What a year of care costs against what families actually earn
Published cost tables tell you what a nursing home charges. They do not tell you what that number means to the household paying it. This page divides one by the other: the annual median cost of each care setting, over the median household income of the same state. Both inputs are published figures with a link; the division is ours, and the formula is printed below so you can repeat it.
Last updated: October 17, 2026
Data: CareScout Cost of Care Survey — 2025 national medians
Costs: CareScout Cost of Care Survey 2025 — ranked median costs by state (fieldwork July through November 2025). Income: U.S. Census Bureau, American Community Survey 1-year estimates, 2025, via Federal Reserve Bank of St. Louis (FRED). Shares are our calculation.
Key figures
One line each, safe to lift straight into an article.
- A year in a private nursing home room costs more than the state's median household income in every one of the 49 states where the survey publishes a private-room median.
- Across those states the median private-room bill equals 161.5% of the median household income.
- For a semi-private nursing home room the median is 145.1% of household income, and it passes 100% in 47 of 50 states.
- Assisted living takes 86.4% of the median household income — above 100% in 8 of 50 states.
- Homemaker-style in-home care takes 92.2% of median household income, and exceeds it in 15 of 50 states.
- Adult day health care is the cheapest setting at 28.5% of median household income; no state where the survey publishes a figure puts it above 100%.
- The highest private-room burden is West Virginia: $159,140 a year against a median household income of $61,770, or 257.6%.
- The lowest is Texas at 107.3% — still $91,250 a year.
- Median household income is the Census Bureau's own state figure, not an average of care applicants; a family paying for care usually has less income than the state median, so these shares are a floor rather than a worst case.
How much of a household’s income does a year of care take?
Median across the states where the survey publishes a figure for that setting. The last two columns name the extremes and the count of states where a year of care costs more than the household earns in a year.
| Care setting | Median share of income | Highest state | States above 100% |
|---|---|---|---|
| Private room, nursing home | 161.5% | West Virginia (257.6%) | 49 of 49 |
| Semi-private room, nursing home | 145.1% | Alaska (325.8%) | 47 of 50 |
| Assisted living | 86.4% | Hawaii (138.1%) | 8 of 50 |
| In-home care (homemaker services) | 92.2% | Wyoming (129.9%) | 15 of 50 |
| Adult day health care | 28.5% | Montana (80.0%) | 0 of 45 |
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Which states are least affordable for nursing home care?
Ranked by a year in a private room as a share of the state’s median household income. The dollar figures are the survey’s state medians; the percentage is ours.
| State | Annual cost, private room | Median household income | Share of income |
|---|---|---|---|
| West Virginia | $159,140 | $61,770 | 257.6% |
| Oregon | $221,372 | $92,740 | 238.7% |
| New York | $200,750 | $86,900 | 231.0% |
| Mississippi | $118,625 | $57,840 | 205.1% |
| Connecticut | $200,750 | $101,400 | 198.0% |
| Vermont | $186,332 | $95,290 | 195.5% |
| Nevada | $173,558 | $88,880 | 195.3% |
| Pennsylvania | $164,250 | $85,880 | 191.3% |
| New Mexico | $127,597 | $67,620 | 188.7% |
| Maine | $178,850 | $95,150 | 188.0% |
Where is it least out of reach?
The ten states with the lowest share. Note what the numbers say: even the cheapest state on this measure is close to a full year of household income.
| State | Annual cost, private room | Median household income | Share of income |
|---|---|---|---|
| Texas | $91,250 | $85,060 | 107.3% |
| Missouri | $91,250 | $84,700 | 107.7% |
| Nebraska | $110,595 | $100,600 | 109.9% |
| Illinois | $110,595 | $93,270 | 118.6% |
| Oklahoma | $93,075 | $75,390 | 123.5% |
| Utah | $127,750 | $102,900 | 124.1% |
| Kansas | $108,770 | $85,540 | 127.2% |
| Montana | $114,975 | $86,770 | 132.5% |
| Georgia | $113,150 | $82,100 | 137.8% |
| South Carolina | $115,340 | $82,320 | 140.1% |
Every state, every care setting
Each column is a separate calculation: that setting’s annual median cost in the state, divided by the state’s median household income. A dash means the survey does not publish a state median for that setting — it is left empty rather than estimated.
