 (#44 most expensive, 2.5% growth)
- Adult day health care: $14,300 (#46 most expensive, 1.9% growth)
- Assisted living/private bedroom: $44,318 (#34 most expensive, 5% growth)
- Nursing home/semi-private bedroom: $83,403 (#31 most expensive, 3.1% growth)
- Nursing home/private bedroom: $92,528 (#30 most expensive, 3.6% growth)

In early January, officials in North Carolina learned surprising news: About $29 million earmarked for long-term care costs is sitting in an account, unused. The money is for grants that nursing homes and other facilities can apply for, but not enough applications have come in to use up the funds.

#40. Tennessee
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#40. Tennessee

- Cost index: 25.7
- Homemaker services: $43,358 (#43 most expensive among all states, 2.2% 5-year annual growth)
- Home health aide: $45,188 (#44 most expensive, 2.5% growth)
- Adult day health care: $17,420 (#34 most expensive, 2.6% growth)
- Assisted living/private bedroom: $47,040 (#26 most expensive, 2.2% growth)
- Nursing home/semi-private bedroom: $76,650 (#39 most expensive, 2.8% growth)
- Nursing home/private bedroom: $82,125 (#40 most expensive, 2.8% growth)

Tennessee has made a commitment to ensure proper long-term care for all residents that need it. To that end, the Medicaid program in the state recently joined forces with NRC Health in a partnership that is expected to improve patient satisfaction and quality of life and care.

#39. Utah
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#39. Utah

- Cost index: 27.4
- Homemaker services: $50,336 (#22 most expensive among all states, 1.9% 5-year annual growth)
- Home health aide: $50,336 (#29 most expensive, 0.9% growth)
- Adult day health care: $12,090 (#47 most expensive, 3.6% decrease)
- Assisted living/private bedroom: $40,200 (#44 most expensive, 3% growth)
- Nursing home/semi-private bedroom: $73,000 (#42 most expensive, 3.9% growth)
- Nursing home/private bedroom: $91,250 (#32 most expensive, 4.8% growth)

In polls, Utah residents overwhelmingly support Medicaid expansion throughout the state to assist with long-term care. But state legislators appears to have ignored the public’s wishes, working to repeal or dismantle the expansion. The closed-door discussions have led to protests throughout the state.

#38. Kentucky
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#38. Kentucky

- Cost index: 28.7
- Homemaker services: $45,760 (#33 most expensive among all states, 3.3% 5-year annual growth)
- Home health aide: $46,904 (#37 most expensive, 3.2% growth)
- Adult day health care: $17,550 (#32 most expensive, 3.1% growth)
- Assisted living/private bedroom: $42,240 (#37 most expensive, 5.3% growth)
- Nursing home/semi-private bedroom: $82,125 (#34 most expensive, 2.3% growth)
- Nursing home/private bedroom: $91,250 (#32 most expensive, 2.3% growth)

Since the end of 2018, lawmakers in Kentucky have been attempting to institute new Medicaid rules that would require "community engagement” in order for recipients to keep their benefits. But twice now, implementation of the new regulations has been blocked by a group of Medicaid recipients filing federal lawsuits.

#37. Kansas
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#37. Kansas

- Cost index: 30.1
- Homemaker services: $45,760 (#33 most expensive among all states, 2.1% 5-year annual growth)
- Home health aide: $48,048 (#34 most expensive, 2.5% growth)
- Adult day health care: $21,125 (#17 most expensive, 4.6% growth)
- Assisted living/private bedroom: $54,675 (#12 most expensive, 5.5% growth)
- Nursing home/semi-private bedroom: $64,970 (#45 most expensive, 2.8% growth)
- Nursing home/private bedroom: $70,379 (#47 most expensive, 2.3% growth)

According to officials in Kansas, long-term care is in crisis. The #1 issue, they say, is staffing. Sixty percent of the state’s nonprofits providing long-term care are located in rural areas, and they can’t find enough workers to meet even basic needs.

