Having affordable, high-quality care doesn't help if there aren't enough providers to go around. Our Access pillar measures how many care options exist relative to each state's 65+ population — including nursing home facilities, home health aide workers, and RN/CNA employment.
States with large and fast-growing retiree populations (like Florida and Arizona) often score lower here because demand outpaces supply. Smaller states with older infrastructure (like North Dakota and Iowa) tend to have more facilities per capita.
Access is one of five pillars in our Elder Care Index. See how states rank on affordability, quality, staffing, Medicaid, or view the overall rankings.
North Dakota, Kansas, South Dakota, and Iowa occupy the top 4 spots. These states maintained their nursing home infrastructure from decades past while growing their senior populations slowly. North Dakota has 27 nursing home facilities per 10,000 seniors — compared to Florida's 1.4. The math is simple: fewer seniors competing for the same number of beds means shorter waitlists and more choices.
Florida scores 4 out of 100 on access — the lowest in the country. With 4.8 million people over 65 (the largest senior population of any state), demand for care slots vastly outpaces supply. This isn't about quality of care — it's about whether you can find a bed. Families relocating parents to Florida for retirement should factor in that finding available care will be significantly harder than in most other states.
Access measures availability, not excellence. North Dakota (#1 access) has plenty of facilities per senior, but its staffing levels are below average. Meanwhile, Hawaii (#50 access) has strong staffing scores because its few facilities are well-staffed. The best states on the overall rankings balance access with quality — having both enough options and good ones.
| # | State | Grade | Score | Facilities per 10K | HHA per 10K | 65+ Pop |
|---|---|---|---|---|---|---|
| 1 | North Dakota | A | 66 | 6.3 | 617 | 115,000 |
| 2 | Kansas | A | 54 | 6.2 | 520 | 482,000 |
| 3 | South Dakota | A | 52 | 6.2 | 267 | 156,000 |
| 4 | Iowa | A | 52 | 7.0 | 426 | 560,000 |
| 5 | New York | B | 52 | 1.8 | 1849 | 3,370,000 |
| 6 | Minnesota | A | 50 | 3.5 | 1254 | 960,000 |
| 7 | District of Columbia | A | 50 | 1.8 | 1249 | 92,000 |
| 8 | Nebraska | A | 49 | 5.6 | 358 | 318,000 |
| 9 | Missouri | A | 46 | 4.4 | 832 | 1,100,000 |
| 10 | Massachusetts | D | 42 | 2.9 | 916 | 1,180,000 |
| 11 | Indiana | B | 38 | 4.6 | 497 | 1,100,000 |
| 12 | Ohio | B | 38 | 4.5 | 475 | 2,070,000 |
| 13 | Pennsylvania | C | 37 | 2.7 | 998 | 2,430,000 |
| 14 | California | B | 35 | 1.8 | 1342 | 6,520,000 |
| 15 | Wisconsin | B | 34 | 3.1 | 762 | 1,050,000 |
| 16 | Rhode Island | D | 33 | 3.7 | 451 | 195,000 |
| 17 | Louisiana | B | 32 | 3.5 | 561 | 755,000 |
| 18 | Illinois | C | 32 | 3.2 | 564 | 2,120,000 |
| 19 | Mississippi | D | 32 | 4.2 | 392 | 485,000 |
| 20 | Texas | C | 31 | 2.8 | 749 | 4,200,000 |
| 21 | Connecticut | F | 31 | 2.9 | 635 | 660,000 |
| 22 | Oklahoma | B | 30 | 4.4 | 320 | 643,000 |
| 23 | Arkansas | A | 27 | 3.9 | 348 | 567,000 |
| 24 | West Virginia | D | 27 | 3.2 | 493 | 380,000 |
| 25 | Kentucky | A | 26 | 3.4 | 350 | 790,000 |
| 26 | New Jersey | F | 26 | 2.3 | 689 | 1,530,000 |
| 27 | Alaska | F | 25 | 2.0 | 635 | 98,000 |
| 28 | Maine | C | 24 | 2.5 | 583 | 310,000 |
| 29 | Vermont | C | 24 | 2.6 | 552 | 130,000 |
| 30 | Delaware | F | 24 | 2.2 | 490 | 199,000 |
| 31 | Utah | B | 23 | 2.5 | 384 | 395,000 |
| 32 | Wyoming | F | 22 | 3.4 | 320 | 105,000 |
| 33 | New Mexico | C | 22 | 1.7 | 934 | 400,000 |
| 34 | New Hampshire | F | 21 | 2.7 | 304 | 270,000 |
| 35 | North Carolina | C | 21 | 2.3 | 333 | 1,800,000 |
| 36 | Michigan | D | 20 | 2.3 | 464 | 1,810,000 |
| 37 | Washington | D | 20 | 1.5 | 766 | 1,310,000 |
| 38 | Colorado | C | 20 | 2.3 | 434 | 926,000 |
| 39 | Montana | B | 19 | 2.8 | 373 | 215,000 |
| 40 | Idaho | C | 19 | 2.4 | 517 | 328,000 |
| 41 | Virginia | D | 18 | 2.0 | 422 | 1,460,000 |
| 42 | Tennessee | F | 17 | 2.5 | 308 | 1,200,000 |
| 43 | Alabama | B | 16 | 2.4 | 227 | 928,000 |
| 44 | Georgia | D | 16 | 2.1 | 276 | 1,680,000 |
| 45 | Maryland | F | 15 | 2.1 | 374 | 1,030,000 |
| 46 | Oregon | D | 14 | 1.6 | 499 | 780,000 |
| 47 | South Carolina | D | 14 | 1.9 | 367 | 980,000 |
| 48 | Arizona | B | 10 | 1.1 | 527 | 1,310,000 |
| 49 | Nevada | C | 7 | 1.2 | 300 | 540,000 |
| 50 | Hawaii | F | 6 | 1.5 | 224 | 280,000 |
| 51 | Florida | F | 4 | 1.4 | 182 | 4,800,000 |
How we calculate these scores → Our Methodology
North Dakota, Iowa, and South Dakota lead in care access relative to their senior population, with more nursing home facilities, home health aides, and nurses per capita. These smaller states have maintained older care infrastructure while growing more slowly.
Florida has the largest 65+ population of any state (4.8 million) but hasn't scaled its care infrastructure proportionally. This creates intense competition for available care slots, longer waitlists, and fewer options per senior compared to less-populated states.
We combine three metrics normalized per 10,000 seniors: nursing home facility count (35%), home health aide employment (40%), and RN + CNA employment (25%). This captures both institutional and home-based care availability.