Senior Health & Safety
Senior Health & Safety
Caring.com's 2020 study ranked all 50 states on senior COVID-19 safety. Here's what it found, how it worked, and how to use the same framework to evaluate any state today.
In 2020, Caring.com ranked all 50 states on how well they protected seniors during COVID-19, scoring each one across 11 metrics grouped into Social Distancing Aggressiveness and Preparedness & Prevention. The CDC data behind the study was stark: roughly 8 out of 10 COVID-19 deaths in the United States were among adults 65 and older. This guide walks through what the rankings found, how the methodology worked, which states rose and fell, and — more importantly — how families today can apply the same kind of thinking when evaluating a state's senior-health environment, whether for a pandemic, flu season, or any public-health decision.
Vermont, Maine, and Hawaii topped Caring.com's updated COVID-19 senior-safety rankings, based on death rates, case rates, and prevention scores. The methodology offers a reusable framework for families evaluating any state's senior-health track record.
When Caring.com first published its COVID-19 state rankings in May 2020, the pandemic's toll on older adults was already impossible to ignore. The CDC's data showed that roughly eight out of every ten COVID-19 deaths in the U.S. were among people 65 and older, a disparity that made state-level policy choices a matter of life and death for that population specifically.
The original study set out to answer a narrow but urgent question: which states were actually doing the best job of both slowing the spread of the virus and treating those who caught it, with a specific focus on outcomes for seniors. By July 2020, enough new data had accumulated that Caring.com's research team revisited and updated the rankings, adjusting both the underlying numbers and the way those numbers were weighted.
The update wasn't cosmetic. Because more time had passed, the researchers could finally measure real outcomes — deaths and cases per capita — rather than relying mostly on which policies states had announced. That shift changed the leaderboard substantially, moving some previously top-ranked states down and pushing others up.
The study graded all 50 states across 11 distinct metrics, organized into two overarching categories: Social Distancing Aggressiveness and Preparedness & Prevention. Social distancing scores were derived largely from Google's mobility data, capturing how much residents actually reduced movement and contact compared to pre-pandemic baselines.
In the July update, the research team deliberately rebalanced the weighting. Preparedness & Prevention was given four times the weight of Social Distancing Aggressiveness, and within that category, per-capita death counts received the single highest weight of any metric in the study. The reasoning was straightforward: by midsummer, there was enough time-lag data to judge states by what actually happened rather than by policy intentions alone.
The researchers also made a point of not penalizing states that had begun safely reopening after successfully containing early outbreaks. States that loosened restrictions after demonstrating strong results were treated differently than states that never controlled the spread in the first place, since the timing allowed real infection and death outcomes to be measured before scoring.
Vermont claimed the number-one spot in the updated rankings, climbing from third place in the original May study and passing both Hawaii and Montana. Vermont earned the second-highest score nationally for Treatment and Prevention, ranking 10th-best for COVID-19 deaths per capita, 5th-best for cases per capita, and 10th-lowest for effective reproduction rate, which sat just above 1.0 as of July 8, 2020.
Maine moved up from fourth to second place, largely because of the methodology shift favoring outcomes over stated policy. Despite ranking a weak 44th in Social Distancing, Maine finished first nationally in Preparedness & Prevention, with the second-lowest effective reproduction score, the seventh-lowest infection rate per capita, and the ninth-lowest death rate per capita in the country.
Hawaii held onto a top-three spot but slipped from first to third, as a recent case spike pushed its Preparedness & Prevention rank from 5th to 7th. Even so, Hawaii still ranked number one nationally for Social Distancing and recorded the lowest death rate per capita of any state, with just 19 total COVID-19 deaths as of July 8, 2020.
| Rank | State | Standout Stat |
|---|---|---|
| #1 | Vermont | 10th-lowest reproduction rate, ~1.0 as of July 8 |
| #2 | Maine | 1st in Preparedness & Prevention nationally |
| #3 | Hawaii | Lowest per-capita deaths; just 19 total deaths |
| Biggest Mover | Oregon | Climbed 10 spots into the top 5 |
Some of the sharpest swings in the July update involved states that had performed very differently just two months earlier. Montana, which had been in the top three in May, fell 12 spots to land at number 14 overall by July, a reflection of how quickly a state's outbreak trajectory could change the picture.
California told a similar story on a larger scale, dropping eight places from a top-five position down to 13th overall. Oregon moved in the opposite direction, climbing ten spots from outside the top 15 into the top five, a sign that its containment measures were producing measurably better results over time.