#36. West Virginia
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#36. West Virginia

- Cost index: 32.9
- Homemaker services: $37,752 (#49 most expensive among all states, 0.8% 5-year annual growth)
- Home health aide: $38,896 (#47 most expensive, 1.2% growth)
- Adult day health care: $15,600 (#42 most expensive, 2.9% decrease)
- Assisted living/private bedroom: $43,425 (#35 most expensive, 2.2% growth)
- Nursing home/semi-private bedroom: $123,370 (#10 most expensive, 7.4% growth)
- Nursing home/private bedroom: $132,860 (#9 most expensive, 7.8% growth)

In West Virginia, the seven state hospitals are chronically underfunded and have staffing issues. The hospitals provide long-term care, plus nursing home and psychiatric services—but problems have left them under-used. The Public Policy Foundation of West Virginia suggests privatizing the hospitals as a solution.

#35. Illinois
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#35. Illinois

- Cost index: 33.5
- Homemaker services: $50,336 (#22 most expensive among all states, 3% 5-year annual growth)
- Home health aide: $51,480 (#27 most expensive, 1.9% growth)
- Adult day health care: $18,806 (#27 most expensive, 1% growth)
- Assisted living/private bedroom: $48,360 (#23 most expensive, 0.1% decrease)
- Nursing home/semi-private bedroom: $70,993 (#44 most expensive, 2.7% growth)
- Nursing home/private bedroom: $81,030 (#42 most expensive, 2.8% growth)

In mid-2018, a report by the Office of Illinois Comptroller Susana Mendoza found some surprising information: The state likely owes nursing homes about $300 million. Because of a backlog of Medicaid eligibility determinations, providers have been delivering care without being reimbursed.

#34. Florida
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#34. Florida

- Cost index: 34.2
- Homemaker services: $45,646 (#40 most expensive among all states, 2.1% 5-year annual growth)
- Home health aide: $46,904 (#37 most expensive, 2.1% growth)
- Adult day health care: $17,550 (#32 most expensive, 2.4% growth)
- Assisted living/private bedroom: $42,000 (#38 most expensive, 3.1% growth)
- Nursing home/semi-private bedroom: $97,820 (#23 most expensive, 3.6% growth)
- Nursing home/private bedroom: $108,770 (#23 most expensive, 3.6% growth)

In Florida, to receive in-home, long-term health care through Medicaid, you have to apply and be accepted into the program, which has a limit on how many people can participate. That’s a big problem for the aging population, many of whom are now facing a waitlist of more than three years. Lawsuits have been filed.

#33. Ohio
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#33. Ohio

- Cost index: 35
- Homemaker services: $48,048 (#31 most expensive among all states, 2.7% 5-year annual growth)
- Home health aide: $49,192 (#33 most expensive, 2.5% growth)
- Adult day health care: $15,860 (#41 most expensive, 3.2% growth)
- Assisted living/private bedroom: $51,336 (#19 most expensive, 1.8% growth)
- Nursing home/semi-private bedroom: $85,410 (#29 most expensive, 2.9% growth)
- Nursing home/private bedroom: $94,900 (#28 most expensive, 2.9% growth)

In 1988, the Scripps Gerontology Center at Ohio’s Miami University partnered with the state to form the Ohio Long-Term Care Research Project. Ever since, it has been providing valuable research into long-term care in the state. It’s even been touted as an example of how states can use data to improve public policy.

#32. New Mexico
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#32. New Mexico

- Cost index: 35.5
- Homemaker services: $41,184 (#45 most expensive among all states, 0.6% 5-year annual decrease)
- Home health aide: $45,760 (#39 most expensive, 0.1% growth)
- Adult day health care: $26,598 (#8 most expensive, 6.3% growth)
- Assisted living/private bedroom: $51,000 (#20 most expensive, 3.9% growth)
- Nursing home/semi-private bedroom: $87,418 (#27 most expensive, 4.3% growth)
- Nursing home/private bedroom: $91,433 (#31 most expensive, 2.8% growth)

As of 2018, New Mexico’s nursing homes ranked dead last for quality care. It’s not surprising, with more than 2,200 incident reported and more than 100 of those considered serious. In 2016, for example, an unsupervised resident was fatally hit by a car and eight patients did not receive insulin properly.

