Moves cost time and money. Time to learn about a place, and money to pay the transaction and resettlement costs. The question is, will it be the last move, or not? If yes, then “where” matters a great deal. If no, then you need funds for multiple moves. For many people “where”’ depends on where the primary caregiver is. For couples the initial caregiver may be a spouse. That makes the “where” for the surviving spouse even more important.

Quality and cost of medical, nursing, and living support are highly local. AARP, Commonwealth Fund, and the SCAN Foundation provide one of several rankings that underscore differences between states’ ability to support older adults. A 25-to-50-mile move can shift you from a top to a bottom quartile state. Also, a warm climate may come with trade-offs. Medicaid is a state-federal program designed to give states significant latitude. For people who rely on Medicaid, or are likely to be Dual Eligibles, the state’s Medicaid program is key to what and whether they are covered. It doesn’t transfer between states, and you are only covered in one state.

There’s also evidence that research and teaching hospitals invest more in both physical and human capital and have better results particularly with higher-risk patients. Virtually all of them participate in Medicare and tend to lead on best practices. They are also anchored in urban centers and attract philanthropic grants.

At the rural end of the spectrum, health and care are problematic. The CDC is aware of the problems and causes, but to drill down on a specific rural area the Rural Health Information Hub may help more. The section on Guides provides more details on the rural-urban areas within each state. To enjoy the rural setting, you need to know where to get help.

Housing Counseling (general)