Disclaimer: General educational research only — not legal, tax or financial advice. Figures are survey-based estimates with the limits explained in the methodology. Verify with official sources and a qualified professional before making decisions.
Estate Planning Data & Research → The Caregiver Shortage Index: Seniors per Home Health Aide by State
When an older parent needs help at home, families often find out the hard way that the help is hard to find. Agencies have waiting lists. Shifts go unfilled. A promised aide doesn’t show up.
To see where the squeeze is likely to be tightest, we compared two federal counts for every state and Washington, D.C.: how many people are 65 and older (and 85 and older, the age group most likely to need daily help), and how many home health and personal care aide jobs there are.
The result is a simple ratio: seniors per aide job. The higher the number, the more older residents there are for each paid aide.
While you plan for care, make sure the legal papers are in place too: a will, a power of attorney and a health care directive. See whether you need a will, a living trust or both.
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Cite this page URL when reusing findings. Not a substitute for official sources or professional advice.
Key findings
- Nationally, there are 15.0 residents age 65+ for every home health and personal care aide job: 64.6 million older Americans and about 4.31 million aide jobs. For people 85 and older, it is 1.6 per aide job.
- Most strained states (most seniors per aide job): Florida (59.3), Hawaii (52.7), Alabama (48.2), South Dakota (43.0) and Tennessee (37.8).
- Least strained: New York (5.8), California (7.1), District of Columbia (7.4), Minnesota (8.7) and Pennsylvania (10.9).
- Florida has about 10 times as many seniors per aide job as New York. Florida has 5.35 million residents 65+ and 90,170 aide jobs. New York has 3.86 million residents 65+ and 663,140 aide jobs.
- Most states are tighter than the national number suggests. Because New York and California have so many aide jobs, the U.S. figure looks better than most places. 41 states have more seniors per aide job than the national average; the middle state has 22.1.
- For the oldest seniors (85+), Hawaii and Florida are tightest, at about 7 residents 85+ per aide job each, followed by South Dakota (5.0), Alabama (4.9) and Oklahoma (3.8).
- The older population keeps growing. The number of Americans 65+ rose 15.5% from 2020 to 2025. Delaware (+23.4%), New Hampshire (+21.5%), Idaho (+21.0%) and Alaska (+21.0%) grew fastest.
Full state ranking
Rank 1 = most residents 65+ per aide job. “Range from survey error” uses the BLS relative standard error for aide employment (approximate 90% range). Hawaii, Rhode Island and Montana have the widest ranges.
| Rank (most strained first) | State | Residents 65+ (July 2025) | Residents 85+ | Home health & personal care aide jobs (May 2025) | Seniors 65+ per aide job | Range from survey error | Residents 85+ per aide job | 85+ rank | Aide jobs per 1,000 seniors | 65+ growth, 2020–2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Florida | 5,346,788 | 633,779 | 90,170 | 59.3 | 56.6–62.3 | 7.0 | 2 | 17 | 16.7% |
| 2 | Hawaii | 324,150 | 43,663 | 6,150 | 52.7 | 45.3–63.0 | 7.1 | 1 | 19 | 14.5% |