#31. Iowa
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#31. Iowa

- Cost index: 36.5
- Homemaker services: $54,912 (#15 most expensive among all states, 3.3% 5-year annual growth)
- Home health aide: $57,200 (#14 most expensive, 3.3% growth)
- Adult day health care: $16,237 (#40 most expensive, 3.7% growth)
- Assisted living/private bedroom: $46,158 (#29 most expensive, 4.1% growth)
- Nursing home/semi-private bedroom: $73,000 (#42 most expensive, 4.4% growth)
- Nursing home/private bedroom: $77,745 (#45 most expensive, 4% growth)

In 2018 skilled nursing facilities in Iowa cared for residents for a combined total of 8.5 million days. This was in the face of financial challenges because of Medicaid shortfalls. It won’t get much better, either, as Iowans on average live longer than most other U.S. residents.

#30. Virginia
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#30. Virginia

- Cost index: 37.3
- Homemaker services: $45,760 (#33 most expensive among all states, 3.3% 5-year annual growth)
- Home health aide: $48,048 (#34 most expensive, 3.1% growth)
- Adult day health care: $18,200 (#31 most expensive, 3.1% growth)
- Assisted living/private bedroom: $53,415 (#15 most expensive, 3.4% growth)
- Nursing home/semi-private bedroom: $89,425 (#26 most expensive, 3.7% growth)
- Nursing home/private bedroom: $102,200 (#25 most expensive, 4% growth)

Virginia is struggling with poor long-term-care facilities. The state is among the worst for quality nursing home care, ranking #40 out of 50 in a recent survey. The survey also showed that Virginia patients in long-term care experience the most pain compared with those in all the other states.

#29. South Dakota
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#29. South Dakota

- Cost index: 38.6
- Homemaker services: $54,912 (#15 most expensive among all states, 3.7% 5-year annual growth)
- Home health aide: $57,200 (#14 most expensive, 4.6% growth)
- Adult day health care: $18,460 (#30 most expensive, 11.5% growth)
- Assisted living/private bedroom: $42,000 (#38 most expensive, 2.9% growth)
- Nursing home/semi-private bedroom: $79,388 (#36 most expensive, 2.7% growth)
- Nursing home/private bedroom: $84,863 (#39 most expensive, 2.7% growth)

South Dakota has long suffered from underpaid long-term care workers. But thanks to the new governor, that may not be an issue for much longer. She proposed an extra $12 million for nursing homes and long-term care facilities.

#28. Idaho
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#28. Idaho

- Cost index: 38.9
- Homemaker services: $45,760 (#33 most expensive among all states, 1.6% 5-year annual growth)
- Home health aide: $45,760 (#39 most expensive, 1.6% growth)
- Adult day health care: $31,200 (#2 most expensive, 5.2% growth)
- Assisted living/private bedroom: $41,700 (#43 most expensive, 1.7% growth)
- Nursing home/semi-private bedroom: $90,885 (#25 most expensive, 2.1% growth)
- Nursing home/private bedroom: $96,543 (#27 most expensive, 2.2% growth)

For some families in Idaho, like the Winklers, long-term-care costs eat up most of their income. Betsy and David Winkler make $51,600 annually, and David’s long-term-care costs are $48,000 a year. It’s an example of a two-faceted problem across Idaho: a higher aging population than in other parts of the country and more than a third of families struggling to pay their bills every month.

#27. Nebraska
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#27. Nebraska

- Cost index: 39.5
- Homemaker services: $53,768 (#19 most expensive among all states, 4.1% 5-year annual growth)
- Home health aide: $54,912 (#18 most expensive, 1.9% growth)
- Adult day health care: $18,655 (#29 most expensive, 8.6% growth)
- Assisted living/private bedroom: $46,131 (#30 most expensive, 2.7% growth)
- Nursing home/semi-private bedroom: $82,855 (#32 most expensive, 5% growth)
- Nursing home/private bedroom: $87,191 (#36 most expensive, 3.9% growth)

Starting in 2016, the Nebraska Department of Health and Human Services launched an initiative to redesign the state’s long-term care system. Some of the goals of the program include improving available services and access to them, promoting in-home health care—or care that allows for the most independence possible—and boosting capacity to match available resources.

