The Best States for Seniors During COVID-19

Published: July 14, 2020
Written By: Daniel Cobb, Managing Editor

In May of 2020, Caring.com released a study that ranked all 50 states on how safe they were for seniors during COVID-19. While much has changed since May, the risk to seniors has not – the CDC still maintains that 8 out of 10 deaths in the United States are seniors over the age of 65. 

For those reasons, Caring.com has updated its rankings with the latest data to take a fresh look at which states are most effective at both preventing the spread of COVID-19 and treating those with the virus for seniors during COVID-19. 

The metrics for this study haven’t changed – all 50 states are ranked based on 11 metrics organized into two main categories: Social Distancing Aggressiveness and Preparedness & Prevention. However, the way that these metrics were weighted has changed. 

A higher priority was placed on the actual results of the efforts that the states were making to slow the spread of the coronavirus, meaning that we placed a higher priority on the metrics that measured the relative number of deaths and cases in each state. For more on our metrics and what changed, read the methodology section below.

Based on the updated data and the tweaks made in the ranking process, many states have moved up and down in the ranking, but Hawaii and Vermont are still in the top 3. Montana, which was formally #2, is now replaced by Maine to round out the top three best states for seniors during COVID-19.

Overall, Caring.com’s latest analysis revealed that Vermont, Maine and Hawaii are the three best states for seniors during COVID-19. Each of these states ranked in the top 10 for Preparedness and Prevention.

Some of the most notable changes from the May rankings are: 

• Montana, formally in the top three,  dropped 12 places to move to number 14 overall 
• California was in the top 5, but has now dropped 8 places to number 13 overall
• Oregon moved up 10 places from the top 15 into the top 5 
• West Virginia, Utah and Kansas were all ranked in the bottom half of the states, but have since moved into the top 10
• Nevada and New Mexico were both in the top 10, but have since fallen into the bottom half of the rankings

Formally ranked #3, Vermont surpassed both Hawaii and Montana to become the highest-ranked state in the nation according to the latest data. One of the main reasons for this change is the fact that it received the second-highest score for Treatment and Prevention. Key to this high score is the fact that it is 10th-best when it comes to deaths from COVID-19 per capita, 5th best for the number of cases per capita, and has the 10th lowest effective reproduction score at just over 1.0 as of July 8th. 

While Vermont has a relatively dense population comparatively (30th most in the nation), the state has managed to take effective measures at reducing the spread and severity of the outbreak. This is evidenced by the fact that the state was formerly ranked 5th for effective social distancing policies. However, the state is now only ranked 22nd for Social Distancing – possibly due to the fact that the state loosened guidelines after doing so well in containing the outbreak. 

In the first iteration of this study, Maine was ranked #4, but suffered due to less-strict adherence to social distancing policies. Since the ranking process for this study has shifted slightly to focus more on the actual results of the policies (cases, deaths, etc.), Maine has now jumped into the #2 spot, even though the state places near the bottom (44th) for Social Distancing. 

As was intended in this scoring shift, Maine is penalized much less for that fact and is #2 overall because it is also first in the Preparedness and Prevention category. The state has the second-lowest effective reproduction score, the seventh-lowest number of infections per capita, and the ninth-lowest number of deaths per capita. 

Hawaii maintained its spot in the top three in the latest rankings, but fell from #1 to #3. The main reason for that is because the state went from 5th in Preparedness and Prevention to 7th. Not a huge step back, but the recent spike in cases has caused the effective reproduction rate to rise, which is the main reason that its score in this category was slightly lower. 

Overall, Hawaiians still have been doing a great job in maintaining social distancing – the state still ranks #1 in that category, and the number of deaths is still very low. In fact, the state received the highest score for the fewest deaths per capita with an impressively low total of 19 as of July 8th.

The July version of this study uses the same 11 metrics across 2 main categories, grading all 50 states on how effective they’ve been at slowing and treating COVID-19. Caring.com’s team of researchers spent numerous hours gathering these data points, developing a system of grading and ranking each metric, and then weighting each based on overall importance. 

What’s Changed

Since the May iteration of this study, much of the data has changed – so the first and most obvious change to the rankings is a result of the change in data, such as the number of cases and deaths. 

There was also a distinct change in our approach this time around. While we still graded states on how effective they were at implementing social distancing (according to Google’s mobility data – more on that below), we put much less of a priority on that category – giving Preparedness and Prevention 4x the weight of Social Distancing. Additionally, within the Preparedness and Prevention Category, we put a higher priority (the highest weight overall) on the number of deaths each state has seen per capita. 