| 3 | Alabama | 1,009,814 | 102,135 | 20,930 | 48.2 | 46.0–50.8 | 4.9 | 4 | 21 | 13.6% |
| 4 | South Dakota | 181,082 | 21,085 | 4,210 | 43.0 | 39.4–47.3 | 5.0 | 3 | 23 | 15.0% |
| 5 | Tennessee | 1,360,588 | 133,326 | 35,950 | 37.8 | 35.8–40.2 | 3.7 | 6 | 26 | 14.7% |
| 6 | Georgia | 1,884,140 | 179,950 | 50,870 | 37.0 | 35.1–39.2 | 3.5 | 9 | 27 | 18.8% |
| 7 | Oklahoma | 741,085 | 77,136 | 20,310 | 36.5 | 34.4–38.8 | 3.8 | 5 | 27 | 13.1% |
| 8 | North Carolina | 2,119,438 | 210,994 | 58,880 | 36.0 | 34.5–37.6 | 3.6 | 7 | 28 | 17.8% |
| 9 | Wyoming | 121,648 | 11,067 | 3,410 | 35.7 | 32.6–39.4 | 3.2 | 11 | 28 | 18.3% |
| 10 | New Hampshire | 325,383 | 32,441 | 9,440 | 34.5 | 32.8–36.3 | 3.4 | 10 | 29 | 21.5% |
| 11 | Nevada | 599,211 | 53,590 | 17,940 | 33.4 | 31.5–35.6 | 3.0 | 15 | 30 | 17.1% |
| 12 | Rhode Island | 233,061 | 26,799 | 7,490 | 31.1 | 27.8–35.4 | 3.6 | 8 | 32 | 16.1% |
| 13 | Arkansas | 591,966 | 60,837 | 19,840 | 29.8 | 27.6–32.5 | 3.1 | 13 | 34 | 11.5% |
| 14 | South Carolina | 1,173,259 | 109,745 | 40,750 | 28.8 | 27.7–29.9 | 2.7 | 18 | 35 | 20.0% |
| 15 | Kentucky | 868,019 | 84,398 | 31,260 | 27.8 | 26.5–29.2 | 2.7 | 17 | 36 | 12.6% |
| 16 | Nebraska | 368,331 | 41,154 | 13,660 | 27.0 | 24.8–29.5 | 3.0 | 14 | 37 | 14.0% |
| 17 | Utah | 460,179 | 44,850 | 17,130 | 26.9 | 25.4–28.5 | 2.6 | 19 | 37 | 19.5% |
| 18 | Mississippi | 571,344 | 56,572 | 21,800 | 26.2 | 24.9–27.6 | 2.6 | 20 | 38 | 12.0% |
| 19 | Iowa | 649,656 | 80,343 | 25,800 | 25.2 | 24.1–26.3 | 3.1 | 12 | 40 | 12.5% |
| 20 | Maryland | 1,149,859 | 126,255 | 46,560 | 24.7 | 23.2–26.4 | 2.7 | 16 | 40 | 16.3% |
| 21 | Montana | 253,772 | 24,810 | 10,400 | 24.4 | 22.1–27.2 | 2.4 | 24 | 41 | 16.8% |
| 22 | Virginia | 1,633,891 | 173,078 | 70,070 | 23.3 | 21.8–25.0 | 2.5 | 22 | 43 | 16.6% |
| 23 | Colorado | 1,029,188 | 99,686 | 44,650 | 23.1 | 21.9–24.4 | 2.2 | 29 | 43 | 17.8% |
| 24 | Indiana | 1,284,435 | 134,204 | 57,050 | 22.5 | 21.5–23.6 | 2.4 | 25 | 44 | 14.3% |
| 25 | Ohio | 2,398,129 | 259,049 | 106,940 | 22.4 | 21.6–23.3 | 2.4 | 23 | 45 | 12.7% |
| 26 | Kansas | 561,319 | 63,246 | 25,350 | 22.1 | 21.3–23.0 | 2.5 | 21 | 45 | 13.8% |
| 27 | Michigan | 2,076,467 | 216,289 | 95,020 | 21.9 | 21.1–22.6 | 2.3 | 26 | 46 | 14.6% |
| 28 | Oregon | 898,568 | 93,346 | 42,330 | 21.2 | 20.1–22.4 | 2.2 | 30 | 47 | 12.4% |
| 29 | Arizona | 1,571,773 | 167,460 | 74,540 | 21.1 | 20.3–21.9 | 2.2 | 28 | 47 | 16.9% |
| 30 | West Virginia | 398,189 | 39,623 | 18,890 | 21.1 | 20.2–22.1 | 2.1 | 31 | 47 | 8.2% |
| 31 | Delaware | 241,321 | 22,783 | 11,820 | 20.4 | 19.1–21.9 | 1.9 | 35 | 49 | 23.4% |
| 32 | Vermont | 155,289 | 15,550 | 7,700 | 20.2 | 19.5–20.9 | 2.0 | 33 | 50 | 16.5% |
| 33 | Louisiana | 868,225 | 85,984 | 45,060 | 19.3 | 18.6–20.0 | 1.9 | 36 | 52 | 13.7% |
| 34 | Maine | 347,617 | 36,155 | 18,630 | 18.7 | 17.8–19.7 | 1.9 | 34 | 54 | 16.3% |
| 35 | North Dakota | 143,139 | 17,523 | 7,730 | 18.5 | 17.6–19.5 | 2.3 | 27 | 54 | 15.2% |
| 36 | Idaho | 379,157 | 37,412 | 20,770 | 18.3 | 17.2–19.4 | 1.8 | 38 | 55 | 21.0% |
| 37 | Alaska | 116,192 | 8,199 | 6,530 | 17.8 | 16.9–18.8 | 1.3 | 46 | 56 | 21.0% |
| 38 | Illinois | 2,379,145 | 275,741 | 134,100 | 17.7 | 17.2–18.3 | 2.1 | 32 | 56 | 13.4% |
| 39 | Connecticut | 751,845 | 90,958 | 49,510 | 15.2 | 14.5–15.9 | 1.8 | 37 | 66 | 16.6% |
