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States with the most expensive nursing homes

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Dmytro Zinkevych // Shutterstock

States with the most expensive nursing homes

The most expensive states in which to live in the United States are likely easy to guess: California and New York easily come to mind as costly places to pay rent, buy a home, and head out to dinner. But with the decision to move into a nursing home at the end of one’s life, the states where it is most and least expensive to do so are not as apparent.

And the same is true in the opposite direction. States where the cost of living is low—West Virginia, for example—often have high costs of care in nursing homes and assisted living facilities. The patchwork of reasons for the gap between the cost of living in a state and the cost of nursing home care are varied and complex. In some cases, such as Alaska—the most expensive state in the country to live in a nursing home—geography plays a role, with the relative remoteness of the state making it difficult to recruit trained professionals.

In other cases, policies surrounding Medicare and other federal reimbursements determine how much money the state or private providers will have to bear, and which costs they may pass on to patients.

To determine the states with the most expensive nursing homes, Stacker consulted Genworth’s 2019 Cost of Care Survey. All 50 states are ranked based on the median annual cost of a semi-private room in a nursing home in 2019, with ties broken by the median annual cost of a private room. Additional data comes from SmartAsset, a financial technology company which ranked every state on its nursing homes using annual costs, nursing home availability, and other metrics, and the U.S. Census (2018 one-year median income estimates).

One conclusion emerged from this review: States with high costs of care are hardly immune from poor quality of care. Some of the most egregious misdeeds at nursing homes occur in states where residents pay the most. Here, click through for a look at the states with the most expensive nursing homes.

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Jacob Lund // Shutterstock

#50. Oklahoma

- Median annual cost of a semi-private room: $58,400 (35.2% below national average; 1.99% five-year cost increase)
- Median annual cost of a private room: $67,525 (33.9% below national average; 3.27% five-year cost increase)
- State median household income: $51,924
- SmartAsset rank: #15 best state for nursing homes
--- 4.96 nursing homes per 10,000 seniors
--- 3.62 average nurse staffing hours per resident per day

Although Oklahoma has one of its lowest unemployment rates of the past decade, all is not rosy for senior health care in the state. Oklahoma has the second-highest uninsured rate in the country, which can push people into nursing homes before they might ordinarily need to go, for lack of preventive care.

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Diego Cervo // Shutterstock

#49. Texas

- Median annual cost of a semi-private room: $58,400 (35.2% below national average; 2.85% five-year cost increase)
- Median annual cost of a private room: $77,015 (24.6% below national average; 3.23% five-year cost increase)
- State median household income: $60,629
- SmartAsset rank: #36 best state for nursing homes
--- 3.53 nursing homes per 10,000 seniors
--- 3.42 average nurse staffing hours per resident per day

Texas has a strong advocacy program for residents of nursing homes. An ombudsman for residents’ rights in the state focuses on improved communication and care for facilities statewide. Advocates in the state are also working diligently to recruit volunteers for homes.

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belushi // Shutterstock

#48. Missouri

- Median annual cost of a semi-private room: $60,736 (32.6% below national average; 2.79% five-year cost increase)
- Median annual cost of a private room: $68,255 (33.2% below national average; 2.66% five-year cost increase)
- State median household income: $54,478
- SmartAsset rank: #8 best state for nursing homes
--- 5.19 nursing homes per 10,000 seniors
--- 3.51 average nurse staffing hours per resident per day

Missouri nursing home workers may soon get a raise to keep a thin workforce. The state faces a shortage of caregivers at nursing homes because of high turnover.

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Pressmaster // Shutterstock

#47. Louisiana

- Median annual cost of a semi-private room: $65,218 (27.7% below national average; 3.29% five-year cost increase)
- Median annual cost of a private room: $68,109 (33.4% below national average; 3% five-year cost increase)
- State median household income: $47,905
- SmartAsset rank: #7 best state for nursing homes
--- 3.96 nursing homes per 10,000 seniors
--- 3.68 average nurse staffing hours per resident per day

Louisiana may have relatively inexpensive nursing home care, but that’s not what it always told the federal government. The state got in trouble for inflating nursing home costs and trying to pass them off as legitimate charges for reimbursement by the federal government.

