Where in the U.S. are People Living the Longest?

America’s aging population: how rapid growth is reshaping healthcare

The United States is experiencing a significant demographic shift as its population ages rapidly, with projections indicating a substantial increase in the number of older adults in the coming decades. As the proportion of individuals aged 60 and above grows, the strain on healthcare and homecare services — including the availability of hospital beds — is becoming more apparent.

Using Census Bureau data, this analysis explores which states in the U.S. have the longest-living residents and how quickly their populations are aging.

Additionally, we examine the impact on nursing facilities — analyzing trends in their availability, quality, and ability to meet rising demand.

Hawaiians are currently living the longest among U.S. states

1. Hawaii

Total proportion of the population over 85: 2.95%

Hawaii has the highest proportion of residents aged 85 and older, with 1.09% males and 1.87% females over 85. This reflects the state’s high life expectancy, among the best in the U.S. Factors such as a strong healthcare system, an active lifestyle, and a diet rich in fresh seafood contribute to this longevity.

However, the high cost of living and a shortage of long-term care facilities pose challenges for seniors who require specialized care. As the elderly population grows, Hawaii must expand its healthcare workforce and invest in home healthcare solutions. 

2. Florida

Total proportion of the population over 85: 2.59% 

Florida has long been a popular destination for retirees, leading to one of the country's highest concentrations of older adults. A higher proportion of women (1.52%) are aged 85 and over, more than men (1.06%), backing that women tend to live longer than men. The state’s warm climate, tax benefits, and senior-friendly communities make it an attractive place to age.

This also puts immense pressure on healthcare systems, particularly in-home care and assisted living facilities. The demand for specialized elderly care is rising, requiring Florida to continue expanding services to support its aging population. 

3. Maine

Total proportion of the population over 85: 2.27%

Maine’s aging population is growing quickly, primarily due to a combination of an older existing demographic and low birth rates. Again, Maine has a higher proportion of women (1.43%) over 85 than men (0.84%).

As a predominantly rural state, Maine faces unique challenges in providing healthcare access to its elderly residents. Many seniors live in remote areas with limited healthcare facilities, increasing reliance on home care services and telemedicine. Expanding eldercare programs and addressing workforce shortages in caregiving professions will be crucial for Maine’s future.

Nevada has the most rapidly aging population in the U.S.

The average proportion of people aged 85 and older across the U.S. increased by just under 40% over 10 years, going from 4.4 million in 2003 to 6.1 million in 2023. But where is home to the most quickly aging populations?

1. Nevada

Change in proportion of population 85+ 2003-2023: 127.35% 

Nevada's 85+ population has more than doubled (127.35%) over the past 20 years, the highest in the nation. This growth has mainly been seen in men, with the proportion of males over 85 almost tripling (187.97%) since 2003.

Nevada is home to 46,780 people 85 and older, which is roughly 1.5% of the total population. The location has become an attractive retirement destination due to its warm climate but with only 67 nursing facilities in the state, this growth could put further strain on resources if it continues. 

2. Alaska

Change in proportion of population 85+ 2003-2023: 122.47% 

While those aged 85 and over only represent just under 1% of the total population, this has risen dramatically in the last 20 years — increasing by 122.47%. This rapid growth is likely due to the state's overall aging demographic, as more residents choose to retire in place rather than move to other states.

Alaska faces unique challenges in elder care due to its remote communities and extreme weather conditions, making access to healthcare and home care services more difficult. Expanding telehealth services and long-term care facilities will be essential to support its growing senior population.

3. Hawaii

Change in proportion of population 85+ 2003-2023: 100.23%

Hawaii ranks third in terms of growth in its proportion of 85+ population, with an 100.23% increase since 2003. The state’s long life expectancy, driven by a combination of healthy diets, strong community support, and access to quality healthcare, has contributed to this trend.

However, the rising cost of living and a shortage of long-term care facilities pose challenges for elderly residents who wish to age in place. Increasing affordable home care options and expanding healthcare infrastructure will be necessary to meet the needs of Hawaii’s growing senior population.

