Washington, Minnesota, D.C. Lead List of Top States for Long-Term Services, Supports 

Minnesota, Washington and Washington, D.C. are the top-three states for long-term services and supports, according to a newly released report from AARP.

Released every three years, the “2023 LTSS State Scorecard” measures the quality of long-term services and supports in every U.S. state and the District of Columbia.States are judged by performance in five categories: Affordability and access, choice of setting and provider, safety and quality, support for family caregivers and community integration. The categories are measured through a variety of points, including nursing home cost, assisted living supply, staff turnover and nurse delegation.

The top states in the 2023 LTSS State Scorecard are:

  1. Minnesota
  2. Washington
  3. District of Columbia
  4. Massachusetts
  5. Colorado

States were judged by how long-term services and supports are shared across multiple groups, including race and ethnicity, gender identity, sexual orientation, age, disability status, and income.

Each state was ranked by tiers in five groups, with tier one representing the best states for long-term services and supports and tier five representing the worst.

Top-ranked Minnesota ranked No. 1 in support of family caregivers and community integration, and No. 2 in the remaining categories, for example.


D.C, Massachusetts and Colorado were new additions to the top-five states compared to the previous scorecard, according to the report.

The number of assisted living beds also ticked up 15% between 2020 and 2023 — a the report noted. The report states there is an average of 55 beds per 1,000 adults aged 75 or older. Minnesota had the overall greatest supply of 138 per 1,000 adults, while New York had the least with 20 per 1,000.

But the affordability of assisted living services is still a big challenge, and senior living communities do not always cater to a diverse group of residents, the report’s authors note.

“Assisted living is expensive, and there is limited Medicaid coverage that pays only for the service component of assisted living,” the authors wrote. “Some assisted living communities are part of continuing care retirement communities, which are prohibitively expensive for most people and serve a predominantly white clientele. In other words, these services are not meaningfully available to most people or available in an equitable manner.”

Among the major findings with the scorecard was that there was a greater acceleration of progress for 2020-2023 compared to 2017-2020, with more overall improvements than declines. Of the 26 indicators tracked, the greatest declines were seen in home care cost and adult day services supply.

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