Top 10 States With the Worst Nursing Home Conditions and How to Choose the Right Facility

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Numerous factors influence nursing home ratings, making ranking quite challenging. Due to the increase in demand, staff shortage, and reports of elderly abuse, it is good to keep in mind which states are not recommended and focus your attention and finances elsewhere. Here are the states with the worst average nursing home conditions, based on several recent reports from the Nursing Home Compare site,, Seniorly, and more. 


The Centers for Medicare & Medicaid Services has a five-star rating quality system based on health inspections, staffing, and quality measures. Louisiana scored the lowest, with 2.34 among 264 facilities. WalletHub also noted that Louisiana has the worst conditions, though it did not make it into the top ten worst states for elderly abuse or gross neglect. 

West Virginia

West Virginia’s average score is 2.56, based on reports from 121 facilities. AARP ranking also found that this state tops the list of worst nursing homes, and WalletHub reported it has the fourth lowest overall nursing home quality.  


Forbes ranked Georgia the lowest for overall healthcare. In the five-star rating system, Peach State scored 2.53 out of 355 facilities, and WalletHub reported that the state is among the worst for programs focused on total elder abuse prevention. 


Texas’ 1,189 facilities had an average score of 2.55, making it the fourth worst state for nursing homes according to the federal government’s 5-star rating system. WalletHub placed Texas fifth in overall nursing home quality and among the top three in eldercare organizations and services.  


The Centers for Medicare & Medicaid Services ranked Mississippi third and second worst for nursing home quality conditions by WalletHub. The overall score for this state is 2.48. Long-Term Services & Supports State Scorecard found that Mississippi was the best out of the top 10 worst states with nursing homes in 2020, so it appears that the facilities have been downgraded since then. 


The American Association of Retired Persons (AARP) placed Alabama second to last. The state has 225 nursing homes, and at least 39 have serious deficiencies, while 177 struggled with Infection-related issues. Deaths caused by nursing home neglect have increased in the last couple of years, and many reports claim that the main problem is staff shortage and hygiene.

South Carolina

ProPublica reported that South Carolina’s 189 nursing homes had 67 with severe deficiencies and 125 infection-related deficiencies. LTSS State Scorecard also found the state to be among the top ten worst for elderly care, and reports from one facility in 2022 found a dementia patient wandering the parking lot while another needed five staples in his head after falling in the dining room. There were also reports of alcohol on the premises despite the facilities ban. 


Tennessee was ranked among the worst states when it comes to abuse, gross neglect, and exploitation complaints, according to WalletHub. The Tennessean also reported severe deficiencies in nursing homes, from a lack of staffers to hygiene and failing the staffing measures that are supposed to be present. 


Oklahoma nursing homes have been among the worst in the US for years. ProPublica reported that 237 of its 288 facilities had infection-related deficiencies. The lack of funding could become a “full-blown crisis,” The Oklahoman wrote in the summer of 2023, warning that closing down facilities could be a significant tragedy for numerous families. 


Despite the small number of only 67 nursing homes, almost all were found faulty. The reports by Families for Better Care found the abuse, neglect, and mistreatment of nursing home residents were widespread, and despite appeals, this issue continues to persist. WalletHub also found that Nevada is among the states with the highest numbers of elder abuse, gross neglect, and exploitation complaints. 

Choosing the right home 

Since these are state-based reports, it does not mean that every facility is faulty, and that is why you need to read real reviews and check out conditions for yourself before committing to a place. While visiting, pay attention to hygiene, other residents, and staff’s efficiency. 

Florida and California are not what they used to be 

A state-by-state guide is helpful if you or your loved ones are open to moving. But even when that’s the case, ask around. You will be surprised to learn that some of the most popular destinations are less glamorous than they used to be. For example, Florida nursing homes see a spike in serious violations, while California nursing home complaints reach a new high. 

States with the highest scores 

Hawaii, Idaho, the District of Columbia, Delaware, Alaska, Utah, and Minnesota placed highest in overall scores across various databases. The need for staff is reaching new heights, especially since over 53 percent of new employees leave after a year. What is noticed among the top-rated nursing homes is that states have strong leadership inside government and in the private sector. For further information, check out WalletHub and AARP.

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