Using US Census data, we mapped the distribution of adults 65+ across every county in the United States and modeled implied home care market size. The largest home care markets are not where most agencies assume.
Key Findings
- The top 10 counties by senior population account for 8.4% of all adults 65+ in the US — highly concentrated, but not the whole story
- The fastest-growing senior populations are in Sun Belt suburbs — not traditional retirement destinations like Florida and Arizona, which are already saturated with agencies
- Markets with high senior density and low agency density represent the clearest white space for expansion — these exist in the mid-Atlantic, Midwest, and Mountain West
- The average county has 1 home care agency per 847 adults aged 65+ — markets below that ratio are underserved; markets above it are competitive
- Rural and exurban counties have the worst agency-to-senior ratios — families in these areas report the longest wait times and fewest options
- Market saturation does not correlate with market quality — some of the most saturated markets (Maricopa County, Palm Beach County) still have high private-pay rates and strong agency revenue
The National Senior Population Map
Adults 65 and older number approximately 57 million in the United States as of 2026, representing about 17% of the total population. That share is growing. The oldest of the Baby Boomers are now in their late 70s; the youngest turn 62 in 2026. The demographic pipeline is full.
The geographic distribution of seniors does not match the geographic distribution of home care agencies. States like Florida and California have high absolute numbers of seniors and high numbers of agencies. But the ratio — agencies per senior — varies enormously by county and by state.
Where Seniors Are
The 10 counties with the largest senior populations:
- Los Angeles County, CA — 1.24 million adults 65+
- Maricopa County, AZ — 940,000
- Cook County, IL — 755,000
- Harris County, TX — 610,000
- San Diego County, CA — 555,000
- Orange County, CA — 525,000
- Broward County, FL — 480,000
- Miami-Dade County, FL — 475,000
- Palm Beach County, FL — 465,000
- Riverside County, CA — 425,000
These markets are large and, in most cases, highly competitive. An independent agency entering Los Angeles or Maricopa County today faces established competitors with deep referral networks, strong GBP profiles, and years of review accumulation.
Where the White Space Is
The more strategically interesting analysis is the agency-to-senior ratio. Markets with a low ratio — few agencies relative to the senior population — represent underserved demand.
The clearest white space markets in our analysis share several characteristics:
- Mid-sized metro areas (not top-30 markets) with growing senior populations
- Counties in the mid-Atlantic, Midwest, and Mountain West where senior growth is outpacing agency formation
- Suburban rings of major metros where seniors are aging in place in newer housing stock, often without established referral networks
These markets have families who need home care and fewer agencies competing for that business. The Map Pack in a white space market may have only one or two agencies with more than a dozen reviews — versus seven or eight in a saturated market.
Sun Belt Suburbs
The fastest-growing senior populations are not in Florida retirement communities or Arizona snowbird markets. They are in the suburban and exurban rings of Sun Belt metros — the communities where people moved in the 1980s and 1990s for space and affordability and are now aging in place.
Counties like Collin County (TX), Forsyth County (GA), and St. Johns County (FL) are in the top quartile for senior population growth and below average for agency density. The seniors aging into home care need in these counties are in newer, less well-served communities with limited local referral networks — which means families are doing more online search, and the Map Pack matters more.
Private Pay Rate Correlation
Senior population density alone does not determine market quality. The other variable is income — specifically, the proportion of seniors who can pay privately for home care without relying on Medicaid or other funding sources.
Our analysis shows that the counties with the highest private-pay potential are not always the counties with the highest absolute senior populations. They are the counties where senior household income is above median, where homeownership rates are high (equity funding home care), and where adult children have the income to contribute to care costs.
Markets with high private-pay rates and growing senior populations — regardless of absolute market size — are often more valuable to an independent agency than larger but lower-income markets with the same or greater agency density.
Rural and Exurban Underservice
The agency-to-senior ratio is worst in rural and exurban counties. Families in these areas report the longest wait times, the fewest agency options, and the least ability to compare providers. Home care in these markets is often a matter of access, not choice.
For agencies with the operational capacity to serve lower-density areas, rural and exurban markets represent a genuine opportunity — not because the marketing is easier, but because the competition is minimal. An agency that serves a three-county rural area with competent caregivers and a responsive office may face no meaningful local competition at all.
The challenge is unit economics: longer drive times, harder caregiver recruitment, and lower density of potential clients per geographic area. These markets require different operating models than metro markets.
Methodology
We used US Census Bureau American Community Survey data (2022-2024) to map the distribution of adults 65+ at the county level across the United States. Agency counts were drawn from our dataset of 64,380 home care agencies identified through Google Maps, state licensing databases, and directory aggregators. Agency-to-senior ratios were calculated for all 3,143 US counties. Private pay potential estimates were modeled from household income, homeownership rate, and Medicare supplement insurance penetration data.
If you're evaluating a geographic expansion or trying to understand whether your current market can support the growth you're planning, the population and competition data here is the starting point. Our home care marketing service includes market analysis as part of strategy — helping you understand where to compete before committing to channels.