Written by: Senior Living Research Team | Published: March 28, 2023
The U.S. Department of Health and Human Services estimates that a person turning 65 today has a 70 percent chance of requiring long-term care services at some point in their golden years. As the massive Baby Boomer generation ages, demand for nursing facilities will continue to climb.
However, not all states will feel this growing demand equally. Many states will face a much larger nursing home crisis than others. To put into perspective those differences, we analyzed data from the U.S. Census Bureau, the federal Centers for Disease Control and Prevention, and Kaiser Family Foundation.
Here are some key findings:
Baby Boomers were born into a post-World War II economy on the verge of greatness. Between 1940 and 1960, about 58 million Baby Boomers were born, and the total gross national product of the U.S. more than doubled.
By 2030, the surviving members of the generation, almost 80 million strong at its peak, will all be 65 or older, and the number of Americans in that age bracket will reach 71 million, an increase of about 23 percent compared to today.
Warm-weather states will have the most significant increases in the 65 and older populations. Census data shows that Arizona will have the most significant jump, with its 65+ population increasing by 41 percent. Florida is a close second at 39 percent, and Nevada’s increase of 37 percent is third. And two other temperate states, Texas and Georgia, round out the top five (for more detailed data tables, jump down to the data appendix).
But this increase isn’t unique to warm weather locales. New Hampshire, where the average November temperature is a chilly 36 degrees (compared to a contiguous-U.S. average of 49 degrees for the month), is expected to have the ninth-highest increase. Every state will have an increase in the number of people over 65, except D.C. This is the only place where the senior population may shrink by 2030.
For states like Florida and Arizona, having large populations of older adults is nothing new. In fact, by percentage, Florida has the second-largest share of residents 65 and older, just behind Maine. Arizona’s 65+ population is also above the current national average of about 17 percent, according to data from the U.S. Census Bureau.
But other states’ elder care infrastructure may not yet be in place, based on today’s share of older adult residents. Nevada, for example, which will have the third-biggest increase in the aging adult population, currently ranks 36th regarding the percentage of residents over 65 (17 percent). While California’s share of older residents is even lower (15 percent), the state is expected to see a 25 percent increase in the number of people 65 and up.
According to our estimates, the nation could need as many as 3,000 new nursing facilities to keep pace with the surge in population among older adults. But, again, the impact is not equal across the country.
Since they’re the most populous states, Texas, California, and Florida all top the list regarding increasing their total number of nursing facilities. They account for nearly 30 percent of our projected increased need in nursing homes. Each of these states may need more than 250 nursing homes by 2030 to maintain the current population-to-nursing-home ratios.
D.C. is the only territory that will not require additional nursing care facilities. Some states, like Alaska, Wyoming, Hawaii, and Vermont, may only need a few new facilities to keep up with population increases.
Building new nursing facilities is easier said than done, partly because nursing homes are notoriously challenging to staff. This problem has gotten worse due to the current economic situation. According to a survey by the American Health Care Association and National Center for Assisted Living, 87 percent of nursing homes deal with moderate to high staffing shortages, and 61 percent limit new admissions due to workforce issues.
The staffing issues primarily come down to two factors:
Instead of (or in addition to) building new nursing facilities, states could focus on adding capacity to existing nursing homes. According to our analysis, the average U.S. nursing home must add about 20 beds to keep up with population growth. Still, that figure is even higher in states where the older adult population will rapidly expand.
For example, the average nursing home in Florida, Arizona, or Nevada would need to add 40 beds to keep up with projected growth. On the other hand, Alaska, Iowa, South Dakota, and West Virginia would need only nine beds per facility to keep pace.
In most states, the primary focus is quality, not quantity, in nursing homes. However, some policies and potential reforms address both issues. Here’s a look at what the federal and some state governments are doing to prepare for the silver wave in nursing homes. Other states may need to implement these initiatives to strengthen their infrastructures:
The rapid growth in the older adult population will undoubtedly create many ripple effects across the healthcare industry and the U.S. economy. However, if policymakers and leaders understand those challenges, they can better future-proof the nursing care system.
For this report, we analyzed population projections created by the U.S. Census Bureau and accessed via the Centers for Disease Control’s WONDER database. These projections are estimates of how many Americans aged 65+ will be living in each state in 2030. We also used Census data to determine the current number of people aged 65 or older.
We also analyzed data from the Kaiser Family Foundation on the current number of certified nursing facilities per state and the number of beds in the average facility per state. We used these numbers to determine the current percentage of the 65+ population in each state that live in nursing facilities and the ratio of people 65+ to the number of facilities and beds per state. We then determined the additional number of facilities and beds that may be needed in 2030 to maintain the current ratios of patients to facilities in each state.
|Percent change in 65+ population, 2022-2030||Projected number of new facilities needed by 2030||Projected number of additional beds needed in average facility by 2030|
|District of Columbia||-4%||-1||-6|