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GagliardiPhotography // Shutterstock

#46. Arkansas

- Median annual cost of a semi-private room: $66,065 (26.7% below national average; 3.15% five-year cost increase)
- Median annual cost of a private room: $73,000 (28.6% below national average; 3.18% five-year cost increase)
- State median household income: $47,062
- SmartAsset rank: #1 best state for nursing homes
--- 4.63 nursing homes per 10,000 seniors
--- 4.09 average nurse staffing hours per resident per day

Nursing care costs in Arkansas also may be relatively low, but that doesn’t always mean the quality of care is high. One facility was forced to close after a state board found quality-of-care issues.

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Photographee.eu // Shutterstock

#45. Kansas

- Median annual cost of a semi-private room: $67,525 (25.1% below national average; 2.95% five-year cost increase)
- Median annual cost of a private room: $74,095 (27.5% below national average; 3.01% five-year cost increase)
- State median household income: $58,218
- SmartAsset rank: #18 best state for nursing homes
--- 7.53 nursing homes per 10,000 seniors
--- 4.04 average nurse staffing hours per resident per day

Low-cost though it may be, some troubling stories have emerged from Kansas nursing home facilities in recent months. “Careless use of smoking materials” was responsible for a fire in early December at one facility in which a resident died.

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Jacob Lund // Shutterstock

#44. Illinois

- Median annual cost of a semi-private room: $71,175 (21.1% below national average; 2.78% five-year cost increase)
- Median annual cost of a private room: $82,125 (19.6% below national average; 1.93% five-year cost increase)
- State median household income: $65,030
- SmartAsset rank: #30 best state for nursing homes
--- 3.73 nursing homes per 10,000 seniors
--- 3.4 average nurse staffing hours per resident per day

The nursing home industry in Illinois lags in meeting quality standards. Seventy-one nursing homes in the state were recently cited for poor care, partly because overburdened workers don’t have the resources to care for their patients.

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Monkey Business Images // Shutterstock

#43. Iowa

- Median annual cost of a semi-private room: $76,103 (15.6% below national average; 4.29% five-year cost increase)
- Median annual cost of a private room: $82,537 (19.2% below national average; 4.1% five-year cost increase)
- State median household income: $59,955
- SmartAsset rank: #13 best state for nursing homes
--- 8.37 nursing homes per 10,000 seniors
--- 3.68 average nurse staffing hours per resident per day

Elder advocates in Iowa are concerned that the state might not be fulfilling its obligations under federal law, including the Older Americans Act. The advocates claim that many nursing homes in the state cannot provide proper oversight to ensure that cases of abuse and neglect do not go undetected.

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YAKOBCHUK VIACHESLAV // Shutterstock

#42. Alabama

- Median annual cost of a semi-private room: $76,650 (15% below national average; 2.24% five-year cost increase)
- Median annual cost of a private room: $81,395 (20.4% below national average; 2.61% five-year cost increase)
- State median household income: $49,861
- SmartAsset rank: #10 best state for nursing homes
--- 2.84 nursing homes per 10,000 seniors
--- 3.9 average nurse staffing hours per resident per day

Alabama recently pioneered a new model of care for senior citizens. Thanks to the state lobbying the federal government, a collaboration between state care and federal Medicaid will give over 20,000 residents expanded choices for later-life care, including the option to receive care at home that they would ordinarily receive in a nursing home.

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Robert Kneschke // Shutterstock

#41. Utah

- Median annual cost of a semi-private room: $76,833 (14.8% below national average; 4.06% five-year cost increase)
- Median annual cost of a private room: $91,250 (10.7% below national average; 4.56% five-year cost increase)
- State median household income: $71,414
- SmartAsset rank: #9 best state for nursing homes
--- 3.01 nursing homes per 10,000 seniors
--- 4.09 average nurse staffing hours per resident per day

Elder advocates in Utah are concerned that the federal government’s new push to deregulate nursing homes will cause a lower quality of care. The Trump administration has proposed “relaxing” the rules covering nursing homes, which advocates suggest will effectively lower standards for many residents in nursing care.