#26. Nevada
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#26. Nevada

- Cost index: 40.1
- Homemaker services: $50,336 (#22 most expensive among all states, 1.9% 5-year annual growth)
- Home health aide: $50,336 (#29 most expensive, 0.9% growth)
- Adult day health care: $18,720 (#28 most expensive, 2.1% growth)
- Assisted living/private bedroom: $42,000 (#38 most expensive, 4.2% growth)
- Nursing home/semi-private bedroom: $98,733 (#22 most expensive, 4.1% growth)
- Nursing home/private bedroom: $111,143 (#21 most expensive, 4.4% growth)

In the face of rising long-term, health-care costs, Nevada has been making some strides to make things easier on the state’s aging population. Some hospitals partnering with transportation companies to cover the cost of getting to appointments and picking up prescriptions, and emergency rooms are being made more amenable to seniors.

#25. Indiana
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#25. Indiana

- Cost index: 40.2
- Homemaker services: $48,048 (#31 most expensive among all states, 3.1% 5-year annual growth)
- Home health aide: $50,336 (#29 most expensive, 3% growth)
- Adult day health care: $22,100 (#12 most expensive, 4.1% growth)
- Assisted living/private bedroom: $52,620 (#16 most expensive, 3.4% growth)
- Nursing home/semi-private bedroom: $82,308 (#33 most expensive, 3% growth)
- Nursing home/private bedroom: $98,915 (#26 most expensive, 2.9% growth)

In Indiana, Vibra Hospital in Fort Wayne, which provided acute-care services for those with long-term needs, laid off 120 employees when it shut down on Jan. 31 The hospital owner attributed the closure to recent changes in health-care reimbursements, making it too difficult to maintain the facility.

#24. Arizona
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#24. Arizona

- Cost index: 41.1
- Homemaker services: $52,052 (#21 most expensive among all states, 3.7% 5-year annual growth)
- Home health aide: $53,196 (#22 most expensive, 3.1% growth)
- Adult day health care: $24,050 (#9 most expensive, 4.3% growth)
- Assisted living/private bedroom: $45,600 (#31 most expensive, 2.6% growth)
- Nursing home/semi-private bedroom: $77,928 (#37 most expensive, 1.4% growth)
- Nursing home/private bedroom: $94,900 (#28 most expensive, 1.9% growth)

Long-term care in Arizona was recently in the news cycle for a horrific reason: A patient receiving long-term care at a facility in Phoenix was assaulted, eventually giving birth to a baby. Other nurses weren’t aware she was pregnant until she gave birth; the nurse who allegedly assaulted her has since been arrested.

#23. Michigan
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#23. Michigan

- Cost index: 44.7
- Homemaker services: $50,336 (#22 most expensive among all states, 3% 5-year annual growth)
- Home health aide: $52,624 (#23 most expensive, 3.4% growth)
- Adult day health care: $20,800 (#18 most expensive, 3.5% growth)
- Assisted living/private bedroom: $46,200 (#28 most expensive, 6.2% growth)
- Nursing home/semi-private bedroom: $102,748 (#19 most expensive, 4.1% growth)
- Nursing home/private bedroom: $109,500 (#22 most expensive, 3.3% growth)

The cost of long-term care in Michigan—as in many other states—is being forced higher due to a lack of qualified workers. Other factors include higher minimum wages, difficulty keeping workers, changing compliance laws, business constraints, and the increasing need for specialized care.

#22. Pennsylvania
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#22. Pennsylvania

- Cost index: 45.4
- Homemaker services: $50,336 (#22 most expensive among all states, 2.7% 5-year annual growth)
- Home health aide: $51,777 (#26 most expensive, 2.5% growth)
- Adult day health care: $16,900 (#36 most expensive, 3% growth)
- Assisted living/private bedroom: $45,000 (#33 most expensive, 3.4% growth)
- Nursing home/semi-private bedroom: $115,340 (#11 most expensive, 4% growth)
- Nursing home/private bedroom: $121,363 (#12 most expensive, 3.1% growth)

Pennsylvania is in the midst of a nursing crisis. It’s not that there aren't enough nurses—it’s just that workplace and leadership issues are pushing more qualified nurses to leave the profession. Ninety-five percent of nurses recently surveyed felt they were unable to provide the best care for their patients.