85+ population could potentially increase by over 100% in Alaska by 2043

2043 Projections
Rank	State	Predicted proportion of population over 85	Predicted percentage change 2023-2043
1	Alaska	2.00%	102.69%
2	Hawaii	5.31%	79.60%
3	Nevada	2.36%	60.68%
4	Arizona	2.94%	46.41%
5	New Mexico	2.74%	43.28%
6	California	2.52%	38.70%
7	Maryland	2.55%	37.88%
8	Virginia	2.37%	36.21%
9	New Hampshire	2.78%	34.77%
10	Delaware	2.50%	31.71%

 

1. Alaska

Prediction proportion of the population over 85 change by 2043: 102.69% 

Alaska is expected to have the highest rise of adults aged 85 and over by 2043, with 2.00%, over double its current total population in this age group. This reflects the state’s high life expectancy and strong healthcare system.

With this projected increase in this population, Hawaii must expand its senior care services significantly. The rising cost of living and shortage of long-term care options could create challenges for older adults hoping to age in place.

Arizona is the least prepared to care for its aging population

Rank	State	Number of nursing facilities	Population over 85 per nursing facility
1	Arizona	142	1,050.2
2	Hawaii	43	958.2
3	Florida	697	836.4
4	New York	606	713.9
5	Nevada	67	698.2
6	Washington	198	642.1
7	District of Columbia	17	634.5
8	California	1,170	601.9
9	Oregon	129	597.0
10	New Mexico	68	590.3

 

1. Arizona

Population over 85 per nursing facility: 1,050.2

In Arizona, there are almost 150,000 people aged 85 and older and only 142 nursing facilities. This means that for every nursing facility, there are over 1,000 people 85+ living in the state. For comparison, Virginia — which has a similar aging population — has 289 facilities.

Interestingly, while Hawaii has the highest proportion of people aged 85+ in the U.S., it has one of the lowest nursing facilities per capita. This potentially puts a strain on the resources available to the older population and the quality of care received.

Iowa is the most prepared to care for its aging population

Rank	State	Number of nursing facilities	Population over 85 per nursing facility
1	Iowa	412	173.5
2	Kansas	313	183.8
3	South Dakota	98	191.2
4	Nebraska	185	204.1
5	North Dakota	77	227.7
6	Oklahoma	292	230.7
7	Indiana	521	231.9
8	Missouri	510	235.7
9	Ohio	946	239.5
10	Mississippi	202	250.7

 

1. Iowa

Population over 85 per nursing facility: 173.5

Iowa ranks first in the nation for the number of nursing facilities relative to its elderly population, with 412 nursing homes serving 71,485 individuals aged 85 and older. This results in approximately 173.5 seniors per nursing facility, making Iowa one of the most well-equipped states regarding long-term care availability.

The state's strong infrastructure for elderly care may be attributed to its rural composition and policies emphasizing accessible healthcare services for older residents. Additionally, Iowa’s long-standing commitment to senior care ensures its aging population has more options for assisted living and skilled nursing care than in many other states.

The states with the biggest decline in nursing facilities in the last 10 years

1. Montana

Change in number of nursing facilities: -27.71%

The number of nursing facilities in Montana stood at 83 in 2015, but by 2024, this number had reduced to 60. This means there was an overall reduction of almost 28% over the years. This lowering of support available for people over 85 means the state could struggle to keep up with demand as its aging population is expected to rise by nearly 7% by 2043.

This state is not an outlier either. In fact, 45 out of 51 states have seen a reduction in nursing facilities despite a national increase in older population.

All nursing homes in these states are classed as deficient

There are four spots in the U.S. where every single nursing facility has been found to have deficiencies — the District of Columbia, Hawaii, Nevada, and Wyoming. The District of Columbia has seen the total number of care centres decrease by almost 11% since 2025. And of the ones left, they are all substandard in some way.

We’ve seen that Hawaii is expected to increase its 85+ population by almost 80% by 2043, but this could mean bad news for the quality of care. It is one of the states with 100% of care facilities with deficiencies. The most common problem within these nursing centres is infection control as 83% of locations in the state have this issue.

Kentucky is improving its nursing facilities the most

1. Kentucky

Change in nursing facilities with deficiencies 2019-2024: -7% 

Kentucky saw a 7% decrease in the percentage of nursing facilities with deficiencies between 2019 and 2024. Despite being at the top of the list in 2019 with 93%, the state has gradually seen an increase in facility quality over the years, dropping to 86% of nursing facilities that have deficiencies in 2024.

This suggests that Kentucky has been performing relatively well in recent years. While the state's nursing homes could have previously experienced increasing challenges, there has been a noticeable decline in facilities falling below regulatory standards.