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SeventyFour // Shutterstock

#40. Arizona

- Median annual cost of a semi-private room: $77,198 (14.4% below national average; 1.4% five-year cost increase)
- Median annual cost of a private room: $97,638 (4.5% below national average; 2.82% five-year cost increase)
- State median household income: $59,246
- SmartAsset rank: #10 best state for nursing homes
--- 1.22 nursing homes per 10,000 seniors
--- 4.17 average nurse staffing hours per resident per day

The quality of elder care in Arizona is slipping to a degree that troubles some state legislators. Three lawmakers recently called for an investigation into why the state health department had been so slow to respond to reports of abuse and neglect at state facilities.

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Monkey Business Images // Shutterstock

#39. Georgia

- Median annual cost of a semi-private room: $80,209 (11% below national average; 4.07% five-year cost increase)
- Median annual cost of a private room: $85,775 (16.1% below national average; 3.18% five-year cost increase)
- State median household income: $58,756
- SmartAsset rank: #49 best state for nursing homes
--- 2.57 nursing homes per 10,000 seniors
--- 3.52 average nurse staffing hours per resident per day

Five Georgia nursing homes were recently flagged by the state with a red warning label for the poor quality of care. Among the offenses were verbal abuse and two deaths, one from a fall, and the other from failure to properly treat a surgical wound.

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wavebreakmedia // Shutterstock

#38. Tennessee

- Median annual cost of a semi-private room: $82,037 (9% below national average; 3.97% five-year cost increase)
- Median annual cost of a private room: $87,600 (14.3% below national average; 3.98% five-year cost increase)
- State median household income: $52,375
- SmartAsset rank: #40 best state for nursing homes
--- 2.95 nursing homes per 10,000 seniors
--- 3.77 average nurse staffing hours per resident per day

Tennessee has a high number of homes on a federal list for failure to provide adequate care. Eleven facilities received a federal flag, including for abuse, filth, neglect, and death. At least one home is now under criminal investigation.

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Diego Cervo // Shutterstock

#37. Mississippi

- Median annual cost of a semi-private room: $82,125 (8.9% below national average; 1.98% five-year cost increase)
- Median annual cost of a private room: $85,045 (16.8% below national average; 2.1% five-year cost increase)
- State median household income: $44,717
- SmartAsset rank: #3 best state for nursing homes
--- 4.4 nursing homes per 10,000 seniors
--- 4.05 average nurse staffing hours per resident per day

A nursing home bill of rights has been making the rounds recently in Mississippi. The legislation comes in the wake of a tragedy at a nursing home in which 12 residents died of overheating.

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Alexander Raths // Shutterstock

#36. South Dakota

- Median annual cost of a semi-private room: $82,125 (8.9% below national average; 3.88% five-year cost increase)
- Median annual cost of a private room: $86,323 (15.5% below national average; 4.04% five-year cost increase)
- State median household income: $56,274
- SmartAsset rank: #14 best state for nursing homes
--- 7.54 nursing homes per 10,000 seniors
--- 3.61 average nurse staffing hours per resident per day

South Dakota has a shortage of areas with nursing homes that are easily accessible. And that shortage is trending in the wrong direction, with six closures in the state in the past 18 months alone.

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didesign021 // Shutterstock

#35. Kentucky

- Median annual cost of a semi-private room: $82,855 (8.1% below national average; 2.57% five-year cost increase)
- Median annual cost of a private room: $91,250 (10.7% below national average; 2.59% five-year cost increase)
- State median household income: $50,247
- SmartAsset rank: #28 best state for nursing homes
--- 4.02 nursing homes per 10,000 seniors
--- 3.95 average nurse staffing hours per resident per day

A particularly troubling story has emerged from the Kentucky nursing home industry in recent months. In one home, the director of the facility stands accused of sexually harassing residents, including groping them.

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Diego Cervo // Shutterstock

#34. Ohio

- Median annual cost of a semi-private room: $83,950 (6.9% below national average; 1.98% five-year cost increase)
- Median annual cost of a private room: $93,805 (8.2% below national average; 1.51% five-year cost increase)
- State median household income: $56,111
- SmartAsset rank: #24 best state for nursing homes
--- 4.95 nursing homes per 10,000 seniors
--- 3.64 average nurse staffing hours per resident per day

The Ohio attorney general is at odds with state lawmakers over a bill of rights for nursing home patients. The measure would set a minimum standard of care for facilities across the state and was initially put forward by a man who alleges that his wife almost died after being neglected in a state facility.

