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5 best and worst U.S. states to grow old

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Retirement is often portrayed in advertising as active senior citizens enjoying the beach or a day at the golf course. But how realistic is that?

Perhaps not very, since many Americans may enter retirement relatively active and healthy yet are likely to need long-term care or assistance as they enter their 80s. The average life expectancy of American men and women who are now 65 years old is 83 and 85 years old, respectively. Researchers have found significant health changes take place at age 80, which increases the risk of impairment or disability.

Americans may want to think about retirement in a different way: Where should they live to age in the best way possible, said Tim Sullivan, vice president of Caring.com, which provides information for people who look after aging parents, spouses and other loved ones. Because retirement includes more than leisure activities, Americans should examine issues like the cost of long-term care in their state, how older residents in their areas rate their own well-being and the quality of care, he noted.

"If you don't think about what your needs will be, you may run into some surprises," he said.

"Our goal is to get people thinking about their 70s and 80s, and not just their 60s, and not to take for granted that their needs are going to be met."

Don't despair if you live in one of the worst-ranked states, Sullivan said. There are many options within states, so the research is meant to give consumers a general understanding of what they might pay for long-term care or other assistance as they age, as well as the quality of care.

"Just because you live in a state that's near the bottom, that doesn't mean you should panic, or if you live near the top, don't take it for granted," he said. "Look hard at resources in your area. Are they any good? Then you have to ask the question: Can you afford them?"

Read on to learn about the five best and worst states in the U.S. for growing old.

5. Best: Nebraska

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Nebraska scores well for adult day-health services and nursing homes, Caring.com found.

The Midwestern state might not seem like a top spot for aging Americans given its sometimes brutal winters and humid summers, but older people who live in Nebraska rate themselves fairly highly in Gallup's poll of well-being.

The cost of an assisted living facility is about $42,000 per year, or roughly at the median national cost for such a service.

Lincoln, Nebraska, was named a top retirement location by Kiplinger's, which praised its bustling city life and acres of parks and wilderness. Home prices are fairly reasonable, which makes it a more affordable location than some coastal cities.

4. Best: Washington

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Washington state has more expensive services than some of the other top states to grow old in, but its quality of care and support for family caregivers get high marks, Caring.com said.

The median cost of an assisted living facility is $54,000, the study found.

One appeal for retirees: The state is one of a handful in the U.S. without an income tax, which can ease the cost of living for retirees on a fixed income.

3. Best: South Carolina

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South Carolina has warmer weather than the other states in the top five places for growing old, but it has a few other things going for it as well.

The state is the sixth-most affordable state for elder care, with assisted living typically requiring $36,000 per year, or $8,000 below the national median cost, according to Caring.com.

Coastal communities such as Hilton Head and Myrtle Beach are among the state's most popular locations for retirees.

2. Best: Iowa

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The Midwestern state of Iowa was runner-up in Caring.com's survey, thanks to its quality of care and lower costs.

The median price for an assisted living community in the state is about $42,000 annually, or slightly lower than national median price.

1. Best: Utah

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The beehive state ranked first in the country for growing old, thanks to strong ratings for quality of life and health care, as well as reasonable costs.

That means older Utahans can find high-quality care at lower prices than the national median. For instance, an assisted living facility costs about $35,400 annually, well below the national median price.

5: Worst: Wyoming

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Wyoming features natural beauty and resort locations like Jackson Hole, but the state doesn't fare well on Caring.com's rankings because of its relatively high costs.

The median annual price for an assisted living facility in the state is almost $49,000, well above the national median cost, the study found. It also ranked in the bottom half for reported well-being of seniors, Caring.com found.

4. Worst: North Dakota

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Like Wyoming, North Dakota ranked low on the list because of the cost of senior care services like nursing homes.

Private rooms in a nursing home will set families back by about $129,276 annually. Home health aides were the most expensive in the U.S., at a median cost of $63,972 a year.

3. Worst: New York

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Costs are also high in New York, which is why the state comes up toward the bottom in Caring.com's rankings.

Despite the higher costs, the quality of care isn't rated highly, which is another reason the state is low on the list. A private room in a nursing home costs about $136,000 per year, making it one of the more expensive states in that category.

2. Worst: Indiana

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The runner-up as the worst state for growing old, Indiana gets poor marks in categories of well-being, although its costs are more reasonable than New York or North Dakota.

The typical cost of a private room in a nursing home is about $92,000, well below New York's $136,000, for example. But in terms of reported well-being, the state ranks 46th out of the 50 states in the survey.

1. Worst: West Virginia

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West Virginia offers some relatively affordable costs for elderly residents, such as lower-than-typical expenses for adult day health care services, but the state ranks near the bottom when it comes to quality of life for seniors.

Reviews of senior services on Caring.com also ranks near the bottom, placing the state in 49th place.