| State | Median income | Private room | Semi-private | Assisted living | In-home care | Adult day |
|---|---|---|---|---|---|---|
| West Virginia | $61,770 | 257.6% | 249.4% | 123.2% | 111.1% | — |
| Oregon | $92,740 | 238.7% | 216.9% | 89.0% | 98.7% | 56.1% |
| New York | $86,900 | 231.0% | 214.4% | 98.2% | 92.2% | 43.1% |
| Mississippi | $57,840 | 205.1% | 198.8% | 90.6% | 94.9% | 28.3% |
| Connecticut | $101,400 | 198.0% | 180.0% | 107.9% | 81.2% | 27.9% |
| Vermont | $95,290 | 195.5% | 177.7% | 108.3% | 108.0% | — |
| Nevada | $88,880 | 195.3% | 159.1% | 84.3% | 95.2% | 23.4% |
| Pennsylvania | $85,880 | 191.3% | 167.0% | 90.5% | 90.6% | 35.4% |
| New Mexico | $67,620 | 188.7% | 161.9% | 105.6% | 101.5% | 76.9% |
| Maine | $95,150 | 188.0% | 176.3% | 103.5% | 107.0% | 31.4% |
| Florida | $77,920 | 187.4% | 159.3% | 86.4% | 94.0% | 25.0% |
| Hawaii | $105,100 | 187.2% | 176.7% | 138.1% | 89.3% | 29.1% |
| Michigan | $76,800 | 187.0% | 175.8% | 90.9% | 103.5% | 50.8% |
| Kentucky | $73,750 | 183.1% | 158.1% | 89.9% | 100.8% | 31.0% |
| Delaware | $99,800 | 182.0% | 174.3% | 91.4% | 80.2% | — |
| California | $100,800 | 180.7% | 144.8% | 83.3% | 90.8% | 24.2% |
| Minnesota | $95,160 | 174.9% | 134.2% | 82.9% | 105.8% | 32.8% |
| North Dakota | $85,060 | 173.6% | 162.6% | 66.7% | 91.5% | 77.9% |
| Washington | $112,600 | 170.2% | 140.2% | 81.0% | 91.4% | 57.5% |
| Wisconsin | $88,020 | 167.9% | 145.1% | 89.2% | 94.2% | 20.7% |
| Idaho | $87,840 | 166.2% | 143.4% | 70.7% | 100.3% | — |
| Rhode Island | $96,880 | 165.8% | 149.9% | 96.4% | 94.5% | 17.4% |
| Indiana | $76,180 | 162.7% | 140.9% | 88.8% | 105.1% | 43.3% |
| Wyoming | $81,030 | 161.8% | 146.8% | 78.9% | 129.9% | 48.7% |
| North Carolina | $80,250 | 161.5% | 145.5% | 97.1% | 85.5% | 27.4% |
| Massachusetts | $118,500 | 160.2% | 146.3% | 97.2% | 77.2% | 24.6% |
| Tennessee | $75,250 | 160.1% | 150.4% | 93.2% | 94.3% | 27.6% |
| Louisiana | $60,670 | 159.7% | 150.4% | 102.1% | 98.1% | 37.8% |
| Arizona | $86,570 | 158.5% | 115.9% | 86.6% | 100.4% | 28.5% |
| New Jersey | $111,400 | 155.6% | 137.6% | 93.8% | 78.0% | 23.3% |
| Alabama | $68,410 | 154.1% | 146.2% | 77.6% | 90.3% | 21.9% |
| Maryland | $116,300 | 149.1% | 133.4% | 74.0% | 68.9% | 26.1% |
| South Dakota | $82,460 | 148.3% | 137.4% | 71.3% | 122.8% | — |
| Iowa | $81,890 | 147.1% | 135.9% | 78.8% | 114.8% | 23.7% |
| Ohio | $85,150 | 146.4% | 129.5% | 86.0% | 91.4% | 25.3% |
| New Hampshire | $112,100 | 143.9% | 131.1% | 85.9% | 81.6% | 21.6% |
| Colorado | $102,500 | 142.6% | 118.9% | 77.1% | 92.6% | 26.6% |
| Arkansas | $68,060 | 142.1% | 131.4% | 81.8% | 84.0% | 29.0% |
| Virginia | $100,000 | 140.2% | 123.0% | 83.3% | 80.1% | 21.0% |
| South Carolina | $82,320 | 140.1% | 131.7% | 78.0% | 87.2% | 22.7% |
| Georgia | $82,100 | 137.8% | 128.9% | 77.5% | 89.2% | 28.5% |
| Montana | $86,770 | 132.5% | 124.1% | 84.0% | 100.2% | 80.0% |
| Kansas | $85,540 | 127.2% | 121.6% | 83.8% | 90.3% | 60.8% |
| Utah | $102,900 | 124.1% | 101.1% | 63.8% | 87.3% | 35.4% |
| Oklahoma | $75,390 | 123.5% | 111.8% | 97.9% | 100.2% | 31.7% |
| Illinois | $93,270 | 118.6% | 106.8% | 80.0% | 88.3% | 25.4% |
| Nebraska | $100,600 | 109.9% | 99.9% | 75.7% | 81.9% | 42.0% |
| Missouri | $84,700 | 107.7% | 95.5% | 76.5% | 89.1% | 29.2% |
| Texas | $85,060 | 107.3% | 79.4% | 79.9% | 80.7% | 27.5% |
| Alaska | $102,500 | — | 325.8% | 115.7% | 84.8% | 44.4% |
| District of Columbia | $107,600 | — | — | — | — | — |
Cost figures for the dollar amounts behind each column are on the state cost tables page.