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wavebreakmedia // Shutterstock

#33. Nebraska

- Median annual cost of a semi-private room: $84,041 (6.8% below national average; 4% five-year cost increase)
- Median annual cost of a private room: $92,345 (9.6% below national average; 4.65% five-year cost increase)
- State median household income: $59,566
- SmartAsset rank: #6 best state for nursing homes
--- 7.15 nursing homes per 10,000 seniors
--- 4.01 average nurse staffing hours per resident per day

Rural nursing homes in Nebraska are closing at an alarming rate. The state has had 14 closures in 2019, more than double the number than 2018.

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Halfpoint // Shutterstock

#32. Indiana

- Median annual cost of a semi-private room: $84,253 (6.5% below national average; 3.01% five-year cost increase)
- Median annual cost of a private room: $102,200 (0% below national average; 3.57% five-year cost increase)
- State median household income: $55,746
- SmartAsset rank: #23 best state for nursing homes
--- 5.33 nursing homes per 10,000 seniors
--- 3.65 average nurse staffing hours per resident per day

A new Indiana startup is focused on improving the quality of care for nursing home residents. The startup will partner with a think tank to focus on reducing hospital trips and controlling costs. The trial of the study at 19 nursing homes in the state was successful.

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Kzenon // Shutterstock

#31. North Carolina

- Median annual cost of a semi-private room: $84,680 (6.1% below national average; 2.76% five-year cost increase)
- Median annual cost of a private room: $91,980 (10% below national average; 2.29% five-year cost increase)
- State median household income: $53,855
- SmartAsset rank: #45 best state for nursing homes
--- 2.63 nursing homes per 10,000 seniors
--- 3.79 average nurse staffing hours per resident per day

One of the most troubling stories coming out of a nursing home in the United States is from North Carolina. Residents with dementia in one Winston-Salem facility were subjected to “fight clubs” by staff meant to provide their care.

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Dmytro Zinkevych // Shutterstock

#30. South Carolina

- Median annual cost of a semi-private room: $85,472 (5.2% below national average; 4.83% five-year cost increase)
- Median annual cost of a private room: $91,250 (10.7% below national average; 4.56% five-year cost increase)
- State median household income: $52,306
- SmartAsset rank: #24 best state for nursing homes
--- 2.18 nursing homes per 10,000 seniors
--- 4.08 average nurse staffing hours per resident per day

The difference between in-home and nursing facility care in South Carolina is particularly stark. A shortage of skilled workers is contributing to the rising costs, along with the costs associated with complying with new state and federal regulations.

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Monkey Business Images // Shutterstock

#29. New Mexico

- Median annual cost of a semi-private room: $87,954 (2.4% below national average; 3.72% five-year cost increase)
- Median annual cost of a private room: $96,725 (5.4% below national average; 3.15% five-year cost increase)
- State median household income: $47,169
- SmartAsset rank: #50 best state for nursing homes
--- 2.11 nursing homes per 10,000 seniors
--- 3.64 average nurse staffing hours per resident per day

The New Mexico Department of Health has a new focus on nursing care. Flu cases are on the rise across the state, and health officials are particularly concerned about the implications in nursing homes, in which residents typically have weakened immune systems and thus are more susceptible to the flu.

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Photographee.eu // Shutterstock

#28. Wyoming

- Median annual cost of a semi-private room: $88,148 (2.2% below national average; 2.26% five-year cost increase)
- Median annual cost of a private room: $96,360 (5.7% below national average; 1.76% five-year cost increase)
- State median household income: $61,584
- SmartAsset rank: #12 best state for nursing homes
--- 4.2 nursing homes per 10,000 seniors
--- 4.22 average nurse staffing hours per resident per day

Even though Wyoming ranks near the middle of the pack in terms of care costs, the disparity between the cost of nursing home care and in-home care is particularly sharp in the state. The cost of in-home care is among the top five in the nation.

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Jacob Lund // Shutterstock

#27. Virginia

- Median annual cost of a semi-private room: $88,206 (2.2% below national average; 2.75% five-year cost increase)
- Median annual cost of a private room: $98,550 (3.6% below national average; 3.17% five-year cost increase)
- State median household income: $72,577
- SmartAsset rank: #39 best state for nursing homes
--- 2.26 nursing homes per 10,000 seniors
--- 3.73 average nurse staffing hours per resident per day

Virginia has been the site of a recent crime at a nursing home. In Northern Virginia, a man stands accused of assaulting a female resident who has a mental illness that prevented her from telling him to stop.

