Methodology & sources

Where the data comes from

Quality & staffing: CMS Care Compare (Nursing Homes), dataset 4pq5-n9py, a public-domain dataset the U.S. Centers for Medicare & Medicaid Services (CMS) publishes for every certified nursing home. Retrieved 2026-09-05; CMS refreshes it roughly monthly. Star ratings shown are CMS's own five-star ratings, and we do not create our own ratings.

Cost figures: national median monthly costs from the CareScout 2025 Cost of Care Survey, cited as published. We do not republish CareScout's compiled tables; costs vary significantly by metro area.

The report-card grade

The letter grade is a plain-English relabel of the facility's CMS overall star rating: 5★ = A, 4★ = B, 3★ = C, 2★ = D, 1★ = F. It adds no hidden judgment. The underlying CMS ratings and flags are always shown alongside it.

Staffing benchmark

“Nurse hours per resident per day” is CMS's payroll-based total nurse staffing measure. We compare each facility to the Texas median of 3.27 hours, computed across the 1,135 rated facilities.

Inspection findings (deficiencies)

Each report card's “recent inspection findings” come from CMS's Health Deficiencies dataset, the specific citations state inspectors issued. We label each by its scope-and-severity code: minimal harm (A–C), potential for harm (D–F), actual harm (G–I), and immediate jeopardy (J–L). We show the most recent and most severe findings, mark those CMS records as corrected, and link to the full inspection history on Medicare.gov. These are the government's findings, presented factually, not our judgment.

Quality measures (drug use and preventable harm)

Report cards also show three long-stay measures from CMS's MDS Quality Measures dataset: the share of residents given an antipsychotic medication, the share who suffered a fall with major injury, and the share with pressure ulcers (bedsores). Each is CMS's four-quarter-average figure (period 2025Q2-2026Q1), shown next to the Texas and national medians so you can see where a home sits. Lower is better on all three. For the ranked falls and antipsychotic studies we include only homes with at least 25 residents, so the percentage reflects a real pattern rather than one or two cases.

What we publish, and what we suppress

Of 1,177 certified Texas nursing homes, we publish a page only for the 1,135 with both a real CMS overall rating and real staffing data. The other 42 are counted but not given a page. We would rather show fewer, complete pages than many thin ones.

Study exclusions (credibility filter)

For the worst-staffed study, we exclude reporting artifacts that would distort a “lowest staffing” ranking: continuing-care retirement communities, facilities with fewer than 25 average residents, and any facility reporting below 1.5 nurse hours per resident per day (below any real operating level, a sign of an incomplete payroll submission, not genuine staffing).

Cost estimates

We do not own proprietary metro cost data. Our cost-of-care pages start from the CareScout 2025 Cost of Care Survey national median for each type of care and adjust it by the BEA Regional Price Parities (All items, 2024, U.S. = 100), the federal measure of local price levels. The result is a transparent estimate to plan around, clearly labeled, never presented as a quote from a specific home. For an exact price, families should call the homes they are considering.

Transparency scorecard

Our transparency scorecard takes every home CMS rates four or five stars overall and flags six serious markers in its federal record: a federal abuse-warning icon, an immediate-jeopardy deficiency in recent cycles, $50,000 or more in federal fines, antipsychotic use in a quarter or more of long-stay residents, and serious-fall or pressure-ulcer rates at least double the Texas median. The three rate-based markers only count for homes with at least 25 residents. Every flag is a factual CMS record, not an allegation of current wrongdoing.

Corrections

CMS data can contain errors, and facilities change. If something looks wrong, tell us and we'll check it against the source. This site is educational information, not medical, legal, or financial advice.