#21. Wisconsin
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#21. Wisconsin

- Cost index: 47.6
- Homemaker services: $53,768 (#19 most expensive among all states, 3.3% 5-year annual growth)
- Home health aide: $54,912 (#18 most expensive, 2.2% growth)
- Adult day health care: $16,900 (#36 most expensive, 1% growth)
- Assisted living/private bedroom: $51,600 (#18 most expensive, 4% growth)
- Nursing home/semi-private bedroom: $100,010 (#21 most expensive, 2.8% growth)
- Nursing home/private bedroom: $112,146 (#20 most expensive, 3% growth)

By 2030 the population of people over 65 in Wisconsin is expected to double, and that might be a problem for the long-term care industry. There aren’t enough health care workers there because of low unemployment and the lengthy time it takes to graduate from medical programs.

#20. Montana
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#20. Montana

- Cost index: 47.8
- Homemaker services: $54,912 (#15 most expensive among all states, 3.7% 5-year annual growth)
- Home health aide: $54,912 (#18 most expensive, 2.7% growth)
- Adult day health care: $29,614 (#3 most expensive, 7.3% growth)
- Assisted living/private bedroom: $47,028 (#27 most expensive, 1.7% growth)
- Nursing home/semi-private bedroom: $84,067 (#30 most expensive, 3.1% growth)
- Nursing home/private bedroom: $87,717 (#35 most expensive, 2% growth)

Assisted living facilities in Montana face a continuing struggle to maintain operations and provide space for Medicaid patients. The government doesn’t pay out enough, providers say. Recently, they asked for more reimbursement money for each patient so they can stop turning away people who need care.

#19. Wyoming
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#19. Wyoming

- Cost index: 48.1
- Homemaker services: $50,336 (#22 most expensive among all states, 2.2% 5-year annual growth)
- Home health aide: $57,200 (#14 most expensive, 4.8% growth)
- Adult day health care: $28,990 (#5 most expensive, 6.9% growth)
- Assisted living/ private bedroom: $50,820 (#21 most expensive, 5.1% growth)
- Nursing home/semi-private bedroom: $86,140 (#28 most expensive, 3.5% growth)
- Nursing home/private bedroom: $90,520 (#34 most expensive, 3.6% growth)

Currently, Wyoming pays out $138 million annually in long-term care costs. But since 2013, Wyoming hasn’t paid into the National Family Caregiver Support program, which brings in workers for light housework so caretakers can get out and run errands. That leaves many counties without those federal dollars.

#18. Maryland
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#18. Maryland

- Cost index: 49.5
- Homemaker services: $49,169 (#29 most expensive among all states, 2.8% 5-year annual growth)
- Home health aide: $50,908 (#28 most expensive, 2.2% growth)
- Adult day health care: $20,800 (#18 most expensive, 0.9% growth)
- Assisted living/private bedroom: $56,070 (#10 most expensive, 6.6% growth)
- Nursing home/semi-private bedroom: $110,778 (#15 most expensive, 4% growth)
- Nursing home/private bedroom: $116,070 (#19 most expensive, 3% growth)

In Maryland, many families are being forced to provide in-home care for their loved ones. When home nurses are approved, families often get bad news: There are no nurses available. That’s mainly because nurses are leaving Maryland en masse to go to nearby states with higher pay rates.

#17. Colorado
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#17. Colorado

- Cost index: 50.4
- Homemaker services: $57,200 (#10 most expensive among all states, 3.6% 5-year annual growth)
- Home health aide: $58,916 (#13 most expensive, 3.6% growth)
- Adult day health care: $19,500 (#24 most expensive, 3.9% growth)
- Assisted living/private bedroom: $48,000 (#24 most expensive, 2.6% growth)
- Nursing home/semi-private bedroom: $94,703 (#24 most expensive, 4.1% growth)
- Nursing home/private bedroom: $107,996 (#24 most expensive, 4.4% growth)

Overall, Colorado has been hit with a double whammy for health-care costs: There is an elevated cost for services in general, and its population goes to the doctor more than residents of other states.

#16. California
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#16. California

- Cost index: 57.5
- Homemaker services: $59,488 (#5 most expensive among all states, 3.4% 5-year annual growth)
- Home health aide: $59,488 (#10 most expensive, 2.5% growth)
- Adult day health care: $20,150 (#22 most expensive, 0.1% growth)
- Assisted living/private bedroom: $54,000 (#13 most expensive, 3.9% growth)
- Nursing home/semi-private bedroom: $100,375 (#20 most expensive, 3.6% growth)
- Nursing home/private bedroom: $117,804 (#16 most expensive, 3.8% growth)

In California, even with the help of friends and family, it’s not uncommon for patients to pay up to $20,000 more out of pocket for care at home. Only after giving up nearly every asset they own can a person apply for Medi-Cal, which is California’s Medicaid program.