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wavebreakmedia // Shutterstock

#26. Montana

- Median annual cost of a semi-private room: $89,513 (0.7% below national average; 4.06% five-year cost increase)
- Median annual cost of a private room: $92,608 (9.4% below national average; 3.27% five-year cost increase)
- State median household income: $55,328
- SmartAsset rank: #43 best state for nursing homes
--- 3.84 nursing homes per 10,000 seniors
--- 3.76 average nurse staffing hours per resident per day

Nursing home evictions are a serious problem, and one pilot program in Montana aims to change the lax regulations and troubling outcomes that often accompany discharges. An $84,000 program will train nursing home staff in the state on discharge regulations.

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belushi // Shutterstock

#25. Nevada

- Median annual cost of a semi-private room: $91,250 (1.2% above national average; 1.81% five-year cost increase)
- Median annual cost of a private room: $111,325 (8.9% above national average; 4.36% five-year cost increase)
- State median household income: $58,646
- SmartAsset rank: #34 best state for nursing homes
--- 1.35 nursing homes per 10,000 seniors
--- 4.15 average nurse staffing hours per resident per day

A caregiver in Nevada has been named Caregiver of the Year. The award is national and was won by 27-year-old Bonnie Croom of Northern Nevada.

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ChameleonsEye // Shutterstock

#24. Idaho

- Median annual cost of a semi-private room: $95,083 (5.5% above national average; 3.58% five-year cost increase)
- Median annual cost of a private room: $102,748 (0.5% above national average; 3.83% five-year cost increase)
- State median household income: $55,583
- SmartAsset rank: #24 best state for nursing homes
--- 3.08 nursing homes per 10,000 seniors
--- 4.52 average nurse staffing hours per resident per day

Recent Idaho budget cuts have affected nursing homes significantly. The state’s recent overall 1% budget cuts will be felt strongly at nursing homes, along with hospitals in the state.

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wavebreakmedia // Shutterstock

#23. Colorado

- Median annual cost of a semi-private room: $98,368 (9.1% above national average; 4.43% five-year cost increase)
- Median annual cost of a private room: $113,150 (10.7% above national average; 4.23% five-year cost increase)
- State median household income: $71,953
- SmartAsset rank: #31 best state for nursing homes
--- 2.96 nursing homes per 10,000 seniors
--- 3.91 average nurse staffing hours per resident per day

Expensive Colorado cities like Aspen often rank at the top of lists as among the greatest places to retire. Those who choose to retire in traditional assisted-living facilities around these areas face even higher costs than the annual cost of living in a community like Aspen because of the care included with housing.

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Paul Vasarhelyi // Shutterstock

#22. Wisconsin

- Median annual cost of a semi-private room: $99,280 (10.1% above national average; 2.59% five-year cost increase)
- Median annual cost of a private room: $112,785 (10.4% above national average; 2.97% five-year cost increase)
- State median household income: $60,773
- SmartAsset rank: #21 best state for nursing homes
--- 3.8 nursing homes per 10,000 seniors
--- 3.93 average nurse staffing hours per resident per day

The number of nursing home closures in Wisconsin is accelerating. The most recent closure cut 71 jobs, and the facility was closed because of “serious quality issues.”

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wavebreakmedia // Shutterstock

#21. Michigan

- Median annual cost of a semi-private room: $100,481 (11.5% above national average; 2.74% five-year cost increase)
- Median annual cost of a private room: $111,508 (9.1% above national average; 3.32% five-year cost increase)
- State median household income: $56,697
- SmartAsset rank: #31 best state for nursing homes
--- 2.67 nursing homes per 10,000 seniors
--- 4.05 average nurse staffing hours per resident per day

Recent legislation proposed in Michigan would cut $2 million in funding for nursing homes in the state’s Upper Peninsula alone. Elder advocates claim that the move would cause facilities to cut staff and therefore diminish the quality of care.