The reason for this shift in our methodology is because enough time has passed to see the results of the efforts each state has been making to slow the spread and limit the severity of the coronavirus in its state. Obviously, the key result there is the number of deaths per capita as well as the number of cases and infection rates.

Additionally, we did not want to penalize states that were safely opening up and relaxing social distancing measures. The timing is important again, because enough time has passed to see the results in infection rates and even deaths for those states that opened up more aggressively and earlier than the other states. 

Overall, this model of scoring has shifted from slightly more predictive to what we believed would be the outcome based on current infection rates, medical infrastructure, and adherence to social distancing policies, to a more descriptive model that places a higher priority on the results of those factors.

Note: The data used in this study is from February – July of 2020.

While almost every state has put stay-at-home orders into place, how aggressive they are and how thoroughly they are followed varies from state to state. One way to measure this is Google’s mobility data which it has made available to the public in a report that measures activity from February 29th to July 8th. 

This data shows overall mobility changes in a state’s population from a baseline established prior to the COVID-19 pandemic. Google uses the same methods to capture this data as it uses to “popular times” at businesses, and it is based on users who voluntarily have their location history set to “on.” Google takes steps to preserve the privacy of its users. 

Social Distancing Aggressiveness is one of the two main categories of metrics used in this study, and it was given a weight of 1.0. It is made up of six metrics, which you can read about in more depth below. 

• Retail and Recreation: This metric measures the mobility trends for retail and recreation travel, such as trips to places like restaurants, libraries, movie theaters, shopping centers, cafes, and more. In the U.S. as a whole, there was a 45% decrease between February 29th and July 8th. This metric was given a weight of 2.0 since much of this travel is non-essential. 
• Grocery and Pharmacy: Farmers markets, grocery stores, drug stores, pharmacies, and similar stores were all included in this metric. This metric was only given a weight of 1.0 since it is typically essential travel and hasn’t seen much of a change from the baseline. 
• Parks: Not just limited to city parks, this metric includes national and state parks, public beaches, marinas, dog parks, and public gardens. The parks metric was assigned a weight of 1.5 since it’s considered “non-essential travel,” but doesn’t have as high of a risk as retail and recreation travel. 
• Transit Stations: This metric measures travel to and from public transit hubs, such as bus stations, subway stations, and light rail stations. Because not all states are equally impacted by a decrease in transit-related travel, this metric was only given a weight of 1.0. 
• Workplaces: The travel to and from places of work is another key metric that shows how well states’ populations are adhering to the social distancing guidelines given by state and local authorities. Since this not only impacts the risk to workers, but also to any members of the general public that interact with them at their place of business, this metric was given a weight of 2.0. 
• Residential: Indicating the people spend much more time at home, residential mobility is the only metric that has increased since the COVID-19 pandemic. This metric was given a weight of 1.0. 

This category measures how equipped states are to treat COVID-19 along with how effective preventative measures have proven to be. Sources for the data points used for the five metrics in this category is the data provided by the CDC, Kaiser Family Foundation (KFF), and rt.live. 

• COVID-19 Effective Reproduction Rate: This metric is based on data from rt.live, a project that takes the COVID-19 data from each state and estimates the effective reproduction rate of COVID-19 in that area using a model known as Rt. This project was started by the founder and former CEO of Instagram, Kevin Systrom. Since it uses data to predict how quickly the virus will spread, it’s of primary importance in understanding the current and future safety for different states and areas in the nation, that’s why we gave it a weight of 2.0. 
• COVID-19 Infection Rates: This metric calculates the number of infections per capita in each state, and is based on the data provided by the CDC. As another primary indicator of safety in each state, this metric was also weighted at 2.0.
• COVID-19 Death Rates: Similarly to the infection rates metric, this data was taken from the CDC and is also calculated based on population (per capita). It was also given the highest weight in this category of 3.0. 
• Hospitals Per Capita: One of the key dangers of COVID-19 is that it is a novel (new) virus, so the lack of immunity and quick spread could easily cause a state’s healthcare system to become overloaded, drastically increasing the death rate, as was seen in places like Italy. To factor that into our study, this metric is focused on the number of hospitals per capita in each state, based on data provided by the Kaiser Family Foundation (KFF). This metric was given a weight of 1.0. 
• Primary Care Doctors Per Capita: Similarly to the hospitals per capita metric, the number of primary care doctors per capita was also factored into this study, and was based on data provided by KFF. This metric was also given a weight of 1.0.