West Virginia, Utah, and Kansas each jumped from the bottom half of the rankings into the top ten, while Nevada and New Mexico fell out of the top ten and into the bottom half. These reversals underscore how volatile a single-point-in-time ranking can be during an active public-health crisis.
A ranking like this is a useful snapshot, but it's exactly that: a snapshot. The rankings changed meaningfully between May and July 2020 alone, driven by both new data and a change in how metrics were weighted. Any family using such a ranking to make a real decision needs to check the publication date and understand what's being measured before drawing conclusions.
The 11 underlying metrics are more durable than the specific rankings themselves. Death rates per capita, case rates per capita, effective reproduction rates, and measured social-distancing compliance are all reasonable ways to evaluate how seriously a state's public-health infrastructure responds to an outbreak, whether that's COVID-19, seasonal flu, or a future health emergency.
Families with aging parents in high-risk states, or those weighing a move to be closer to family, can use this same framework as a starting point: look up current per-capita outcome data for the states in question rather than relying on general reputation or a single older study.
If a family is genuinely trying to compare states for an older relative's safety, the process from this study is more valuable than its 2020 conclusions. Start with outcome data — deaths and cases per capita — rather than headline policy announcements, since the study's own methodology shift showed that outcomes tell a more accurate story than intentions.
Next, weigh prevention infrastructure over short-term restriction strictness. Maine ranked near the bottom for social distancing but still finished first in Preparedness & Prevention, showing that a state's underlying health-system capacity can matter more than how strict its rules looked on paper.
Finally, treat any single ranking as a starting point for further research, not a final answer. Cross-check current numbers from the CDC, state health departments, or organizations like the National Institute on Aging before using a 2020 study to inform a 2026 decision about where an older loved one should live.
The specific numbers behind this study are now several years old, and any state's current standing on senior health and pandemic preparedness has likely shifted since 2020. Vaccination rates, healthcare capacity, and public-health leadership have all changed materially in every state since the original rankings were published.
What hasn't changed is the underlying vulnerability the study was built around: older adults consistently bear a disproportionate share of risk from infectious respiratory illness, which is why state-level preparedness continues to matter disproportionately for families with aging parents.
Families evaluating a state today should look for current, dated sources — state health department dashboards, CDC data, or recent AARP state comparisons — rather than relying on any single study's original conclusions, no matter how well-researched those conclusions were at the time.
If you take one thing from this study, take the method, not the 2020 leaderboard. The most concrete next step for any family is to stop relying on which state 'won' a ranking years ago and instead pull current per-capita death and case data for the specific states you're actually considering, directly from the CDC or the relevant state health department.
This matters because the study itself proved how quickly things change: Montana dropped 12 spots and California dropped 8 in just two months, while Oregon climbed 10. A state's public-health performance is not a fixed trait — it shifts with leadership, funding, vaccination coverage, and the nature of whatever outbreak is currently circulating.
When comparing options for an aging parent, ask three questions the original study answered for 2020: What is the current death rate per capita for older adults in this state? How robust is the state's healthcare and prevention infrastructure? And how recent is the data you're relying on to answer the first two questions?
Once you have current answers, use them alongside the non-health factors that matter for any move — proximity to family, cost of living, and access to specialized senior care — rather than treating a single old ranking as the deciding factor.
Rankings like this one are a snapshot, not a guarantee. Use the underlying metrics — deaths per capita, case rates, reproduction rates — as a template for evaluating any state's senior-health environment, then confirm current numbers before making a decision.
Caring.com's COVID-19 state rankings were never meant to be a permanent scorecard — they were a snapshot of how well each state's policies were protecting older adults at one moment in a fast-changing pandemic. The core lesson holds beyond 2020: seniors bear the heaviest share of infectious-disease risk, so the states that paired aggressive prevention with strong treatment outcomes protected their older residents best. For families today, the useful takeaway isn't "move to Vermont" — it's the method. Look at per-capita deaths and cases, not raw counts. Weigh actual outcomes over stated policy. And revisit any ranking's date before trusting it, because a state's position can shift by a dozen spots in a matter of months.
If you're using any state ranking to make a real relocation or care decision for an aging parent, treat outdated or single-source data as a red flag. Cross-check current death and case rates, vaccination coverage, and healthcare capacity directly from state health departments or the CDC before trusting conclusions drawn from 2020 data.