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Kristo-Gothard Hunor // Shutterstock

#20. Florida

- Median annual cost of a semi-private room: $102,565 (13.8% above national average; 4.09% five-year cost increase)
- Median annual cost of a private room: $112,639 (10.2% above national average; 4.22% five-year cost increase)
- State median household income: $55,462
- SmartAsset rank: #19 best state for nursing homes
--- 1.65 nursing homes per 10,000 seniors
--- 4.3 average nurse staffing hours per resident per day

Generator requirements have been a major issue for Florida nursing homes. One reason is that hurricanes regularly batter nursing homes along the coast and generator failures can have serious consequences. Electrical power fuels many life-sustaining medical devices at nursing homes.

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Monkey Business Images // Shutterstock

#19. California

- Median annual cost of a semi-private room: $105,120 (16.6% above national average; 3.9% five-year cost increase)
- Median annual cost of a private room: $127,750 (25% above national average; 4.19% five-year cost increase)
- State median household income: $75,277
- SmartAsset rank: #5 best state for nursing homes
--- 2.17 nursing homes per 10,000 seniors
--- 4.29 average nurse staffing hours per resident per day

A California nursing home recently made national news for evicting an elderly resident who had nowhere to go. The woman was discharged before she could care for herself and simply deposited at a family member’s door with no explanation.

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SeventyFour // Shutterstock

#18. Washington

- Median annual cost of a semi-private room: $109,343 (21.3% above national average; 3.44% five-year cost increase)
- Median annual cost of a private room: $119,173 (16.6% above national average; 3.16% five-year cost increase)
- State median household income: $74,073
- SmartAsset rank: #46 best state for nursing homes
--- 1.91 nursing homes per 10,000 seniors
--- 4.17 average nurse staffing hours per resident per day

Washington’s nursing homes are in a state of crisis, according to some legislators. Inadequate reimbursements for Medicaid patients have led to facility closures, and the state has the fourth-largest Medicaid shortage in the country.

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Photographee.eu // Shutterstock

#17. Oregon

- Median annual cost of a semi-private room: $114,610 (27.1% above national average; 4.21% five-year cost increase)
- Median annual cost of a private room: $124,100 (21.4% above national average; 5.11% five-year cost increase)
- State median household income: $63,426
- SmartAsset rank: #29 best state for nursing homes
--- 1.88 nursing homes per 10,000 seniors
--- 4.69 average nurse staffing hours per resident per day

One Oregon woman is bringing nearly free joy to Oregon nursing homes. The woman’s tactic? Llamas, which she takes when she visits the nursing home residents. “When we go to nursing homes we always go to bedrooms and people forget where they are, they’re so entranced,” said Shannon Joy.

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belushi // Shutterstock

#16. New Hampshire

- Median annual cost of a semi-private room: $114,975 (27.5% above national average; 1.6% five-year cost increase)
- Median annual cost of a private room: $125,925 (23.2% above national average; 1.2% five-year cost increase)
- State median household income: $74,991
- SmartAsset rank: #16 best state for nursing homes
--- 3.13 nursing homes per 10,000 seniors
--- 3.89 average nurse staffing hours per resident per day

One specific facet of elder care in New Hampshire? The power each state resident holds being a citizen in the nation’s first presidential primary contest. Some residents have argued that candidates who focus on elder issues, including the quality and the cost of nursing home care, would receive a sizable share of primary votes.

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Halfpoint // Shutterstock

#15. Maryland

- Median annual cost of a semi-private room: $116,070 (28.7% above national average; 3.37% five-year cost increase)
- Median annual cost of a private room: $120,085 (17.5% above national average; 2.79% five-year cost increase)
- State median household income: $83,242
- SmartAsset rank: #48 best state for nursing homes
--- 2.5 nursing homes per 10,000 seniors
--- 3.95 average nurse staffing hours per resident per day

Nursing home care may be relatively expensive in Maryland, but 226 facilities in the state have made a list of the nation’s best facilities. In contrast, only three facilities in the state were deemed below federal standards.

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Monkey Business Images // Shutterstock

#14. Pennsylvania

- Median annual cost of a semi-private room: $116,800 (29.6% above national average; 3.32% five-year cost increase)
- Median annual cost of a private room: $124,830 (22.1% above national average; 3.04% five-year cost increase)
- State median household income: $60,905
- SmartAsset rank: #44 best state for nursing homes
--- 3.06 nursing homes per 10,000 seniors
--- 3.82 average nurse staffing hours per resident per day

A new Pennsylvania state bill would provide reimbursements for nursing home services like ventilator care. The reason? Medicare reimbursements are declining for such services, and many residents struggle to pay for the services themselves.