#15. Rhode Island
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#15. Rhode Island

- Cost index: 57.7
- Homemaker services: $58,344 (#8 most expensive among all states, 5% 5-year annual growth)
- Home health aide: $61,776 (#5 most expensive, 3.3% growth)
- Adult day health care: $19,500 (#24 most expensive, 2.9% growth)
- Assisted living/private bedroom: $52,200 (#17 most expensive, 1% growth)
- Nursing home/semi-private bedroom: $105,850 (#17 most expensive, 0.7% growth)
- Nursing home/private bedroom: $116,800 (#17 most expensive, 1% growth)

The Unified Health Infrastructure Project (UHIP) in Rhode Island caused more problems than it was worth. The program promised $400 million in reimbursements for long-term care facilities. Instead, though, the release was botched, many reimbursements were delayed, and a number of long-term care facilities were pushed to near-bankruptcy.

#14. Delaware
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#14. Delaware

- Cost index: 59
- Homemaker services: $48,620 (#30 most expensive among all states, 1.1% 5-year annual growth)
- Home health aide: $52,624 (#23 most expensive, 0.9% growth)
- Adult day health care: $21,570 (#16 most expensive, 5.8% growth)
- Assisted living/private bedroom: $64,200 (#5 most expensive, 0.7% decrease)
- Nursing home/semi-private bedroom: $125,925 (#8 most expensive, 4.7% growth)
- Nursing home/private bedroom: $131,400 (#10 most expensive, 4.1% growth)

As Medicaid reimbursement rates have stagnated, medical facilities in Delaware providing long-term care have turned to more lucrative solutions—like phasing out Medicaid beds in favor of short-term rehabilitation beds. This has caused long-term care facilities to have extensive waiting lists, such as the one at Little Sisters of the Poor, which stretches for two years.

#13. Oregon
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#13. Oregon

- Cost index: 61.8
- Homemaker services: $58,344 (#8 most expensive among all states, 5% 5-year annual growth)
- Home health aide: $59,488 (#10 most expensive, 4.4% growth)
- Adult day health care: $23,790 (#10 most expensive, 0.6% decrease)
- Assisted living/private bedroom: $55,110 (#11 most expensive, 2.7% growth)
- Nursing home/semi-private bedroom: $111,325 (#14 most expensive, 5.6% growth)
- Nursing home/private bedroom: $119,720 (#14 most expensive, 5.3% growth)

More than 60,000 Oregon residents have some sort of long-term care every day. It’s also some of the best long-term care in the country, ranking fourth on AARP’s Long-Term Services and Supports State Scorecard—which could help explain why it’s so expensive.

#12. Minnesota
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#12. Minnesota

- Cost index: 63.3
- Homemaker services: $61,776 (#2 most expensive among all states, 5.2% 5-year annual growth)
- Home health aide: $66,352 (#2 most expensive, 3% growth)
- Adult day health care: $21,580 (#15 most expensive, 4.7% growth)
- Assisted living/private bedroom: $48,000 (#24 most expensive, 3.6% growth)
- Nursing home/semi-private bedroom: $109,500 (#16 most expensive, 8.7% growth)
- Nursing home/private bedroom: $122,260 (#11 most expensive, 8.9% growth)

Minnesota has two viable ideas for dealing with its long-term care costs. The first is a program that would convert life insurance into long-term care insurance once you retire. The second is a home care benefit rolled directly into Medicare.

#11. Washington
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#11. Washington

- Cost index: 64.1
- Homemaker services: $64,064 (#1 most expensive among all states, 5.4% 5-year annual growth)
- Home health aide: $64,064 (#3 most expensive, 4.5% growth)
- Adult day health care: $16,900 (#36 most expensive, 0.8% decrease)
- Assisted living/private bedroom: $61,620 (#6 most expensive, 3.9% growth)
- Nursing home/semi-private bedroom: $104,025 (#18 most expensive, 3.3% growth)
- Nursing home/private bedroom: $116,618 (#18 most expensive, 4% growth)

Under a new bill, Washington may have a solution for excessively high long-term care costs. The Long-Term Care Trust Act would establish a fund that workers pay into that would be used exclusively for long-term care needs if it should be required. Lifetime benefits, though, would remain low, at $36,500 per person.

