The Most Expensive States for Long-Term Care - And What It Would Actually Cost You to Age There

Long-term care can quickly become one of the biggest financial pressures retirees face. 

CareScout's 2025 Cost of Care Survey found that a private nursing home room now carries a national median cost of roughly $129,000 per year, while assisted living averages more than $74,000 annually. But the national average only tells part of the story. In some states, aging could cost dramatically more, especially for retirees who need years of ongoing care.

That's one reason location matters so much in retirement planning. A move that once looked affordable could eventually come with six-figure bills that quickly drain savings. Understanding where long-term care costs are highest could help you avoid money mistakes in retirement.

Maine

• Private Nursing Room Annual Cost: $178,850
• Assisted Living Annual Cost: $98,460

Maine starts out our list with some of the nation's highest nursing home and assisted living costs. As the state's population continues to age rapidly, long-term care demand could remain elevated, potentially keeping prices high for future retirees as well.

Delaware

• Private Nursing Room Annual Cost: $181,588
• Assisted Living Annual Cost: $91,200

Delaware may not immediately come to mind as a high-cost retirement state, but long-term care costs tell us a different story. Private nursing rooms exceed $181,000 annually, while even semi-private rooms approach $174,000. Assisted living also ranks among the nation's most expensive. 

Retirees relocating for tax advantages may want to weigh health care and long-term care costs alongside potential benefits.

Vermont

• Private Nursing Room Annual Cost: $186,332
• Assisted Living Annual Cost: $103,167

Vermont also ranked near the top nationally for both assisted living and nursing home care. Smaller rural health care networks and staffing challenges may also contribute to the rise of care costs throughout the region. Those expenses could catch retirees off guard if they only budget for basic living costs in retirement.

Massachusetts

• Private Nursing Room Annual Cost: $189,800
• Assisted Living Annual Cost: $115,200

Massachusetts remains one of the country's most expensive states for aging-related care. Even semi-private rooms at nursing homes topped $173,000 annually. For retirees in high-cost Northeast states, health care expenses can easily become one of the largest retirement risks outside of housing itself.

Washington

• Private Nursing Room Annual Cost: $191,625
• Assisted Living Annual Cost: $91,200

Washington ranked highly across multiple forms of care, including private nursing homes, assisted living, and adult day health services. The state's long-term care expenses have risen steadily alongside broader health care and housing costs in many parts of the Pacific Northwest.

Hawaii

• Private Nursing Room Annual Cost: $196,735
• Assisted Living Annual Cost: $145,155

Retiring in Hawaii may sound appealing, but the state has the highest assisted living costs in the country. Median assisted living expenses climbed to roughly $145,000 annually. Nursing home care also ranked among the nation's highest. 

Because everyday living expenses are already elevated in Hawaii, long-term care costs could become especially difficult for retirees who are underinsured or relying heavily on savings.

Connecticut

• Private Nursing Room Annual Cost: $200,750
• Assisted Living Annual Cost: $109,410

Connecticut ranked among the most expensive states for both private and semi-private nursing home care. For retirees living on fixed incomes, these costs could place serious pressure on savings, especially for those who require care for several years rather than months.

New York

• Private Nursing Room Annual Cost: $200,750
• Assisted Living Annual Cost: $85,320

New York ranks near the top for nearly every category of long-term care. A private nursing home room now costs roughly $200,750 annually, while semi-private care averages more than $186,000 per year. Assisted living costs also remain elevated compared to national averages. 

High labor costs and dense metropolitan areas are likely driving prices upward across the state.

Oregon

• Private Nursing Room Annual Cost: $221,372
• Assisted Living Annual Cost: $82,494

Oregon posted the highest median cost for a private nursing home room in the nation at more than $221,000 annually. Semi-private nursing home care also exceeded $200,000 per year. Even adult day health services ranked among the most expensive nationally, too. 

For retirees planning to age in the Pacific Northwest, these numbers highlight how quickly long-term care expenses can easily overwhelm a retirement budget.

Alaska

• Private Nursing Room Annual Cost: N/A
• Assisted Living Annual Cost: $118,578

Alaska stands out as the most expensive state overall for several forms of long-term care. According to CareScout, a semi-private nursing home room carries a median annual cost of nearly $334,000. Remote geography and higher operating costs likely contribute to the state's unusually high care expenses.

Bottom line

Long-term care costs are rising quickly, and where you live can dramatically impact how much you ultimately pay. In several states, nursing home care now exceeds $150,000 per year, which could quickly drain even sizable retirement accounts. For retirees whose retirement savings are stretched thin, those expenses may become one of the biggest financial risks later in life.

Medicare generally does not cover extended long-term custodial care. That means retirees often rely on personal savings, long-term care insurance, or Medicaid after spending down assets. Reviewing care costs before relocating, especially to high-cost retirement states, could help households free up their retirement budget.

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