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MANDY GODBEHEAR // Shutterstock

#13. Rhode Island

- Median annual cost of a semi-private room: $119,538 (32.6% above national average; 5.55% five-year cost increase)
- Median annual cost of a private room: $127,750 (25.0% above national average; 3.13% five-year cost increase)
- State median household income: $64,340
- SmartAsset rank: #22 best state for nursing homes
--- 4.59 nursing homes per 10,000 seniors
--- 3.59 average nurse staffing hours per resident per day

Despite the relatively high cost of care, a tragedy occurred at Rhode Island facilities in the past three years. Twelve patients have died over that time span from incorrectly inserted breathing tubes.

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Robert Kneschke // Shutterstock

#12. Maine

- Median annual cost of a semi-private room: $120,450 (33.6% above national average; 3.71% five-year cost increase)
- Median annual cost of a private room: $125,925 (23.2% above national average; 3.18% five-year cost increase)
- State median household income: $55,602
- SmartAsset rank: #20 best state for nursing homes
--- 3.52 nursing homes per 10,000 seniors
--- 4.4 average nurse staffing hours per resident per day

A new Maine program aims to improve the quality of care for dementia patients in particular. The program will bring together professionals across the state to address quality-of-care issues and best practices, with the goal of improved and affordable care for dementia patients statewide.

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Jacob Lund // Shutterstock

#11. Minnesota

- Median annual cost of a semi-private room: $120,914 (34.1% above national average; 7.75% five-year cost increase)
- Median annual cost of a private room: $132,448 (29.6% above national average; 8.39% five-year cost increase)
- State median household income: $70,315
- SmartAsset rank: #4 best state for nursing homes
--- 4.37 nursing homes per 10,000 seniors
--- 4.15 average nurse staffing hours per resident per day

Nursing home care is expensive in Minnesota, and not all that money has gone to good causes recently. The director of one facility in the state was charged with stealing $30,000 from the nursing home—money that could have gone to provide care for the residents but lined her personal pockets instead.

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#10. New Jersey

- Median annual cost of a semi-private room: $127,750 (41.7% above national average; 3.13% five-year cost increase)
- Median annual cost of a private room: $139,795 (36.8% above national average; 3.34% five-year cost increase)
- State median household income: $81,740
- SmartAsset rank: #16 best state for nursing homes
--- 2.57 nursing homes per 10,000 seniors
--- 3.8 average nurse staffing hours per resident per day

Despite the high cost of care and the small size of the state, 24 New Jersey nursing home facilities received a rating of failing to provide adequate care. Thirty-eight facilities received the highest rating from U.S. News & World Report, which evaluates both long- and short-term care.

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#9. West Virginia

- Median annual cost of a semi-private room: $128,480 (42.5% above national average; 6.79% five-year cost increase)
- Median annual cost of a private room: $138,335 (35.4% above national average; 7.42% five-year cost increase)
- State median household income: $44,097
- SmartAsset rank: #47 best state for nursing homes
--- 3.54 nursing homes per 10,000 seniors
--- 3.77 average nurse staffing hours per resident per day

The high cost of care in at least one West Virginia facility comes with a commitment to emotional care. Residents of the Sundale Rehabilitation and Long-term Care are likely to be surprised by over 1,000 gifts this holiday season, thanks to a community drive to provide each resident with at least one or two presents.

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#8. Vermont

- Median annual cost of a semi-private room: $128,663 (42.7% above national average; 4.98% five-year cost increase)
- Median annual cost of a private room: $135,415 (32.5% above national average; 4.17% five-year cost increase)
- State median household income: $60,782
- SmartAsset rank: #33 best state for nursing homes
--- 3.07 nursing homes per 10,000 seniors
--- 3.99 average nurse staffing hours per resident per day

A nursing home in Vermont is under fire from two women who claim it abused their mother by drugging her daily with a powerful drug that sedated her. The family members claim they were never told their mother was given the drug, and that it was not necessarily medically advisable.

