Mirador Living research · Retirement Care Readiness Gap
Mirador Living compared older-population growth and interstate movement with nursing-home beds, home-health agencies, hospitals and general living costs, across all 50 states and Washington, DC. The result is a relative index of where demographic pressure most exceeds measured care readiness.
Arizona +68.5 index points
Ranks first overall, combining the second-highest net 65+ migration rate (12.4 per 1,000 residents aged 65+) with the second-lowest certified nursing-home bed rate (26.6 per 1,000 residents aged 75+).
See Arizona's profileAlaska 24.1 per 1,000
Fewest certified nursing-home beds per 1,000 residents aged 75+, with Arizona (26.6) and Hawaii (32.5) next lowest. Missouri records the most, 110.7 per 1,000.
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 (+22.5%) and Idaho (+22.4%).
Open the growth rankingAll 50 states and Washington, DC. Choose a measure, sort either direction, or search for a state, then open any row for the full profile.
Colour 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). Click a state to open its profile; Washington, DC appears in the table.
Arizona records the widest gap in the study (+68.5 index points). It combines the second-highest net 65+ migration rate (12.4 per 1,000 residents aged 65+) with the second-lowest certified nursing-home bed rate (26.6 per 1,000 residents aged 75+). Hawaii ranks second: its care readiness score, 9.0 out of 100, is the lowest in the analysis, and its general price level, 110.0 against a US average of 100, is the second-highest nationally. South Carolina ranks third, with the fourth-highest demographic pressure score (93.0) and the third-highest recorded net 65+ migration rate (8.9 per 1,000).
Relative to residents aged 75+, certified nursing-home beds are scarcest in Alaska (24.1 per 1,000), Arizona (26.6) and Hawaii (32.5), and most plentiful in Missouri (110.7) and Arkansas (109.6).
Alaska's population aged 75+ also grew fastest between the 2015-2019 and 2020-2024 Census estimates (+28.9%), ahead of Nevada (+22.5%), Idaho (+22.4%) and Hawaii (+19.1%). Idaho records the largest net gain from interstate migration among adults aged 65+ (12.66 per 1,000), with Arizona second (12.40).
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 per 1,000 residents aged 75+, home-health agencies and hospitals per 100,000 residents 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. Component and weighting choices affect rankings. 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 can point you toward places to look more closely, but the details that matter are local. Before choosing a community or a state, Mirador Living's advisors suggest checking:
Dharam Khalsa · co-founder and CEO, Mirador Living