The most common nursing home deficiencies in the U.S.

 

The biggest issue in U.S. nursing facilities is the quality of care, affecting 72% of nursing facilities, with Nevada reporting the highest rates. This, paired with the second most common deficiency of resident rights (58%), can significantly diminish the quality of life, leaving many over 85s vulnerable to neglect and mistreatment.

Nearly half of facilities across the nation fall short in infection control (49%) and comprehensive resident-centered care plans (50%), both of which are necessary for maintaining residents' health and personalized support.

The District of Columbia consistently reports some of the highest rates across multiple categories, including freedom from abuse, neglect, and exploitation, raising concerns about oversight and regulatory enforcement.

With one of the lowest ratios of nursing facilities to over 85s, the issues seen in centers in the District of Columbia could be down to overcrowding and a lack of resources needed to deliver quality care.

Comparing the change in 85+ populations to the change in nursing facilities in the U.S.

Nevada had an 7.63% increase in the proportion of its population aged 85+ between 2018 and 2023, and has seen a substantial increase of more than one-quarter (26.42%) in nursing facilities since 2018. However, despite this growth in facilities, Nevada also has the highest percentage of nursing facilities with deficiencies in 2023 (100%), suggesting that while supply may be increasing, the quality of care might not be improving at the same pace.

Alaska had a growth of 2.62% in the proportion of its population aged 85+ but also experienced an 11.11% increase in nursing facilities, with a relatively lower deficiency rate, nine in 10 (95%) among its facilities.

On the other hand, states like Connecticut and Nebraska have witnessed some of the steep declines in the proportion of the population aged 85+ and the number of nursing facilities. Nebraska, for example, has experienced a 12.16% decrease in the proportion of older adults, alongside a 15.98% decline in nursing facilities. This lower pressure on resources can be seen in its comparatively low nursing facility deficiency rate — 94% compared to the national average of 95%.

Interestingly, while seeing moderate declines in older populations, states such as California and the District of Columbia maintain relatively high deficiency rates, particularly in areas like freedom from abuse, neglect, and exploitation, and resident rights.

Nicole Holland from Opera Beds U.S. comments:

“As the U.S. population ages, many older adults choose to ‘age in place’ — remaining in their own homes rather than moving to assisted living or nursing facilities. The right tools and home modifications are essential to do this safely and comfortably. For instance, home hospital beds, mattresses, and rotating chair beds can significantly improve sleep quality, reduce pressure sores, and assist with mobility issues, making them a crucial investment for seniors and their caregivers. 

“Additionally, home hospital beds provide enhanced support for those with more complex medical needs, easing the burden on family members and reducing the necessity for frequent hospital visits.

“Beyond the personal benefits, aging in place with the right support tools can also alleviate pressure on healthcare systems. By reducing hospital readmissions and long-term care facility stays, healthcare providers can allocate hospital beds and resources more efficiently, ensuring that acute care is available for those who need it most. With an increasing number of seniors looking for solutions to maintain their independence, investing in high-quality home care equipment is not just a personal advantage — it’s a broader healthcare necessity."

Assistive products like the Opera Rotobed rotating hospital bed can help seniors stay independent at home for longer.

Methodology

 Using the United States Census Bureau data, we were able to source the proportion of the population aged 85 and over in every state in the U.S., using their 2000-2010, 2010-2019, and 2020-2024 datasets. We then used this data to calculate the 20-year (2003-2023) difference in the proportion of each state's 85-plus residents. We then calculated the estimated projection for each state's proportional 85-plus population in 20 years (2043) from the most recent data (2023).

We then used KFF’s “Total Number of Certified Nursing Facilities” data to get the number of nursing facilities in each state, which we then calculated as the number of residents over 85 per nursing facility. We also took the number of nursing facilities in each state between 2015 and 2024 to calculate the percentage change in facilities over this timeframe.

We then used KFF’s “Percent of Certified Nursing Facilities with Deficiencies” to show each state's number of nursing facilities with deficiencies from 2019 to 2024. We then showed which states have the highest number of facilities with deficiencies and which have had the biggest decrease in facilities with deficiencies from 2019 to 2024.

Lastly, we analyzed KFF’s “Percent of Certified Nursing Facilities with Top Ten Deficiencies” data to reveal the most prevalent deficiencies in nursing facilities in the U.S., highlighting which deficiencies are the most prevalent in which states.