The most and least expensive states for assisted living

Nearly 58 million Americans are now age 65 or older, representing 17.3% of the population, and demand for senior housing is at a record high. 

Senior housing occupancy reached 84.4% in late 2023. Although that level remained below the pre-pandemic rate of 87.1%, occupancy rose for the ninth consecutive quarter, according to the National Investment Center for Seniors Housing & Care. That steady increase means demand is outpacing supply, while rent and other costs are also rising for assisted living communities 

Assisted living communities are residential settings for older adults that provide help with daily tasks such as meals, transportation, laundry, and medication management, but they don't provide medical care. These communities also offer opportunities to connect with people at a similar stage of life, which can support friendship and companionship, a meaningful benefit for older adults.

Keep in mind that room and board charges in assisted living communities typically aren't covered by Medicaid, the federal program for people with low incomes. In some cases, Medicaid can cover specific medical care costs in nursing homes or assisted living settings. As a result, people in assisted living communities typically pay most fees using their own resources, such as savings, a long-term care insurance policy, or proceeds from selling a home. 

But how much does assisted living actually cost, and how do those prices compare with other options, such as in-home care? This analysis compares care costs and identifies the states with the most and least expensive assisted living communities. 

Here's what the analysis found:

• New Hampshire is the most expensive state. A place in an assisted living community costs $8,248 per month on average, nearly double the national average of $4,401. It's also one of only six states where assisted living costs more per month on average than in-home care. 

• Assisted living is getting more expensive. Between 2021 and 2023, average costs rose in 30 states. The largest increases occurred in Wyoming (53%), West Virginia (46%), and New Hampshire (46%). 

• In-home care is more affordable than assisted living in most states. Median home health aide costs are lower than assisted living costs in all but six states. The largest differences are in New Hampshire, where assisted living costs $1,674 more per month than in-home care, and Minnesota, where in-home care costs $3,861 more than assisted living, on average. 

The most and least expensive states 

Average monthly assisted living rent ranges from $2,946 in Louisiana to $8,248 in New Hampshire. Average costs exceed $5,000 per month in 10 states, mostly in New England and the Mid-Atlantic. More affordable states are spread across the country and include Indiana ($3,695), Iowa ($3,420), and South Dakota ($3,378). 

These price estimates account for the distribution of community types and sizes. States with a higher concentration of large or higher-end assisted living communities are therefore likely to have a higher average cost.

Assisted living is getting more expensive 

Across the U.S., average assisted living costs reached $4,401 per month in 2023, an 8% increase from $4,057 just two years earlier. Between 2021 and 2023, costs rose in 30 states, fell in 15 states, and remained relatively flat in six states. For this analysis, relatively flat means the average monthly rent rose or fell by less than $90.

Inflation also remained above the Federal Reserve's 2% target beginning in March 2021. According to the Bureau of Labor Statistics Consumer Price Index Calculator, $4,401, the average cost of one month of assisted living, had the same purchasing power as $3,796 in March 2021 when compared with the November 2023 CPI, the most recent data available when this study was conducted. Overall senior living prices are rising faster than inflation, according to the New York Times, making it more important than ever to find suitable care at an affordable rate.

Wyoming recorded the largest increase, with costs rising from $3,845 to $5,894, a 53% jump. Seven other states had increases of 25% or more. In contrast, costs fell by more than 10% in nine states. Washington had the largest decline at 16%, with costs falling from $4,995 to $4,176. Costs in New Jersey fell by $835 after the state ranked as the most expensive for assisted living in 2021. Even so, New Jersey remained among the 10 most expensive states in 2023, with monthly costs of $5,058. 

It takes 17.2 years of savings to afford one year of assisted living 

To show how significant the financial commitment can be, the analysis calculated how long the typical American would need to save to afford one year of assisted living. It used the U.S. Census Bureau's 2022 median annual household income for each state and assumed savings of 4.1% of median earnings, the national average in November 2023, down from 7.5% in September 2021, according to the Bureau of Economic Analysis.

Using those earnings and savings rates, it would take the average American 17.2 years to save enough for one year of assisted living.

Because this measure accounts for prevailing wages in each area, it reflects assisted living affordability based on what residents earn. New Hampshire again ranks first. Its median household income of $89,992 suggests annual savings of $3,689.67. At that rate, it would take 26.8 years to save enough to cover one year of assisted living costs, or $98,976. West Virginia, Mississippi, Wyoming, and Delaware round out the top five.

Maryland sits at the other end of the spectrum, where residents would need to save for an average of 11.7 years to cover one year of assisted living. Maryland's median household income is $94,991, translating to $3,894.63 in annual savings, just barely enough to cover one month in an assisted living community. Utah, Minnesota, Georgia, and Washington follow Maryland.

The chart below ranks each state by the number of years residents would need to save to afford one year of assisted living. 

How in-home care costs compare 

In-home care for older adults can also be expensive, and it may cost more or less than assisted living depending on the state and your family's needs. According to our Cost of Care tool, which projected median costs for 2023, Americans could expect to pay $5,462 per month for a home health aide.

Costs vary widely by state. In Minnesota, the most expensive state for home health aides, the median monthly cost is $7,333, compared with $3,472 for assisted living. In West Virginia, the least expensive state for home health aides, the monthly cost is $3,793, compared with average assisted living rent of $4,846.

In New Hampshire, however, home health aides cost $6,574 per month, while assisted living costs $8,248. If you're helping a family member choose care, carefully compare the costs and support available through each option before making a decision. 

Choosing an affordable care option 

For many older adults, assisted living is the next phase of residential life, offering opportunities to make new friends while receiving help with everyday tasks. This type of support can be rewarding, but it comes at a cost. If you're helping an older family member consider their options, look beyond the price tag and weigh financial practicality alongside their well-being. The right support should provide the care they need while helping them maintain comfort and dignity as they age.

Methodology 

The assisted living cost averages and rankings were derived from 2023 move-in data from a network of 60,000 senior living communities and a proprietary Pricing Estimator algorithm.

To identify the states with the largest cost increases over time, the analysis compared 2023 data with 2021 data.

To calculate how long it would take the average American to save for one year of assisted living, the analysis divided the annualized assisted living cost by each family's estimated yearly savings. It used the national average savings rate of 4.1% from November 2023 from the Bureau of Economic Analysis and the median household income for each state from the U.S. Census Bureau.

The median cost of in-home care was based on an analysis of 2023 projections from CareScout's Cost of Care Survey because the official figures for that year hadn't yet been released.