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The 5 best and worst states in which to grow old

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Everyone ages, but how a person copes with the health challenges that come with old age can depend on many factors, including where they live.

It turns out that some states offer better options for elder care than others, after calculating the costs of in-home care, assisted living centers or nursing homes, as well as quality of care, according to a new study from Caring.com. While warm states such as Florida and Arizona exert strong pulls on retirees, the best states to grow old in tend to be colder ones, the research found.

While the study provides insights into the cost and quality of elder care across the U.S., it's meant to spark a discussion among families rather than suggest that retirees head for the top-ranked states or move out of the lowest-ranked ones, said Dayna Steele, Caring.com's Chief Caring Expert and the author of "Surviving Alzheimer's with Friends, Facebook and a Really Big Glass of Wine." Many Americans are under the misapprehension that assisted living costs are covered by health insurance or Medicare, and aren't adequately planning for elder-care expenses that can be startlingly large, she noted.

"So many people think that if you need to go into assisted living that it will be covered, but unless you have long-term care insurance, it's not covered," Steele said. "This will be the next financial disaster in the country as the Baby Boomers age into elder care. We're going to see families just devastated by this. You have to take care of them, you have to work, so what will you do with mom and dad if you don't have long-term care insurance or $5,000 to $6,000 a month to spend."

Steele recommends that family members make a point of discussing health issues, end-of-life care and finances, even though they can be a difficult or touchy subjects. (Her list of questions can be found here.)

"It's as important as having a will. Look at Prince dying without a will," she said. "This is going to be a source of pain and frustration and hassle for his family for years to come. Having a talk and having answered questions like these for your family is just as important as having a will."

Read on to learn about the 5 best and worst states to grow old in.

5th best: Oregon

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Oregon scores well on the quality of care available in the state, although its assisted living and nursing home costs tend to be in the middle of the pack. The state's population is rapidly aging, with its over-65 age group growing by 18 percent from 2010 to 2014, as the Baby Boomers hit retirement age.

The average cost of a year in an assisted living facility in Oregon is almost $47,000, according to Caring.com, while a nursing home will require almost $96,000 in annual costs.

4th best: Alaska

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Alaska tends to be an expensive place to live, and that holds true for the cost of assisted living or a nursing home. But the state rates high when it comes to the quality of care provided by elder services, Steele said. One reason for Alaska's high costs is its small pool of workers, which in turn pushes up labor costs.

The typical cost of a year in an assisted living facility is about $68,000, while a nursing home will cost more than $281,000, the study found.

3rd best: Minnesota

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Another snowy state that made the top of the list, Minnesota also scores high when it comes to the quality of care. Costs are in the mid-range for assisted living and nursing homes, which cost an annual average of $41,613 and $84,406, respectively.

2nd best: Iowa

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Iowa tends to be one of the more affordable states among the top five, with annual nursing home costs coming in at just under $64,000. A year at an assisted living center will cost about $42,000.

The state's ranks fairly high on quality of care and among the reviews of caregivers on Caring.com, the study found.

Best overall: South Dakota

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Balancing costs and quality of care, South Dakota ranked as the top choice for places to grow old. Assisted living costs were the lowest among the top five states, with annual expenses amounting to less than $37,000 annually. A year at a nursing home will cost families about $73,000.

Still, South Dakota's nursing homes are now the target of the Justice Department, which found that thousands of patients with health or mental issues are unnecessarily restricted to such facilities. Not all of those patients are seniors, but instead suffer from disabilities or ailments such as diabetes.

Nevertheless, the state fared well on factors such as quality of care and support for caregivers, Caring.com found. For instance, South Dakota ranked fifth out of the 50 states for quality of life and care.

5th worst: Indiana

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Indiana may not rank as the most expensive state, but the combination of costs with below-average marks for support for caregivers and quality of care pushed it near the bottom of the list.

A year at an assisted living facility in the state will cost $44,310, while a nursing home runs $78,475 in annual expenses.

4th worst: Kentucky

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Kentucky's assisted living and nursing home facilities have similar costs to Indiana's, but the state scored slightly lower in quality, ranking 49th out of the 50 states for both choice of setting and provider and quality of care.

Assisted living facilities cost an average of $40,200 a year, while nursing homes in the state will set families back by about $76,000.

3rd worst: New York

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New York state ranks among the worst for aging Americans because it's expensive, yet the quality of care isn't high, according to the study. The average assisted living facility costs about $49,200 a year, while a nursing home will require almost $132,000 annually.

But when it comes to quality of care, the state ranks 33rd out of 50, while the reviews of caregivers on Caring.com put it near the bottom.

2nd worst: New Jersey

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Like neighboring New York, New Jersey is both expensive and ranks low on issues such as quality of care.

A year in an assisted living facility costs an average of $68,700, while nursing homes cost about $117,000 a year. When it comes to setting and choice of provider, New Jersey ranks 36th out of 50 states.

Worst: West Virginia

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This Appalachian state is relatively expensive for nursing home care, requiring almost $103,000 annually for an elderly person to secure a spot. It also ranks at the bottom of all the states when it comes to reviews of caregivers on Caring.com, and 47th out of 50 states for quality of life and care, the study found.

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