States Most and Least Prepared for the Silver Tsunami

The United States faces a seismic demographic shift—the "Silver Tsunami"—raising urgent questions about whether its current systems can support an aging population that is growing faster than the infrastructure designed to serve it.

This year, a record 4.2 million Americans will celebrate their 65th birthday, marking a major milestone for the nation’s aging population. By 2050, more than one in five Americans will be at retirement age — a powerful shift that’s already reshaping communities across the country. And as the population grows older, the number of adults 85 and up — those who often need the most care — is expected to more than double, reaching 17.4 million, according to federal data.

The graying of America is more than a demographic shift — it’s a growing challenge that could ripple across housing, healthcare, and even the nation’s social safety nets, like social security.

The warning signs are already here. By 2030, the U.S. is expected to face a shortfall of more than 63,000 registered nurses, putting even greater pressure on already overburdened family caregivers. At the same time, Social Security and Medicare are projected to face funding gaps within the next decade. Without policy reform, Social Security benefits could be cut by 24% as soon as 2032.

Financial strain is also mounting for older adults. Seniors in 41 states and D.C. are projected to outlive their savings, while long-term care costs continue to soar. According to a Harvard University report, nearly 11.2 million older Americans now spend more than 30% of their income on housing — a level that puts them at risk of housing insecurity in retirement.

If these trends go unaddressed, the U.S. could find itself on a trajectory similar to Japan — a nation struggling with long-term economic stagnation fueled by an aging population and low birth rates.

Importantly, these demographic shifts aren’t unfolding evenly across the nation. In Alaska, Idaho, and Delaware, for example, the population of adults 65 and older has surged by roughly 50% between 2014 and 2024, according to Census data — placing enormous strain on local infrastructure, healthcare, and social services.

On the other hand, states experiencing out-migration of older adults may face less pressure on local systems, but that trend comes with its own warning: it suggests those states may be less attractive or supportive environments for seniors.

As Americans consider where to spend their retirement years, understanding these regional dynamics is essential.

Seniorly, a CareScout company conducted a nationwide analysis examining three critical dimensions—population trends, financial readiness, and healthcare capacity—to uncover where communities are most prepared to support older adults.

This work builds on the foundation of CareScout’s annual Cost of Care Study, the industry’s benchmark study relied upon by policymakers, insurers, and financial professionals to forecast changes in the cost of long-term care nationwide. 

“The silver tsunami represents one of the most profound demographic shifts in modern history,” said Samir Shah, CEO of CareScout Services. “States that prepare now — investing in healthcare, housing, and workforce development — will not only mitigate crisis, but set the standard for how we support aging with dignity, security, and purpose"

Ultimately, these insights empower families to plan for the future with greater confidence. With foresight and strategic investment, the coming silver tsunami can serve as an opportunity to strengthen systems of care, deepen community ties, and foster meaningful connection — rather than a crisis waiting to unfold.

Key Findings

• Hawaii Is the Most Prepared State: Driven by a low rate of seniors living alone (34.3%) and strong nursing home quality (3.4 stars on average). Fellow sunny state Florida came in second, attracting many more seniors than leaving the state and expecting to have enough nurses in 2035.
• Oregon Is the Worst Prepared State: Due to low labor force participation among seniors (16.2%) and skyrocketing costs for home health aides over the past decade (83.9%). On the other side of the country, Missouri came in second-to-last with poor nursing home quality (2.5 stars on average).
• Few Regional Trends in Top and Bottom States: The coasts often fare well on measures of senior wellbeing, while the Southeast tends to score poorly. But when it comes to preparing for the silver tsunami, there’s no clear regional winner. The top 10 span New England (Massachusetts and New Hampshire), the Mid-Atlantic (New Jersey, Delaware and the District of Columbia), the West (Utah), the Southeast (Florida and Alabama) and even go beyond the continental U.S. (Hawaii and Alaska). Similarly, the bottom 10 include states in the West (Oregon, Washington, Colorado and New Mexico), New England (Rhode Island and Maine), the Midwest (Illinois and Missouri), the North Central region (South Dakota) and the Southeast (Kentucky).
  

Best States

• No. 1 Hawaii has the lowest rate in the country for seniors living alone, at 34.3%, as well as the third-highest average nursing home star rating (3.4) and a sufficient nursing workforce, with 131% adequacy expected in 2035.
• Meanwhile No. 2 Florida is best in the U.S. for nursing adequacy (197% in 2035), it has strong net migration (29,175 more seniors moved in than out last year, representing 0.57% of the senior population).
• Utah, Washington, D.C., and Delaware rounded out the top five. They tended to score well on nursing home star ratings, access to doctors and the adequacy of their nursing workforces.