#10. New York
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#10. New York

- Cost index: 64.2
- Homemaker services: $56,285 (#14 most expensive among all states, 4.2% 5-year annual growth)
- Home health aide: $57,200 (#14 most expensive, 2.6% growth)
- Adult day health care: $19,500 (#24 most expensive, 0% decrease)
- Assisted living/private bedroom: $50,220 (#22 most expensive, 1.2% growth)
- Nursing home/semi-private bedroom: $141,073 (#5 most expensive, 3.1% growth)
- Nursing home/private bedroom: $146,274 (#5 most expensive, 3.1% growth)

The cost of long-term care in New York is so high that government programs can’t even keep up. In 2010 it was reported that reimbursement for nursing home stays was coming up almost $50 short per day, per person.

#9. New Hampshire
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#9. New Hampshire

- Cost index: 65
- Homemaker services: $57,200 (#10 most expensive among all states, 2.6% 5-year annual growth)
- Home health aide: $61,776 (#5 most expensive, 2.6% growth)
- Adult day health care: $20,410 (#21 most expensive, 3.9% growth)
- Assisted living/private bedroom: $56,100 (#9 most expensive, 5.4% growth)
- Nursing home/semi-private bedroom: $124,100 (#9 most expensive, 2.9% growth)
- Nursing home/private bedroom: $133,225 (#8 most expensive, 2% growth)

According to AARP, New Hampshire suffers from increased long-term care costs because of the way the state structures its budget. More than 80% of the long-term care budget goes to prohibitively expensive nursing homes and neglects in-home care—which costs about 60% less.

#8. Maine
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#8. Maine

- Cost index: 66.4
- Homemaker services: $57,200 (#10 most expensive among all states, 4.1% 5-year annual growth)
- Home health aide: $59,488 (#10 most expensive, 3.4% growth)
- Adult day health care: $28,600 (#6 most expensive, 2.3% growth)
- Assisted living/private bedroom: $59,400 (#7 most expensive, 1.9% growth)
- Nursing home/semi-private bedroom: $113,150 (#13 most expensive, 2.8% growth)
- Nursing home/private bedroom: $121,180 (#13 most expensive, 3.1% growth)

Part of the high care costs in Maine has to do with demand. A number of facilities have been forced to close over the past few years due to operational losses; at one facility, they were as high as $200,000 annually. There also aren’t enough new workers to staff the remaining facilities, which means space is at a premium.

#7. Connecticut
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#7. Connecticut

- Cost index: 66.5
- Homemaker services: $49,192 (#28 most expensive among all states, 2.5% 5-year annual growth)
- Home health aide: $52,624 (#23 most expensive, 1.8% growth)
- Adult day health care: $22,100 (#12 most expensive, 1.2% growth)
- Assisted living/private bedroom: $56,400 (#8 most expensive, 1.2% decrease)
- Nursing home/semi-private bedroom: $151,475 (#2 most expensive, 1.5% growth)
- Nursing home/private bedroom: $164,798 (#2 most expensive, 1.8% growth)

Even though Connecticut is among the most expensive states for long-term care, facilities that provide that care appear to be lacking. Connecticut Public Radio recently discovered that since 2015, nursing homes saw 247 incidents of lapses in care. Some of those lapses led to avoidable hospitalizations.

#6. North Dakota
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#6. North Dakota

- Cost index: 69.3
- Homemaker services: $61,776 (#2 most expensive among all states, 3% 5-year annual growth)
- Home health aide: $61,776 (#5 most expensive, 3% growth)
- Adult day health care: $29,029 (#4 most expensive, 12.2% growth)
- Assisted living/private bedroom: $39,780 (#46 most expensive, 3.1% growth)
- Nursing home/semi-private bedroom: $132,320 (#6 most expensive, 8.6% growth)
- Nursing home/private bedroom: $140,277 (#7 most expensive, 9% growth)

Over the past 10 years, federal regulations have made it more difficult for people in North Dakota to get Medicaid. As a result, many nursing homes turned to an antiquated law requiring children to support impoverished parents and sued offspring for unpaid bills. Under a proposed bill, however, such steps may no longer be allowed.

