Study Finds Just 16 states Provide Four or More Nurse staffing hours per Resident Daily

Three years into the COVID-19 pandemic, staffing shortages continue to affect medical care facilities around the U.S., and long-term care is no exception.

ValuePenguin health care expert Robin Townsend says this and other factors are putting the quality of long-term care at risk.

"When staff is spread thin, they’re less equipped to meet a facility’s standard level of care," Townsend says. "Meanwhile, the cost of care will likely increase as the overall cost of living rises."

Despite this, some states provide better long-term care than others. According to the latest ValuePenguin study — which analyzes data from the Centers for Medicare & Medicaid Services (CMS), U.S. Bureau of Labor Statistics (BLS), U.S. Census Bureau County Business Patterns and more to assess cost, accessibility and quality of care in each state — Arizona ranks highest for long-term care. Keep reading to find where long-term care is most affordable, and which health insurance programs can help lower the cost.

• Key findings
• Arizona ranks highest for long-term care
• The District of Columbia is the worst state for long-term care, despite providing high-quality care
• Most states provide less than 4 nurse staffing hours per resident daily
• Long-term care is most expensive in Alaska, District of Columbia
• Top expert tips to determine the right long-term care option
• Methodology

Key findings

• Arizona is the best state for long-term care. ValuePenguin researchers used three overall metrics — cost, access to care and quality of care at each state’s nursing homes and assisted living facilities — with Arizona coming out on top. Idaho and Missouri rank second and third.
• The District of Columbia is the worst state for long-term care, even though it ranks among the highest for quality of care. The District of Columbia has a lower density of long-term care facilities and medical professionals than most states, and it’s among the most expensive states for long-term health care. However, those who can overcome these cost and access issues do well, as D.C. ranks in the top five in three of four quality-of-care metrics. Wyoming and New Hampshire are the second and third lowest-ranking states, respectively.
• Just 16 states provide four or more nurse staffing hours per resident daily. This comes amid the Biden administration’s February 2022 call to establish a minimum nursing home staffing requirement. According to a 2001 report to Congress that's still widely shared, the CMS recommended to Congress a minimum standard of 4.1 hours of nurse staffing hours per resident daily.
• In Alaska, a shared room at a nursing home costs an average of $378,140 annually or $1,036 a day — highest in the nation. Additionally, assisted living facilities in the state cost an average of $81,690 annually, second-highest in the U.S. And home health care aide workers make an average of $34,900 — fourth-highest in the nation.
• On the other hand, Texas and Missouri are the most affordable states for nursing homes and assisted living facilities, respectively. The annual average cost of a nursing home in Texas is $61,503. Meanwhile, Missouri ranks highest for assisted living facility affordability, with facilities in the state costing an average of $36,000 annually.

How did we rank long-term care?

ValuePenguin researchers used three overall metrics to rank long-term care in each state: cost, access and quality. Within each metric, researchers looked at the following:

• Cost of care: Average annual nursing home costs for a shared room, average annual assisted living facility costs and average wages among home health care aides
• Access to care: Density of home health care aides, medical professionals, nursing homes and assisted living facilities
• Quality of care: Average Quality of Patient Care Star Rating, nursing staff hours per resident daily, number of outpatient emergency department visits per 1,000 long-stay resident days and the percentage of long-stay residents whose need for help with daily activities has increased since admittance

To calculate the density-based figures, ValuePenguin researchers compared in-state to national figures. To determine the density of home health care aides, for example, we divided the rate of home health care aides in a given state by the rate of aides nationally.

The 11 metrics were evenly weighted to create a final score.