Care types US · Federal & 50 States

Published May 27, 2026 Updated Aug 13, 2026

The 2026 Senior Care Quality Gap: Where Government-Rated Care Is Best and Worst

Expertly Reviewed by Luis Diaz Sendel, Founder, families.care

Updated on August 13, 2026

Infographic map of U.S. senior care quality by state based on CMS star ratings: Utah ranks first with 54.2% top-rated facilities while West Virginia, Mississippi and Louisiana rank last; the national average is 2.97 out of 5 stars

Key Takeaways

We analyzed 22,937 government-rated senior care facilities nationwide. Below-average facilities outnumber top-rated ones, and a senior in Utah is more than twice as likely to find a top-rated facility as one in New Mexico.

Quality of care varies significantly by state, with 35.5% of facilities nationwide rated as below average and only 34.5% achieving a top 4-5 star rating.
Geography is a major factor in care quality; for example, Utah has 54.2% of facilities rated as top-tier, while New Mexico has only 21.8% in that same category.
Families should always verify the official CMS star rating before choosing a facility, as regional quality gaps mean that local options may not meet high standards.

CMS.gov, CareScout 2025 Cost of Care Survey & families.care 2026 Senior Care Quality Gap Analysis

Grounded visual comparison · Care continuum

Matching Daily Support Needs to 2025 National Cost Benchmarks

01Daytime & part-time

Adult Day & In-Home Aides

$95/day · $35/hr

Ideal for aging in place when a loved one needs daytime socialization, respite, or targeted morning/evening ADL help.

0224/7 residential

Assisted Living & Memory Care

$6,200/mo AL median

Bundles private apartment, meals, medication management, and awake staff (memory care adds secured dementia design).

0324/7 clinical nursing

Skilled Nursing & Hospice

$9,581/mo–$10,798/mo

Round-the-clock licensed nursing for complex medical care, or Medicare Part A hospice comfort support anywhere.

Grounded in CareScout 2025 Cost of Care Survey & CMS Care Setting Definitions.

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.^[1]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.^[1] 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.^[1]
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.

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Verified references & primary sources

5 verified sources

Quantitative and regulatory claims in this guide are grounded against official registries and benchmark datasets.

[1] Cost of Care Survey (2025)
Statutory Registry

CareScout · Verified 2026-08-15 · General senior-care planning information.
[2] Skilled nursing facility coverage
Statutory Registry

Medicare.gov · Verified 2026-08-15 · General senior-care planning information.
[3] Medicaid coverage and eligibility
Statutory Registry

Medicaid.gov · Verified 2026-07-10 · General senior-care planning information.
[4] Long-term-care guidance for families
Statutory Registry

National Institute on Aging · Verified 2026-07-10 · General senior-care planning information.
[5] VA Aid and Attendance eligibility
Statutory Registry

U.S. Department of Veterans Affairs · Verified 2026-08-15 · General senior-care planning information.

How we research and verify this information

Our team compiles this listing from public records and provider data, and reviews it against authoritative sources. Read our editorial standards and research methodology.

Editorial review by John Richie, Senior Care Research Editor.

Cost of Care Survey (2025)Publisher: CareScout. Supports: General senior-care planning information for this guide. Last checked: 2026-08-15.
Skilled nursing facility coveragePublisher: Medicare.gov. Supports: General senior-care planning information for this guide. Last checked: 2026-08-15.
Medicaid coverage and eligibilityPublisher: Medicaid.gov. Supports: General senior-care planning information for this guide. Last checked: 2026-07-10.
Long-term-care guidance for familiesPublisher: National Institute on Aging. Supports: General senior-care planning information for this guide. Last checked: 2026-07-10.
VA Aid and Attendance eligibilityPublisher: U.S. Department of Veterans Affairs. Supports: General senior-care planning information for this guide. Last checked: 2026-08-15.