How to choose a nursing home in Texas

When a parent needs a nursing home, most families start with the star rating and stop there. That is a mistake. The star rating is a useful starting point, but it blends several things together and can hide a serious weakness. The homes that keep residents safe are the ones that score well on the numbers underneath the star, and those numbers are public and free to check.

This is a plain-English guide to the figures that actually predict safety, what each one means, and how to read them before you tour. It is educational information, not medical advice. Every number below comes from the government's own records, which you can look up for any Texas home on our nursing home report cards.

Start with the star rating, but do not stop there

CMS gives every certified nursing home an overall rating of one to five stars. That overall star is a blend of three separate scores, and each one tells you something different:

• Health inspections. How the home did on its state safety inspections. This is the score CMS weighs most heavily, and the hardest for a home to game.
• Staffing. How many nurse hours each resident gets per day.
• Quality measures. Data the home reports about resident outcomes, such as falls and pressure sores.

A home can earn a decent overall star while carrying a weak health-inspection score. So open all three. A five-star quality score paired with a two-star health-inspection score is a warning, not a clean bill of health.

Nurse staffing is the number that matters most

If you look at one thing, look at staffing. It is the single strongest predictor of nursing home safety. Homes with too few nurses have more falls, more pressure sores, more infections, and more trips to the hospital. It is also the number pay-to-play referral sites almost never show you.

The measure to use is total nurse hours per resident per day, drawn from payroll records that every home reports to CMS. The federal target is 3.48 hours. The median Texas home reports about 3.27. A home well below that, and especially one under about 2.5 hours, is thin on staff for the care most residents need.

Two more staffing details are worth a look. Registered nurse hours matter, because RNs handle the most serious medical needs, and many homes run very low on them, particularly on nights and weekends. And staff turnover matters, because a home that loses most of its staff every year cannot give consistent care, no matter what its star says.

Read the actual inspection findings

The health-inspection star is a summary. The detail behind it is the list of specific deficiencies that state inspectors cited, and that detail is where the real picture lives.

Each finding carries a severity level from A to L. The most serious, J through L, mean immediate jeopardy, a situation that put a resident's health or safety in serious danger. Watch for a federal abuse-warning icon as well, which CMS adds when inspectors cite a home for abuse that harmed a resident or could have. It is a factual government finding, not an allegation, and it is a strong signal to look harder. Every report card on Ellery Care lists a home's recent inspection findings and flags in plain language.

The numbers most families never see

Two figures rarely show up on referral sites, and both are worth your attention.

Antipsychotic drug use. This is the share of long-stay residents given antipsychotic medication. These drugs are sometimes used to sedate residents with dementia, a practice the FDA warns can be dangerous for older adults. Lower is better. The typical Texas home sits around 8 percent, well below the national figure, but some homes give these drugs to a quarter or more of their long-stay residents. A high rate is a reason to ask the staff directly why.

Federal fines. CMS fines a home only after an inspection documents a serious or repeated violation. A large fine total usually points to a real problem, a pattern over time, or both. A fine can also reflect a problem the home has already fixed, so read the total next to the home's current rating and its recent findings, not in isolation.

Ownership is context, not a verdict

Most Texas nursing homes are for-profit, and many belong to large chains. Ownership alone does not decide quality, and there are excellent for-profit homes and troubled nonprofit ones. But it is useful context. If a home recently changed hands, ask how staffing and care have held up through the transition, because ownership changes can disrupt both.

Put it together, then go see for yourself

No single number tells the whole story, so read them together. A home with strong staffing, a clean inspection record, low antipsychotic use, and no fines is a very different place from one that looks fine on the star alone. Our side-by-side compare tool lets you line up the homes you are considering on every one of these measures at once.

Then visit. The data tells you where to look, but a tour tells you how a home feels and whether the staff know residents by name. Walk in already knowing the numbers, and bring questions. Our free Nursing Home Tour Checklist has the 30 to ask and the red flags to watch for.

What to do this week

1. Look up every home you are considering on our Texas nursing home report cards. Write down the staffing, the antipsychotic rate, the fines, and any flags.
2. Compare your shortlist side by side, so the differences are obvious.
3. Tour the top two or three with the checklist in hand.
4. Plan for the cost while you choose. Our free calculator estimates how long care is affordable, and our guide on how to pay for a nursing home in Texas walks through the funding side.

You do not need to become an expert to choose well. You need to read the few numbers that matter, in the government's own records, and then trust your own eyes on the tour. That is the whole method, and it is free.