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Posted 08/11/2022

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

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 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.

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