Choosing senior care is rarely a calm, deliberate decision. A hospital discharge or a fall forces families to act fast, usually close to home. So we asked a simple question: if you have to find care near you, how good is it likely to be — and does that change depending on the state you live in?
We analyzed 22,937 senior care facilities that carry an official U.S. government (CMS) star rating across all 50 states and Washington, D.C., spanning nursing homes, home health agencies, dialysis centers, and hospitals. The answer: where you live changes the odds dramatically.
Key findings
- Below-average care outnumbers top-rated care nationally. 35.5% of rated facilities score 1-2 stars (below average), versus 34.5% at 4-5 stars. The national average is 2.97 out of 5.
- A 2.5x gap between states. In Utah, 54.2% of rated facilities earn 4-5 stars. In New Mexico, just 21.8% do; in Nevada, 23.0%. Same care need, very different odds.
- The retirement-destination paradox. Florida, the top state seniors relocate to, ranks 39th for rated care quality (average 2.87; 39% of facilities below average). Nevada shows the same pattern.
- West Virginia is the hardest place to find good care: 51.8% of its rated facilities score 1-2 stars, a majority below average.
- A clear regional pattern. The Mountain West and Upper Midwest cluster at the top (Utah, Colorado, Minnesota, the Dakotas, Wisconsin); the Deep South clusters at the bottom (West Virginia, Mississippi, Georgia, Louisiana).
Why this matters for families
Families rarely get to shop around for senior care, and these numbers show that "close to home" means very different quality depending on the state. The practical takeaway: always check the government star rating before choosing. Medicare's Care Compare tool and our directory both surface it, and the baseline odds vary enormously by location.
Full ranking: senior care quality by state
Ranked by average CMS star rating across all rated senior-care settings.
| Rank | State | Rated facilities | Avg rating /5 | % 4-5 star | % 1-2 star |
|---|---|---|---|---|---|
| 1 | Utah | 179 | 3.45 | 54.2% | 27.9% |
| 2 | Hawaii | 106 | 3.42 | 46.2% | 16.0% |
| 3 | Colorado | 383 | 3.35 | 49.6% | 27.2% |
| 4 | New Jersey | 416 | 3.33 | 44.2% | 25.7% |
| 5 | Alaska * | 37 | 3.32 | 37.8% | 18.9% |
| 6 | Maryland | 549 | 3.28 | 50.5% | 26.0% |
| 7 | Rhode Island | 106 | 3.19 | 45.3% | 34.0% |
| 8 | Minnesota | 671 | 3.19 | 42.3% | 28.3% |
| 9 | Delaware | 112 | 3.19 | 35.7% | 28.6% |
| 10 | Washington | 365 | 3.15 | 38.4% | 31.2% |
| 11 | Massachusetts | 488 | 3.15 | 43.2% | 33.4% |
| 12 | South Dakota | 139 | 3.14 | 41.7% | 33.1% |
| 13 | Maine | 129 | 3.14 | 41.9% | 33.3% |
| 14 | District of Columbia * | 45 | 3.13 | 31.1% | 24.4% |
| 15 | Idaho | 182 | 3.12 | 36.8% | 29.7% |
| 16 | Wisconsin | 521 | 3.11 | 42.0% | 34.4% |
| 17 | North Dakota | 110 | 3.10 | 40.0% | 34.5% |
| 18 | California | 1,559 | 3.10 | 38.3% | 30.7% |
| 19 | Arizona | 478 | 3.09 | 31.2% | 28.0% |
| 20 | Virginia | 618 | 3.08 | 39.6% | 31.1% |
| 21 | Pennsylvania | 554 | 3.07 | 33.4% | 28.9% |
| 22 | Iowa | 434 | 3.07 | 39.9% | 33.6% |
| 23 | North Carolina | 951 | 3.05 | 31.8% | 26.3% |
| 24 | South Carolina | 435 | 3.04 | 35.9% | 32.2% |
| 25 | Kansas | 409 | 3.04 | 39.6% | 35.9% |
| 26 | Wyoming * | 54 | 3.02 | 37.0% | 38.9% |
| 27 | Michigan | 633 | 3.01 | 36.3% | 38.1% |
| 28 | Alabama | 548 | 3.01 | 34.7% | 32.7% |
| 29 | New Hampshire | 123 | 3.00 | 35.0% | 36.6% |
| 30 | New York | 485 | 2.99 | 34.8% | 35.9% |
| 31 | Connecticut | 296 | 2.98 | 36.5% | 39.5% |
| 32 | Arkansas | 363 | 2.98 | 34.7% | 38.0% |
| 33 | Nebraska | 279 | 2.96 | 38.7% | 38.0% |
| 34 | Indiana | 713 | 2.96 | 31.7% | 35.6% |
| 35 | Vermont * | 55 | 2.93 | 32.7% | 40.0% |
| 36 | Oregon | 239 | 2.93 | 30.1% | 36.8% |
| 37 | Montana | 92 | 2.92 | 35.9% | 37.0% |
| 38 | Tennessee | 589 | 2.91 | 32.8% | 36.8% |
| 39 | Florida | 1,414 | 2.87 | 29.7% | 39.0% |
| 40 | Kentucky | 456 | 2.86 | 33.3% | 40.6% |
| 41 | Texas | 1,112 | 2.85 | 30.2% | 37.7% |
| 42 | Ohio | 911 | 2.82 | 25.8% | 40.9% |
| 43 | Illinois | 1,074 | 2.78 | 30.3% | 42.9% |
| 44 | Missouri | 756 | 2.77 | 28.4% | 38.2% |
| 45 | Oklahoma | 436 | 2.75 | 31.4% | 43.8% |
| 46 | New Mexico | 197 | 2.75 | 21.8% | 41.1% |
| 47 | Nevada | 278 | 2.67 | 23.0% | 42.1% |
| 48 | Louisiana | 577 | 2.67 | 25.8% | 44.0% |
| 49 | Georgia | 717 | 2.67 | 25.9% | 46.3% |
| 50 | Mississippi | 364 | 2.66 | 28.6% | 48.4% |
| 51 | West Virginia | 195 | 2.60 | 29.2% | 51.8% |
Methodology
We measured the 22,937 facilities in the families.care directory that carry an official CMS (Centers for Medicare & Medicaid Services) overall star rating from 1 to 5, aggregated across five federal rating programs: nursing-home, home-health, dialysis, hospital, and CMS quality measures. For each state we report the number of rated facilities, the average star rating, the share rated 4-5 stars, and the share rated 1-2 stars.
These figures reflect CMS-rated facilities only (those participating in Medicare or Medicaid), not every senior-care option. Puerto Rico (5 rated facilities) is excluded as too small to rank, so the state ranking below totals 22,932. States marked with an asterisk have fewer than 60 rated facilities, so their averages are directional. This is a quality ranking of rated facilities, not a per-capita measure of access.