Widest gap
Arizona +68.5 index points
Combining the second-highest net 65+ migration rate with the second-lowest certified nursing-home bed rate.
Where America is growing older faster than its care is growing.
How ready is America to care for its aging population? Mirador Living compared a decade of population change with the care and costs available in all 50 states and Washington, DC.
Arizona +68.5 index points
Combining the second-highest net 65+ migration rate with the second-lowest certified nursing-home bed rate.
South Dakota −75.0 index points
Where care readiness most exceeds demographic pressure. Iowa and Nebraska come next.
Alaska 24.1 per 1,000
Fewest per 1,000 residents aged 75+, with Arizona and Hawaii next lowest.
Colour shows where demographic pressure exceeds measured care readiness.
Gap values run from −75.0 (South Dakota) to +68.5 (Arizona).
Mirador Living compared how much demographic pressure each state faces with the care available there, across all 50 states and Washington, DC. Pressure combines 75+ population growth and net 65+ migration; readiness combines certified nursing-home beds, home-health agencies, hospitals and regional price levels. Every measure is ranked from 0 to 100 with equal weights, and the gap is pressure minus readiness, so larger positive gaps mean pressure exceeds measured readiness. 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.
A negative gap means measured readiness exceeds demographic pressure in this index; it does not establish spare care capacity.
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.
The general price level is a broad measure of consumer costs (BEA regional price parities), not a care-cost measure.
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.
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