More than 61 million Americans are now 65 and older, according to the U.S. Census Bureau, and in several states older adults account for more than one in five residents.
As the nation's population continues to age, where people live is increasingly shaping how easy -- or difficult -- it is to access affordable health care, long‑term support and home‑based services.
A new report by Opera Beds, which analyzed demographic trends, health care affordability and care infrastructure across all 50 states and Washington, D.C., found stark differences in how well states are equipped to support older residents. The analysis combined data on the size of the 65‑and‑older population, medical cost burden, long‑term care costs, care capacity and life expectancy.
According to the report, northeastern states such as Vermont and Maine are under some of the greatest strain. These states have among the highest proportions of residents aged 65 and over, while also facing high costs for home‑based care.
Vermont ranked as the state facing the greatest pressure on its senior care system, receiving an elderly care pressure score of 8.36 out of 10. More than 20 percent of Vermont's population is aged 65 and older, one of the highest shares in the country.
The report found that the state has fewer nursing homes and home health services per senior than the national average, while the annual cost of a full‑time home health aide approaches $100,000.
Maine ranked third overall, with 21.9 percent of its population aged 65 and older -- the highest share nationally. Home health aide costs in the state average more than $98,000 annually, while nearly 15 percent of older adults report difficulty paying medical bills.
By contrast, several southern and central states ranked among the most supportive for aging, according to the report's scoring system.
Louisiana received the lowest Elderly Care Pressure Score overall at 1.58 out of 10. The state benefits from comparatively low home health aide costs -- averaging about $50,000 per year -- and a higher‑than‑average number of nursing homes per senior.
Texas also ranked well, in part because only 13.2 percent of its population is aged 65 and over, easing demographic pressure.
The report found that Texas has one of the strongest networks of home health services in the country, even though a higher‑than‑average share of older adults report difficulty paying medical bills.
Taken together, the findings underscore how aging in America is shaped by an uneven mix of demographics, infrastructure, affordability and longevity.
States with older populations often face higher costs and tighter capacity, while others are better positioned to absorb growing demand.
"With the U.S. population continuing to age, ensuring equal access to affordable and appropriate care will become an increasingly important policy challenge," the report noted, warning that regional disparities could influence where older Americans choose -- or are able -- to live.