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#7. Hawaii

- Median annual cost of a semi-private room: $129,795 (44% above national average; 2.84% five-year cost increase)
- Median annual cost of a private room: $160,418 (57% above national average; 3.5% five-year cost increase)
- State median household income: $80,212
- SmartAsset rank: #38 best state for nursing homes
--- 1.73 nursing homes per 10,000 seniors
--- 4.51 average nurse staffing hours per resident per day

Hawaii may have a high cost of care for nursing homes, but it’s not for nothing. The state was ranked as among the best in the country for eldercare by U.S. News & World Report.

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#6. Delaware

- Median annual cost of a semi-private room: $130,761 (45% above national average; 4.03% five-year cost increase)
- Median annual cost of a private room: $136,328 (33.4% above national average; 3.8% five-year cost increase)
- State median household income: $64,805
- SmartAsset rank: #27 best state for nursing homes
--- 2.66 nursing homes per 10,000 seniors
--- 4.45 average nurse staffing hours per resident per day

A nursing home in Delaware was recently forced to pay the state for providing insufficient care. The facility was criticized for failing to keep residents from danger, including taking adequate measures to prevent falls and coffee burns.

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#5. New York

- Median annual cost of a semi-private room: $139,357 (54.6% above national average; 2.35% five-year cost increase)
- Median annual cost of a private room: $148,190 (45.0% above national average; 2.55% five-year cost increase)
- State median household income: $67,844
- SmartAsset rank: #41 best state for nursing homes
--- 1.96 nursing homes per 10,000 seniors
--- 3.72 average nurse staffing hours per resident per day

A state judge recently stopped cuts to Medicaid payments in New York. If the proposed cuts go through, over $350 million cuts would take effect, which the judge determined would cause “irreparable harm” to residents and the health and future of the state overall.

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#4. North Dakota

- Median annual cost of a semi-private room: $142,503 (58.1% above national average; 10.18% five-year cost increase)
- Median annual cost of a private room: $143,832 (40.7% above national average; 8.97% five-year cost increase)
- State median household income: $63,837
- SmartAsset rank: #2 best state for nursing homes
--- 7.1 nursing homes per 10,000 seniors
--- 4.36 average nurse staffing hours per resident per day

Although people typically move into nursing homes at the end of their lives, many transfer to hospices to live out their final days, weeks, or months. Until recently, North Dakota was the only state in the country without a hospice. But that’s all changed now that the state’s first hospice has opened in Fargo.

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#3. Massachusetts

- Median annual cost of a semi-private room: $149,672 (66% above national average; 3.46% five-year cost increase)
- Median annual cost of a private room: $158,545 (55.1% above national average; 3.37% five-year cost increase)
- State median household income: $79,835
- SmartAsset rank: #42 best state for nursing homes
--- 3.5 nursing homes per 10,000 seniors
--- 3.79 average nurse staffing hours per resident per day

A shocking one of four nursing homes in Massachusetts is at risk of closing, according to an industry trade group. Underfunding from the state, rising costs of care, and competition from home care all contribute to the risk, the Massachusetts Senior Care Association found.

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#2. Connecticut

- Median annual cost of a semi-private room: $152,388 (69% above national average; 1.4% five-year cost increase)
- Median annual cost of a private room: $166,988 (63.4% above national average; 1.48% five-year cost increase)
- State median household income: $76,348
- SmartAsset rank: #37 best state for nursing homes
--- 3.58 nursing homes per 10,000 seniors
--- 3.71 average nurse staffing hours per resident per day

The high cost of care in Connecticut isn’t enough to buy the decency of some of its care workers. One North Haven worker was recently fined over $1,000 for posting a Snapchat video of a resident in a wheelchair asking for a grilled cheese.

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#1. Alaska

- Median annual cost of a semi-private room: $362,628 (302.2% above national average; 8.86% five-year cost increase)
- Median annual cost of a private room: $362,628 (254.8% above national average; 8.52% five-year cost increase)
- State median household income: $74,346
- SmartAsset rank: #35 best state for nursing homes
--- 2.17 nursing homes per 10,000 seniors
--- 7.51 average nurse staffing hours per resident per day

One reason health care costs are so high in Alaska? The cost of recruiting skilled professionals to staff the more remote nursing homes in the already-remote state. A new state-led program aims to change that by providing funds for relocation packages.

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