Worst States

• No. 51 Oregon is the worst prepared state, driven by its low labor force participation among seniors (16.2%), low home ownership rate (77.7%) and the 83.9% growth of its home health aide costs over the past decade.
• Missouri ranked second-to-last, with one of the lowest average nursing home star ratings (2.5) and a high share of seniors living alone (44.9%).
• South Dakota, Rhode Island and Colorado also landed among the bottom five. They scored poorly on net migration, with more seniors moving out than in relative to their overall 65+ populations. Costs for home health aides also grew faster than in most other states over the past decade.

Best and Worst States by Metric

Growth of 65+ population: Measures how quickly the older adult population is expanding, with faster growth signaling greater demand on housing, health care, and support services.
Net migration among seniors: Measures whether older adults are moving into or out of a state. While greater in-migration suggests more demands on housing, health care and social services, it also shows that a state is attractive for seniors.
Seniors living alone: Indicates the share of households where older adults live with family, with higher rates suggesting more built-in caregiving support.
Labor force participation among seniors: Captures economic engagement of older adults, with higher participation reflecting greater financial security and resilience.
Home ownership among seniors: Shows housing stability among older adults, where higher rates indicate potential for secure, aging-in-place options.
Home health aide cost growth: Tracks how quickly long-term care costs are rising, with faster growth posing affordability challenges for families and states.
Average star rating for nursing homes: Measures quality of institutional care, where higher ratings suggest better preparedness to meet older adults’ health needs.
Doctors per 1,000 seniors: Captures availability of medical care for seniors, with higher numbers indicating stronger capacity to manage aging-related health needs.
Expected nursing adequacy: Estimates future workforce gaps, where a larger projected shortage signals potential difficulty providing adequate elder care.

Proactive Planning: 5 Essential Steps for Family Security

To meet the challenges of the "Silver Tsunami," American families must shift from hoping for the best to actively preparing for the future.

Secure the Blueprint for Care: Define aging wishes before a crisis. A frank family discussion on aging in place vs. residential care prevents forced, rushed decisions later on. Work with a Geriatric Care Manager, or a company like CareScout, which offers flat pricing for personalized Care Plans.

Create a Safe Home Base: Assess your living situation immediately. Is adaptation possible (e.g., bathroom updates, stairlifts), or is downsizing a better, safer, and more financially sound move?

Finance the Future: Don't underestimate the expense of longevity. Get clear on long-term care costs locally and establish a funding strategy, utilizing savings, insurance, and available benefit programs. CareScout, the parent company of Seniorly, offers long-term care insurance plans.

Confirm Healthcare Readiness: Proximity matters. Know your local medical landscape—including hospitals and specialized geriatric care—to ensure seamless and timely treatment.

Establish a Shared Load: End the myth of the solo caregiver. Building a robust support network of family, friends, and community resources is the single best way to share responsibilities and prevent the emotional toll of isolation.

Conclusion

The population boom of older adults isn't a distant forecast—it's already here, demanding immediate attention. This demographic shift is placing immense and uneven strain on state resources, particularly in healthcare capacity, affordable housing, and professional caregiving systems. Proactive planning isn't just a suggestion; it is the essential blueprint for stability. By collaborating and leveraging these key demographic, economic, and health indicators, both families and policymakers can move past crisis management and begin building truly sustainable, secure, and dignified support structures for our aging communities.

Methodology

We used the most recent data for nine metrics across three categories to determine the states most and least prepared for the silver tsunami. We used a Z-score distribution to scale each metric relative to the mean across all 50 states and Washington, D.C., and capped outliers at +/-3. We multiplied some scores by -1 because it was better to have a lower rate, including home health aide cost growth, seniors living alone and growth of the 65+ population. A state’s overall ranking was calculated using its average Z-score across the nine metrics. If states were missing metrics, their overall score was determined using the remaining data points.

Here’s a closer look at the metrics we used:

• Population Shifts
  • Growth rate of 65+ population (Census Bureau, 2014-2024)
  • Net migration among 65+ population, measured as a percentage of the total senior population to account for differences in state sizes (Census Bureau, 2024)
  • Share of householders 65+ living alone (Census Bureau, 2024)
• Financials
  • Labor force participation among 65+ population (Census Bureau, 2024)
  • Home ownership among 65+ population (Census Bureau, 2024)
  • Median home health aide cost growth rate (Genworth Cost of Care survey, 2014-2024)
• Health Care
  • Average star rating for nursing homes (Centers for Medicare & Medicaid Services, 2025)
  • Doctors per 1,000 people ages 65+ (Health Resources and Services Administration, 2023 and Census Bureau, 2024)
  • Adequacy of the registered nurse workforce expected in 2035 (Health Resources and Services Administration)