#5. New Jersey
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#5. New Jersey

- Cost index: 70.8
- Homemaker services: $54,912 (#15 most expensive among all states, 3.2% 5-year annual growth)
- Home health aide: $54,912 (#18 most expensive, 2.7% growth)
- Adult day health care: $23,400 (#11 most expensive, 2.4% growth)
- Assisted living/private bedroom: $72,780 (#2 most expensive, 0.2% growth)
- Nursing home/semi-private bedroom: $127,750 (#7 most expensive, 3.2% growth)
- Nursing home/private bedroom: $142,350 (#6 most expensive, 3.3% growth)

New Jersey may have some of the highest long-term, health-care costs, but costs across the state actually vary by about 20%. Assisted living, for example, is cheaper in the southern part of the state and on the Pennsylvania border. As of last year, assisted living for a month was about $5,000 on average.

#4. Vermont
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#4. Vermont

- Cost index: 72.2
- Homemaker services: $61,776 (#2 most expensive among all states, 5.2% 5-year annual growth)
- Home health aide: $61,776 (#5 most expensive, 2.4% growth)
- Adult day health care: $35,360 (#1 most expensive, 1% growth)
- Assisted living/private bedroom: $54,000 (#13 most expensive, 3.7% growth)
- Nursing home/semi-private bedroom: $113,698 (#12 most expensive, 3.2% growth)
- Nursing home/private bedroom: $118,808 (#15 most expensive, 2% growth)

In 2018, Vermont’s attorney general introduced an Elder Protection Initiative to investigate how the state could better provide for and protect those in long-term care. It includes training to help recognize elder abuse and exploitation.

#3. Massachusetts
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#3. Massachusetts

- Cost index: 74.9
- Homemaker services: $58,916 (#7 most expensive among all states, 2.3% 5-year annual growth)
- Home health aide: $62,005 (#4 most expensive, 2.3% growth)
- Adult day health care: $17,332 (#35 most expensive, 2.1% growth)
- Assisted living/private bedroom: $65,940 (#4 most expensive, 2.1% growth)
- Nursing home/semi-private bedroom: $144,175 (#4 most expensive, 2.7% growth)
- Nursing home/private bedroom: $153,300 (#4 most expensive, 2.9% growth)

According to news reports from January 2019, Massachusetts nursing homes are in serious trouble because of Medicaid shortfalls. Twenty closed in the last year alone, and more than half are operating at a deficit. Advocates say the issue is due to Medicaid rates based on 2007 costs.

#2. Hawaii
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#2. Hawaii

- Cost index: 81
- Homemaker services: $57,200 (#10 most expensive among all states, 1.3% 5-year annual growth)
- Home health aide: $68,640 (#1 most expensive, 3.7% growth)
- Adult day health care: $19,760 (#23 most expensive, 1.7% growth)
- Assisted living/private bedroom: $66,000 (#3 most expensive, 5.5% growth)
- Nursing home/semi-private bedroom: $146,000 (#3 most expensive, 2.7% growth)
- Nursing home/private bedroom: $163,885 (#3 most expensive, 2.4% growth)

In Hawaii, costs for private nursing home care alone are 40% more than the national average. Because of 2016 cuts in the state’s Kupuna Care program, which took away some state financial assistance, many Hawaiians are being forced to become caregivers for family members.

#1. Alaska
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#1. Alaska

- Cost index: 88.6
- Homemaker services: $59,488 (#5 most expensive among all states, 1.2% 5-year annual growth)
- Home health aide: $61,776 (#5 most expensive, 2% growth)
- Adult day health care: $27,373 (#7 most expensive, 1.4% decrease)
- Assisted living/private bedroom: $75,600 (#1 most expensive, 1% growth)
- Nursing home/semi-private bedroom: $351,495 (#1 most expensive, 5.4% growth)
- Nursing home/private bedroom: $330,873 (#1 most expensive, 5.3% growth)

Alaska’s health-care costs are nearly double the rest of the country, and with good reason: Almost all supplies have to be shipped in by boat or plane. On the plus side for providers though, they’re paid more than double what providers in other expensive states make.

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