How the share is calculated
One formula, applied identically to every state and every care setting:
share of income = (annual median cost of care ÷ median household income) × 100
Worked example — West Virginia: $159,140 a year for a private room ÷ $61,770 median household income = 257.6%.
The numerator is the annual median cost as the survey publishes it, for the same 365-day year the survey uses. The denominator is the Census Bureau’s median household income for the state, 2025 (series MEHOINUSWVA646N, retrieved from Federal Reserve Bank of St. Louis (FRED)). Neither figure has been adjusted, annualised, smoothed or rounded before dividing.
What this does and does not tell you
- It compares two medians: the median cost of care in a state against the median household income in that state. It is not a statement about any individual family, and it is not the amount a particular family ends up paying.
- A household paying for care often has less income than the state median, because retirement, illness or a spouse stopping work frequently precede the bill. On that reading these shares are a floor, not a worst case.
- These are private-pay rates. Medicaid, long-term care insurance and veterans’ benefits can cover part of the cost for people who qualify, and home equity and savings are commonly used — none of which changes the sticker price this page measures.
- A state median income hides a wide spread within the state. A figure for the whole of California says nothing reliable about a household in Fresno or in San Francisco.
- Settings are not interchangeable. Adult day health care is a few days a week by design; a nursing home is full-time residential care. The cheap row is not the same service as the expensive one.
How to cite this page
Copy either line. They are written so a reader can find the page and both original sources from the citation alone.
Plain text
Elder Care Cost Guide. (2026). Care costs as a share of household income, by state. Retrieved from https://nursingcost.com/data/care-cost-affordability/ — cost figures from CareScout’s Cost of Care Survey (fieldwork July through November 2025); income figures from the U.S. Census Bureau, American Community Survey 1-year estimates via Federal Reserve Bank of St. Louis (FRED). Last updated October 17, 2026.
In-text, for one figure
“…in West Virginia, a year in a private nursing home room at the median rate came to 257.6% of the state’s median household income (Elder Care Cost Guide, 2026).”
Sources
- CareScout. CareScout Cost of Care Survey 2025 — ranked median costs by state. Fieldwork July through November 2025. View the survey tables (PDF).
- U.S. Census Bureau, American Community Survey 1-year estimates — median household income by state, 2025 1-year estimates, retrieved through Federal Reserve Bank of St. Louis (FRED). Series MEHOINUSWVA646N.
How figures are selected and checked is set out on the methodology page. If a number here disagrees with its source, tell us and it will be corrected.
Put a number to your own situation
A share of a median is a starting point, not a bill. The care cost calculator turns these rates into a monthly figure for the hours or days of care you actually expect, and the cost of care guides explain what each setting includes.
Frequently asked questions
What exactly does “share of income” mean on this page?
It is the annual median cost of that care setting in the state, divided by the state's median household income, multiplied by 100. Both inputs are published figures — costs from CareScout's Cost of Care Survey 2025, income from the Census Bureau's American Community Survey — and the division is this site's own calculation. The formula is printed in full further down the page so anyone can redo it.
Is a nursing home really more expensive than a whole household's income?
In most states, yes. A private room at the median rate runs past the state's median household income in 49 of the 49 states where the survey publishes that median. That is a comparison of two medians, not a claim about any one family: many families paying for care have already lost an income, and some draw on savings, home equity or Medicaid.
Why use household income rather than the income of the person in care?
Because care is normally paid out of a household, not out of one person's pocket — a spouse's income, an adult child's contribution, or both. Household income is also the only income measure the Census Bureau publishes for every state every year, which keeps the comparison consistent across all 50 states and the District of Columbia.
Does the calculation include Medicaid, insurance or home equity?
No. These are private-pay median rates as the survey reports them. Medicaid covers long-term care for people who qualify, and some insurance policies pay part of the bill, but neither changes the sticker price of a year of care — which is what this page measures. Nothing here should be read as what a particular family ends up paying.
Why is the number of states different for different care settings?
The survey publishes a state median only where it has enough responses to support one. Where it reports N/A, that state is left out of that setting's count rather than filled with an estimate. Each figure on this page therefore names its own denominator.
Can I quote these figures?
Yes, free to reuse, including commercially. The cost figures belong to CareScout's survey and the income figures to the Census Bureau; the shares are ours. The citation block below gives a ready-made line, and crediting both publishers is the accurate way to do it.