2021 Report on Best States for Nurses and Personal Care Aides

by Jennifer L. Gaskin and The Senior List Team | Last Updated, February 10, 2021

For many years, the vast majority of Americans have rated nurses as among the most trustworthy professionals, and the ongoing COVID-19 pandemic will surely do little to dampen the trust people tend to place in nursing professionals as vaccine rollout continues through 2021.

Even when there’s no pandemic to worry about, nurses, nursing assistants, and personal care aides are essential for millions of older adults in the U.S. who depend on these professionals to maintain and improve their quality of life. But not every state presents an ideal place for these skilled care workers to ply their trade. 

To understand which states are best for nursing professionals, we compared data like wages, job openings, and cost of living to find out where these workers can expect to have the best shot at a long and happy career. (Want to know what the picture is like for consumers? Check out this companion piece.)

Looking for a state that ranks well for both? Consider Connecticut and Maine, which are in the top 10 for both studies.

Table of Contents

Key Findings

  • Massachusetts is the No. 1 state for workers.
  • There isn’t much overlap among states that ranked well for affordability for consumers and also for workers. However, Connecticut and Maine were among the top 10 in both studies.
  • New Mexico, California and Mississippi have the highest average wages for nurses and home-care aides compared to typical household wages in that state.


As in our report on access and affordability, we’ve analyzed data for three major types of jobs that care for seniors – using the definitions of the Bureau of Labor Statistics. Understanding the distinctions can be helpful in diagnosing how well each state is handling the in-home care crunch:

  • Home health and personal care aides: Generally, home health aides complete tasks like taking a person’s temperature or blood pressure or helping administer medications, while personal care aides’ tasks are more often limited to non-medical services, like cooking, cleaning or providing social interaction. Some professionals will provide both types of service.
  • Nursing assistants: Sometimes referred to as nursing aides, nursing assistants can provide basic care like measuring and recording vital signs as well as helping with day- to-day activities like bathing and dressing.
  • Registered nurses: The most experienced of all three major in-home and nursing care jobs, registered nurses can provide the highest degree of hands-on medical care, assessing an individual’s condition, monitoring medical equipment and performing diagnostic tests.

We’re using those broad but distinct occupations to help paint the picture of which states for nursing and in-home care workers, and we’ve ranked each state from best to worst across these areas:

  • Average annual wage for home health and personal care aides
  • Average annual wage for nursing assistants
  • Average annual wage for registered nurses
  • Average annual nursing and in-home care wage
  • Average annual entry-level nursing and in-home care wage
  • Average annual experienced nursing and in-home care wage
  • Average annual nursing and in-home care wage as percentage of typical household income
  • Nursing and home care job openings per 1,000 residents
  • Annual rent costs as percentage of annual nursing and in-home care wage

Each state was assigned a value equal to its rank in each category, and 51 was the best possible score a state could receive in a category.

Summary Rankings

As we’ve already hinted, there’s not a ton of overlap between the circles of states that are great for families and great for workers. Massachusetts is the best state for nursing and in-home health care workers, followed by Rhode Island, New York and California. In all of the top 10 states in this index, nursing and in-home health care jobs are plentiful and well-paying, while the cost of living compares favorably to what professionals can expect to earn.

No. 1 on this list, Massachusetts is just outside the bottom 10 for families, though two states, Connecticut and Maine, appear in the top 10 for both groups. Six of the 10 best states for these workers are in the Northeast.

Category Rankings

Let’s take a closer look at the best and worst states in each of the nine unique categories (we included the three employment figures from the affordability study) that went into our ranking of which states’ job markets for in-home and nursing care workers are the best, including wages, job openings and cost of living.


Home health and personal care aides have the lowest average wage of the three occupations included in our analysis, but there are wide variations depending on the area of the country in how much these workers can expect to earn, with Alaska’s No. 1 wage almost doubling the lowest wage for this job.

Similarly to home health and personal care aides, nursing assistants can expect to find the highest average wage in Alaska and the lowest in Louisiana.

Registered nurses are among the highest paid of all nursing occupations and represent the pinnacle when it comes to professionals who often provide in-home care. RNs earn an average of $113,240 in California and $59,540 in South Dakota.

California’s average wage for the three in-home care wages we studied was the highest, and Mississippi’s was the lowest.

Expected income levels, of course, vary considerably depending on a person’s experience level. But even entry-level workers can expect to make the most in California — about $40,557.

Veteran or specialize nursing and in-home care workers earn an average of about $45,000 in Alabama, which is the worst high-end estimate for the three roles.

Another way of understanding how well-paid nursing and in-home care workers are is by comparing them to the typical household in each state. For example, in Maryland, these workers make only about 53 percent of the average household income, while they compare most favorably in New Mexico.

Job openings

A look at some real-time job opening data shows that nursing and home care jobs are most highly sought-after in Delaware — by a huge margin., which may be due to the fact that many companies are incorporated in the state for tax purposes. On the other end of the spectrum, hiring is slowest for these jobs in Utah, Nevada and California.

Cost of living

A high annual wage is only one part of the equation when it comes to how attractive a job is. That’s because some areas of the country are much more expensive than others when it comes to housing affordability, so we also compared rent costs to the wages of nursing and in-home care workers.

The typical wage for these workers compares most favorably to the Zillow Rent Index, a proprietary index published by real estate site Zillow that estimates the average rental cost in each state, in North Dakota, where the average annual cost of rent takes up only 28 percent of the average annual wage for nursing and in-home care workers.

Those in the District of Columbia, on the other hand, can expect to see more than half their income eaten up by rent.

State Details


Everybody wants to believe that when they need it, qualified compassionate in-home care will be there, but that depends on states being able to attract experienced, trained individuals who can perform these services. Still, it’s clear some states are ahead of the game in balancing being places where these people want to work with ensuring this important care is affordable for families.

Data Sources

Here’s a look at the data underlying this report:

  • Annual rental cost, Zillow Rent Index, States
  • Job openings, pulled from and in April 2020
  • Employment and wages, Bureau of Labor Statistics, May 2019 publication
  • Household income and population figures, U.S. Census Bureau, most recent publications on all topics