| 40 | New Jersey | 1,767,250 | 206,230 | 117,080 | 15.1 | 14.6–15.6 | 1.8 | 39 | 66 | 15.8% |
| 41 | Wisconsin | 1,241,547 | 133,736 | 82,430 | 15.1 | 14.6–15.5 | 1.6 | 40 | 66 | 16.3% |
| 42 | Texas | 4,711,381 | 461,222 | 329,590 | 14.3 | 14.0–14.7 | 1.4 | 44 | 70 | 19.6% |
| 43 | Washington | 1,460,563 | 150,667 | 103,260 | 14.1 | 13.8–14.6 | 1.5 | 41 | 71 | 15.9% |
| 44 | Missouri | 1,230,134 | 133,254 | 94,810 | 13.0 | 12.7–13.3 | 1.4 | 42 | 77 | 13.7% |
| 45 | Massachusetts | 1,421,793 | 165,591 | 117,940 | 12.1 | 11.5–12.6 | 1.4 | 43 | 83 | 15.6% |
| 46 | New Mexico | 448,253 | 43,798 | 38,910 | 11.5 | 11.2–11.9 | 1.1 | 47 | 87 | 14.0% |
| 47 | Pennsylvania | 2,799,790 | 327,495 | 257,370 | 10.9 | 10.6–11.1 | 1.3 | 45 | 92 | 12.5% |
| 48 | Minnesota | 1,113,573 | 128,077 | 128,680 | 8.7 | 8.4–8.9 | 1.0 | 48 | 116 | 16.7% |
| 49 | District of Columbia | 94,423 | 11,617 | 12,810 | 7.4 | 7.1–7.7 | 0.9 | 49 | 136 | 10.6% |
| 50 | California | 6,901,168 | 809,992 | 970,150 | 7.1 | 7.1–7.2 | 0.8 | 50 | 141 | 14.6% |
| 51 | New York | 3,860,551 | 478,142 | 663,140 | 5.8 | 5.8–5.9 | 0.7 | 51 | 172 | 14.1% |
| — | United States | 64,617,088 | 7,041,036 | 4,305,810 | 15.0 | 14.9–15.1 | 1.6 | — | 67 | 15.5% |
Source: Family Estate Guide analysis of U.S. Census Bureau Vintage 2025 population estimates (July 1, 2025) and BLS Occupational Employment and Wage Statistics, May 2025 (SOC 31-1120).
Why some states look so different
A big gap like Florida’s 59 vs. New York’s 6 is partly about how each state organizes and pays for home care, not just how many people do the work.
- Medicaid program design. Some states pay for a lot of in-home care through Medicaid, including programs where older adults or people with disabilities hire their own aides (often relatives). How those workers are employed (through an agency, a fiscal intermediary or a government program) affects whether and where they show up in the federal job survey. States with large programs of this kind tend to post high aide counts.
- Who the survey misses. The BLS survey counts wage and salary jobs at businesses and organizations. It does not count self-employed caregivers or people hired directly by a family. In states where many caregivers work as independent contractors or are hired privately, the aide count, and so the supply, is understated. That may be part of the story in states at the top of this list. We can’t measure how much from these data.
- Aides don’t only serve seniors. Home health and personal care aides also help younger adults with disabilities. The ratio compares aides to the older population as a yardstick; it does not mean every aide works with someone 65+.
- Family fills the gap. Where paid help is thin, more of the work falls on spouses and adult children. Our companion piece, Where Family Caregivers Would Earn the Most if They Were Paid, shows what those unpaid hours are worth.
So read a high number as “expect to look harder and plan earlier for paid help here,” not as a precise count of workers available to your family.
What this means for your family
Start looking before you need it. In states near the top of this list, finding a reliable aide can take time. If a parent is starting to need help, ask local agencies now about waiting lists, minimum shifts and backup coverage.
