Is your state on one of these lists? Topics to consider include health care, weather, housing costs and walkability.
Each year, thousands of older adults flock to Florida to enjoy a sunny, state income tax-free retirement. In fact, in 2023, Florida attracted 11% of the 338,000 retirees making an inter-state move, according to the National Reverse Mortgage Lenders Association. Yet, according to a recent study, you may want to think twice before settling in the Sunshine State – at least, if you’re one of the 75% of people who want to age in place.
The National Institute on Aging defines aging in place as living in your own home as you grow older. Several measures – such as maintaining strong social connections, leading an active lifestyle, seeing your doctor regularly and remodeling your home– can help you do so successfully, according to UC Health. However, according to a recent report by Seniorly, a platform that helps connect families and individuals with senior living communities, where you live could be just as important. The study ranks the best and worst states (and the District of Columbia) for aging in place, with some surprising standouts; Florida, for example, came in last, while Utah placed first.
Here’s a look at the top 10 “best” and “worst” states, as well as expert tips for deciding if a move is right for you.
What Factors Did the Report Consider?
Although assisted living and retirement communities can offer several benefits, such as convenience, security, built-in community and on-site health services, many people prefer the independence, autonomy and comfort of remaining at home. Additionally, while in-home support services can be expensive, aging in place is often more affordable.
“Too often, we oversimplify aging in place to just the home itself, when in reality, it requires a web of supports: health care access, transportation, affordability and social connection.”
However, aging at home has its downsides and, in some cases, may even be dangerous. For example, adults aging in place may be more vulnerable to isolation and loneliness, an issue that may affect one in four older adults, according to Cleveland Clinic. In a report published in 2020, the National Academies of Sciences, Engineering and Medicine said this a “serious yet underappreciated” public health risk with implications including an increased risk of dementia, depression, heart disease and premature death. Moreover, people living at home may be less equipped to handle emergencies including fire, natural disasters or falls. Home maintenance, including everyday chores, can become a burden, as well.
Seniorly considered these and other factors when establishing their rankings. Altogether, they looked at the following 10 criteria:
Risk of isolation
Home health aide availability
Home health care quality
Emergency care timeliness
Smart home adoption
Housing costs
Road safety
Local walkability
Food delivery availability
Weather hazards
These 10 factors could result in the “perfect storm” if they collectively scored poorly in an older adult’s life, says Marilyn Gugliucci, Ph.D., professor and director of Geriatrics Education and Research at the University of New England College of Osteopathic Medicine in Portland, Maine. “They address health and safety issues for older people and consider support systems, health care quality and timeliness, autonomy, access to services and well-being – each a component contributing to successful aging in place.”
Pooja Patel, Dr.OT, occupational therapist and founder of Aging Together, agrees, noting that the study highlights the complexity of aging in place. “Too often, we oversimplify aging in place to just the home itself, when in reality, it requires a web of supports: health care access, transportation, affordability and social connection,” says Patel, who resides in the Greater Chicago area. “By looking beyond housing costs to include walkability, road safety and home health aide availability, this study captures real-world barriers that I see families struggling with every day.”
Best States
Utah probably isn’t among the first few (or several) states to come to mind when you think of popular retirement destinations. However, according to Seniorly, the Beehive State has one of the lowest risks of social isolation, with 35.7% of older adults living at home, compared with the national average of 43%. It also has moderate weather compared to some other states, with just 10.1 inches of annual rain and snowfall. Moreover, it has the highest rate of smart home technology adoption; approximately 37% of residents use such devices.
Despite high housing costs, New Jersey performs well in health care access and transit options.
According to Seniorly, the top 10 states, ranked from best to worst, are: Utah, North Dakota, New Jersey, Idaho, Texas, Nebraska, California, New Mexico, Kansas and Washington.
Patel says the rankings make sense, noting that the top five states have very distinct benefits:
Utah and Idaho: These states appear to have strong community ties, walkability (in certain areas, including Boise), and relatively low crime rates.
North Dakota: The Peace Garden State has a smaller population, less congestion and stronger health care metrics (with the nation’s shortest ER times at 110 minutes) than many others, Patel says. According to Seniorly, North Dakota also has the highest rate of meal deliveries for older adults via the Older Americans Act, providing 11,069 meals per 100,000 seniors.
New Jersey: Despite high housing costs, New Jersey performs well in health care access and transit options, Patel says. Specifically, according to Seniorly, it has some of the country’s highest-quality home care, and its 59 largest cities are pedestrian friendly.
Texas: Patel says the Lone Star State is a mixed bag – housing affordability and home health aide availability (13 seniors per aide) are notable positives. However, she says, extreme weather is a real, growing risk.
