Widest gap
Arizona +68.5 index points
The widest gap in the study, combining the second-highest net 65+ migration rate with the second-lowest certified nursing-home bed rate nationally.
See Arizona's profileWhere America is growing older faster than its care is growing.
Mirador Living compared how fast each state is aging with the care and costs available there, across all 50 states and Washington, DC.
Arizona +68.5 index points
The widest gap in the study, combining the second-highest net 65+ migration rate with the second-lowest certified nursing-home bed rate nationally.
See Arizona's profileAlaska 24.1 per 1,000
Fewest certified nursing-home beds per 1,000 residents aged 75+, with Arizona and Hawaii next lowest.
Open the nursing-bed rankingAlaska +28.9%
The fastest growth in residents aged 75+ between the 2015-2019 and 2020-2024 Census estimates, ahead of Nevada and Idaho.
Open the growth rankingColour shows where demographic pressure exceeds measured care readiness. Darker shades mean a wider gap.
Gap values run from −75.0 (South Dakota) to +68.5 (Arizona). Select a state for its full profile; Washington, DC appears in the table.
Mirador Living compared demographic pressure with care provision and general living costs across all 50 states and Washington, DC. Pressure combines net 65+ interstate migration per 1,000 residents aged 65+ and 75+ population growth between the 2015-2019 and 2020-2024 ACS estimates. Readiness combines certified nursing-home beds, home-health agencies and hospitals per resident aged 75+, and the BEA regional price parity for all consumer spending (US = 100, reversed so lower costs score as more ready).
Each measure is percentile-ranked from 0 to 100 across the 51 geographies using average ranks for ties, with equal weights within each subscore; the gap is the pressure score minus the readiness score. Larger positive gaps mean demographic pressure exceeds measured readiness within this index. It is a relative index, not a care-sufficiency, care-quality, or best-place-to-retire ranking.
Rankings are point estimates. Twenty-one net migration estimates, including Hawaii's and Vermont's, are not statistically distinguishable from zero at 90% confidence, and the ranks are not demonstrated to be statistically distinct.
Migration figures use ACS PUMS person files. Records with suppressed origins are excluded from known flows rather than counted as zero moves; Connecticut accounts for 548 such records (weighted 7,672 people), which limits interpretation of its recorded net loss of 1,658.
Certified bed totals sum reported beds only. Ten active nursing homes with blank certified-bed counts (California 4, Montana 2, and one each in Georgia, Hawaii, Maryland, and Mississippi) remain in facility counts, so bed totals may slightly undercount certified beds. Home-health agency counts reflect organisations, not carers, visits, or service volume.
Provider vintages differ (nursing homes and hospitals August 2026; home health July 2026), and the ACS periods include pandemic disruption. Growth and provider rates share the 2024 aged-75+ denominator, so their association is partly mathematical, not independent evidence that states failed to add supply.
What families can check
A state ranking points you toward places to look more closely. Before choosing a community or a state, Mirador Living's advisors suggest checking: