Western, Southern States Lag Behind Rest of Nation in Nursing Home Usage

A new analysis from the Centers for Disease Control and Prevention (CDC) found that large swaths of the Western and Southern states lag far behind the national average for nursing home usage, while the Northeast and the Midwest surged above the pack.

In 2016, 24 out of every 1,000 people over the age of 65 was in a nursing home on any given day, according to the National Study of Long-Term Care Providers — a wide-ranging survey of LTC usage and operational trends compiled by the CDC’s National Center for Health Statistics every other year.

But the NCHS numbers reveal stark divides in nursing home usage by region, with a distinct concentration in the northern half of the country: North Dakota led all states with a rate of 47 nursing home residents out of 1,000 seniors aged 65 and older, followed by Iowa at 43 and Rhode Island at 42. Of the states that the CDC identified as having usage rates that were statically significantly higher than the national average, none were west of the Dakotas, and only Arkansas, Louisiana, and Mississippi represented the South.


On the other side of the coin, Alaska came in last place with a usage rate of 6, with Arizona and Oregon right behind at 8 and 9, respectively. The American West had nine states identified as below the national average at a statistically significant clip, while the entire Eastern seaboard south of Maryland also came in significantly below 24 — including Florida at 16.

The results followed largely the same pattern for the cohort of citizens aged 85 and older, with a distinct Midwest and Northeastern pattern of winners and a Western group of states below the national average. Among that group, the national average sits at 85 out of 1,000; Alaska again came in last at 23, with North Dakota leading the way at 177.


For comparison, home health agency usage did not fluctuate nearly as much across the country, with only three states — Massachusetts, Louisiana, and Texas — identified as having significantly higher penetration than the national average of 76 out of 1,000 for residents aged 65 and older.  A handful of states in the Upper Midwest, along with Alaska, Hawaii, and Arizona, had rates that were significantly lower than the average.

The CDC and the NCHS have released several national projections and analyses based on the survey data, which probes multiple types of long-term health care providers. The unified National Study of Long-Term Care Providers replaced individual surveys of nursing home, hospice, and residential care providers in 2012; its direct ancestor for the skilled nursing industry, the National Nursing Home Survey, was last conducted in 2004.

Written by Alex Spanko

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