Worst States
Florida has long been a haven for retired people. But according to Seniorly, the state has lots to improve upon in terms of access to home health aides, housing costs and weather hazards. Specifically, Seniorly says, there’s only one aide per 56 seniors, and over 30% of older homeowners spend almost a third of their income on housing. Meanwhile, despite its sunny reputation, Florida has 53 inches of annual rainfall – more than most states – and is a hotbed for hurricanes and tropical storms.
According to Seniorly, the bottom 10 states, ranked from worst to best include: Florida, Kentucky, North Carolina, Georgia, Alabama, Tennessee, Mississippi, Vermont, Oklahoma and Hawaii.
Again, Patel says these generally make sense, though they may be surprising.
Florida: Older adults are often more vulnerable during power outages, flooding and other repercussions of extreme weather events, so the higher risk of extreme weather is not something to take lightly. Additionally, many people aging in place don’t need home health aides right away. However, research suggests at least half need some sort of assistance eventually. As a result, Patel says, the relative lack of availability is concerning.
Georgia only provides meal delivery to 957 of every 100,000 older adults in the state through the Older Americans Act.
Kentucky and Alabama: These states have some of the highest poverty rates in the country, as well as less access to health care and aging-friendly infrastructure, Patel says. Moreover, according to Seniorly, Kentucky has one of the nation’s highest rates of fatal car crashes involving older adults.
North Carolina and Georgia: These states have underdeveloped long-term care support systems, and walkability and transportation are major barriers outside metro areas, Patel says. Moreover, according to Seniorly, older adults in North Carolina have comparatively long emergency room wait times at about 195 minutes. Meanwhile, Georgia only provides meal delivery to 957 of every 100,000 older adults in the state through the Older Americans Act.
No State Is Perfect
As Seniorly acknowledges, no state is perfect. Even those with the lowest ratings have redeeming qualities, and those with the highest have shortfalls, Gugliucci says. Also, she notes, a community within a state may have features quite different than the state as a whole.
Uchenna Umeh, M.D., a pediatrician, speaker, professor, author and advocate also known as “Dr. Lulu” has experienced this firsthand. In February 2024, at age 55, she moved from San Antonio to Atlanta.
“I wasn’t just looking for a new ZIP code. I wanted to live somewhere where Black people are not just surviving but thriving,” she says. “I wanted to see Black queer people walking boldly and visibly in the world. I wanted to age in a place that reflects my identity and values. And Atlanta felt like the place.”
“Regardless of what the data presents, aging in place is an inside job.”
While she’s been disappointed by certain aspects, including the state’s increasingly restrictive trans health care policies, she says the move itself has been deeply affirming. “No move is perfect. The traffic in Atlanta is legendary and the policy landscape for queer and trans folks is a constant fight,” she says. “But culturally? Spiritually? Professionally? I feel aligned. I feel inspired. I feel home — at least for now.”
Deciding Where to Move
Gugliucci recommends first asking yourself what matters most to you. “Regardless of what the data presents, aging in place is an inside job,” she says. “Know yourself, know what matters most to you, understand what resources you need and resources you have to age in place successfully (as defined by you), and be realistic about your abilities and your commitment in supporting your own health.” These components, she says, will do far more in preparing you for successful aging in place than deciding based on another person (or entity’s) rankings.
Simran Malhotra, M.D., founder of Wellness By LifestyleMD in Bethesda, Maryland, agrees. She says that while Seniorly’s rankings generally make sense, they aren’t one-size-fits-all. “Rankings should generally be seen as a guide,” she says. “Each older adult should take inventory of their individual values, medical needs and support system, which can then help them decide.”
5 Questions to Consider
Malhotra also suggests asking the following five questions to determine if a move is right for you:
Do I have family, friends, access to a local community or spiritual centers that help me feel loved, connected and supported in all my needs? Make a list of everyone in your life you feel connected to, their proximity and how often you communicate, Malhotra suggests. Also, visit local senior and community centers to see what activities are available.
Can I safely and easily walk to places like parks, markets, shops and friends’ houses? Malhotra recommends taking a walk (or spending a few days) in your potential future neighborhood to see if it would support your daily activities, social engagement and overall independence. Note how safe, pleasurable and accessible it feels.
If I need in-home care, do I have easy access to affordable, trained and reliable caregivers? It’s always best to be prepared, Malhotra says. Search local home health agencies or ask your medical team to help you look into home health services in your area.
Does the area have frequent bad weather that could make it hard to get around, isolate me or make it hard to get help? Review recent/annual weather patterns or talk to locals to get familiar with how weather affects everyday life, Malhotra suggests.
Can I use smart home technology or delivery services that would help me manage my daily activities more safely and easily while improving my quality of life and ability to remain independent in my home? And if not, would I be willing to learn and ask for help to set up these technological devices and services? Malhotra suggests making a list of your current challenges (i.e. mobility, hearing, medication management, fall risk, etc.) and getting help from loved ones, your medical team or a tech professional to explore what smart home technology or delivery services in the area could benefit you.
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