Line up the paperwork so someone can act. Hiring and paying an aide, signing an agency contract, or talking with a parent’s doctor usually requires a durable power of attorney and a healthcare directive. These are much easier to sign while a parent is healthy. If things are already urgent, see We Need a Plan Now.
Have a backup plan if home care falls through. Know the other options where your parent lives: nursing home costs by state and nursing home capacity by state. Also check our data on older adults living alone. A parent who lives alone in a tight-supply state is the situation that most needs a plan.
Understand how Medicaid fits in. Medicaid is a major payer for home care, and rules differ by state. If a parent may need Medicaid later, learn the basics early, including Medicaid estate recovery in your state, which affects what is left for heirs. A will or trust should be part of the same conversation.
Talk as a family. Decide who will coordinate care, who handles money, and how siblings will share the load. Our guide to the family conversation and My Parents Are Getting Older: Where Do I Start? can help you get started.
Methodology
Older population. U.S. Census Bureau, Population Estimates Program, Vintage 2025, “Annual State Resident Population Estimates for 6 Race Groups by Age, Sex, and Hispanic Origin: April 1, 2020 to July 1, 2025” (file sc-est2025-alldata6.csv, posted June 25, 2026). We summed the resident population for both sexes, all origins and all six race groups at ages 65 and over and at age 85 and over (the file’s top age group is 85+), for July 1, 2025 (POPESTIMATE2025) and July 1, 2020 (POPESTIMATE2020). We checked these totals against the companion civilian file sc-est2025-agesex-civ.csv; they match.
- https://www2.census.gov/programs-surveys/popest/datasets/2020-2025/state/asrh/sc-est2025-alldata6.csv
- File layout: https://www2.census.gov/programs-surveys/popest/technical-documentation/file-layouts/2020-2025/SC-EST2025-ALLDATA6.pdf
Aide jobs. U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (OEWS), May 2025 (published May 2026), state file state_M2025_dl.xlsx (oesm25st.zip) and national file (oesm25nat.zip). Occupation SOC 31-1120, Home Health and Personal Care Aides, which BLS publishes as a single combined occupation (separate state figures for 31-1121 and 31-1122 are not published). We used total employment (TOT_EMP) and its relative standard error (EMP_PRSE). No state was suppressed. OEWS counts jobs by the state where the work is located and excludes self-employed workers and private-household employees.
Calculations.
- Seniors per aide job = residents 65+ (July 1, 2025) ÷ aide jobs (May 2025). Same for 85+.
- Aide jobs per 1,000 seniors = aide jobs ÷ residents 65+ × 1,000.
- Approximate 90% range = residents 65+ ÷ (aide jobs × (1 ± 1.645 × relative standard error)). This reflects survey error in the job count only; the population figures are estimates too, but Census does not publish error ranges for them.
- Growth = July 2025 ÷ July 2020 − 1, from the same Vintage 2025 file.
The full CSV is available in the Downloads section above.
Frequently asked questions
Does a high number mean I can’t find an aide in my state?
No. It means paid aides are spread across more older residents than in other states, so it may take longer or cost more to find help. Local conditions vary a lot, even within a state.
Why are New York and California so low?
They have very large paid home care workforces (663,140 aide jobs in New York and 970,150 in California), likely tied in part to how their Medicaid home care programs are set up. Some of these programs let people hire relatives as their paid aides. We did not measure how much each program adds to the count. A low number is good news for supply, but it doesn’t guarantee an opening near you.
Are nurses and nursing assistants included?
No. This index covers only home health and personal care aides (SOC 31-1120), the workers who most often provide hands-on help at home. Nursing assistants in nursing homes and hospitals, and nurses, are counted in other occupations.
How often is this updated?
BLS releases new state job figures each spring, and Census releases new population estimates each summer. We plan to refresh the index when both are out.
Cite this data
Family Estate Guide, “The Caregiver Shortage Index: Seniors per Home Health Aide by State,” October 2026. Analysis of U.S. Census Bureau Vintage 2025 population estimates and BLS Occupational Employment and Wage Statistics (May 2025, SOC 31-1120). https://familyestateguide.com/estate-planning-data/caregiver-shortage-index/
You’re welcome to use these figures with a link back to this page. The full CSV is free to download.
Published October 1, 2026. Data vintage: Census Population Estimates Vintage 2025 (July 1, 2025; released June 2026); BLS OEWS May 2025 (released May 2026). Editorial standards.