Care Quality Check
It’s never easy deciding on a nursing home, and location often plays a bigger role than people expect. A place that feels safe and well-managed in one state may be far from ideal in another. That’s why looking at the states that consistently do the best—and the ones that don’t—is important. To begin with, let’s look at 10 states where conditions often fall short.
1. Texas
You're searching for quality nursing care for a loved one, only to discover that Texas ranks dead last—51st place—on Families for Better Care's comprehensive report card. What makes this state particularly troubling is its provider-to-resident ratio hovering around 1.3 per occupied bed.
2. North Carolina
Hurricane seasons arrive like clockwork, but North Carolina's nursing homes remain perpetually unprepared for emergencies that widen the already massive gap between urban and rural care quality. Several homes have been put on special focus lists for repeated violations.
3. Illinois
Legacy mega-facilities pepper Illinois's environment like monuments to outdated care models. Their massive size crafts staffing nightmares that intense regulatory activity can't seem to solve. The Prairie State's 49th-place standing brings to light a repeated pattern of low overall grades.
4. Georgia
Metro Atlanta hoards nursing home capacity like a jealous guardian. This leaves rural counties to face impossibly long transfer distances when emergencies strike and weather systems strain already inadequate surge planning. Provider-to-resident ratios match Texas at approximately 1.3 per occupied bed.
5. New Mexico
Specific nursing residences like Casa de Oro Center (Las Cruces), Casa Maria Healthcare (Roswell), Clovis Healthcare and Rehabilitation Center (Clovis), Ladera Center (Albuquerque), and Sandia Ridge Center (Albuquerque) have a history of repeated and serious deficiencies. These facilities have been noted for poor sanitation.
6. Pennsylvania
Snowy winters arrive with predictable fury. This complicates staffing schedules and emergency transfers across Pennsylvania's nursing home network, despite the region's strong union presence in healthcare. The Keystone State's 46th-place on Families for Better Care underlines deeper structural problems.
7. Michigan
The Michigan Attorney General’s office announced a $4.5 million settlement in July 2025 involving six Detroit-area nursing homes accused of gross neglect. Allegations included understaffing, failure to prevent falls and infections, neglect of pressure ulcers (bed sores), and poor assistance with toileting.
8. Oklahoma
Tornado season turns into an annual nightmare for Oklahoma's care center administrators, who must repeatedly test emergency preparedness plans that often fail when real disasters strike the state's vulnerable facilities. The Sooner State's provider-to-resident ratios are around 1.4 per occupied bed.
9. Louisiana
Hurricane evacuations remain the most visible crisis here. Louisiana holds the distinction of having the lowest share of 5-star facilities in U.S. News analysis, a statistic that mirrors systematic failures rather than isolated incidents. High humidity brings persistent infection control challenges.
10. Arkansas
Mid-sized nursing homes housing 100–149 residents dominate the healthcare sector. The Natural State's mountainous terrain presents logistical nightmares for patient transfers during medical emergencies, often adding critical minutes to life-threatening situations. The facilities operate in communities where backup medical support remains hours away.
Now, let’s explore 10 of the best-known states for nursing homes.
1. Hawaii
The Aloha State holds the #1 spot for nursing home quality nationwide. According to the U.S. Centers for Medicare and Medicaid Services (CMS), 18 out of Hawaii's 46 nursing homes, or about 39%, received the highest rating of five stars.
2. Delaware
Small systems often outperform massive bureaucracies. Well, Delaware proves this theory perfectly with its #2 overall grade on Families for Better Care rankings. The region’s compact geography eliminates any transfer time issues. Plus, simplified oversight catches problems before they become full-blown crises.
3. Alaska
What makes Alaska particularly impressive is its strong veteran-home presence. Military healthcare traditions blend seamlessly with civilian elder care. A few specific examples of care centers here include Alaska Gardens Health and Rehabilitation and Quyanna Care Center.
4. Rhode Island
Dense geography becomes a superpower when it comes to nursing home inspections, allowing Rhode Island to maintain top-five rankings on Families for Better Care. Briarcliffe Manor is said to be a valuable nursing home for both short and long-term care.
Kenneth C. Zirkel on Wikimedia
5. Utah
Newer facility stock in rapidly growing suburbs gives Utah a distinct advantage over states struggling with outdated infrastructure and legacy problems from decades past. The Beehive State earned its top-five Families for Better Care grade through innovative approaches to elder care.
6. Idaho
Mountain winters force Idaho's nursing homes to develop superb emergency planning. This one consistently earns top-ten rankings from Families for Better Care through high inspection ratings. Aspen Transitional Rehab specializes in short-term nursing and rehabilitation services with private suites.
7. Arizona
Many facilities in Arizona have high ratings for quality of care, with some nursing homes recognized as "Best Nursing Homes" by U.S. News & World Report. Notable top facilities in the area include Bella Vita Health and Rehabilitation Center in Glendale (176 certified beds).
8. Oregon
Oregon has around 128 nursing homes and skilled nursing facilities across the state. Resident outcomes tend to be positive with low rates of avoidable injuries and infections. Besides, its regulatory oversight includes regular inspections and transparent reporting.
9. New Jersey
Heavy use of specialty units and competitive healthcare markets drive New Jersey's care centers to innovate and improve constantly. Famous institutions include Seacrest Rehabilitation & Healthcare Center, recognized nationally for excellence with specific programs in pulmonary rehab, orthopedic rehab, and memory care.
10. Maine
Maine earns its Families for Better Care top-ten ranking through solid AARP LTSS performance. The average cost of nursing home care in this location is about $6,687, with a variety of senior care options available based on individual needs and budgets.
