Ellery Care data study
For-profit vs. non-profit: the Texas nursing-home quality gap
Who owns a nursing home shapes how much of its money reaches the bedside. Using CMS data (2026-09-05), we grouped every rated Texas home into its three ownership sectors and measured them side by side. The pattern is consistent: for-profit homes are about 2.1 times as likely to carry a federal abuse flag as non-profit homes (12.2% versus 5.9%), and they staff lower, rate lower, and pay more in fines. This describes a sector, not any single home, and there are strong for-profit homes and weak non-profit ones. Each home's own record is on its report card.
For-profit companies run most of Texas's nursing homes: 804 of the 1,135 rated homes, about 71%. Non-profits and government-run homes are a smaller share, and on every measure below they carry a lighter record. The full comparison:
| Ownership | Homes | Median staffing | Avg CMS rating | Abuse-flagged | Avg federal fines |
|---|---|---|---|---|---|
| Non-profit | 102 | 3.66 hrs | 3.69★ | 5.9% (6) | $26,250 |
| Government | 229 | 3.26 hrs | 2.72★ | 10.5% (24) | $36,922 |
| For-profit | 804 | 3.26 hrs | 2.51★ | 12.2% (98) | $49,143 |
Median nurse staffing = reported total nurse hours per resident per day (federal target 3.48). Abuse-flagged = share of homes carrying the CMS abuse-warning icon. Fines average counts a home with no recorded fine as $0.
Why the gap shows up
A nursing home does not decide its quality in a vacuum. Its owner sets the budget, and the biggest line in that budget is nursing labor. Non-profit and government homes answer to no shareholders, so more of each dollar can stay at the bedside. That difference shows up first in staffing, which is the strongest single predictor of whether residents are kept safe, and it flows downstream into inspection findings, fines, and the abuse flag. The Texas numbers follow that logic: non-profits post the highest median staffing and the lightest record, for-profits the lowest staffing and the heaviest, with government homes in between.
None of this settles the question for a specific family. Ownership is a starting signal, not a conclusion. A well-run for-profit home can and does outperform a struggling non-profit down the road, and the reverse happens too. Use the sector pattern to know what to ask about, then let the individual home's record answer it.
How we built this
We took every rated Texas nursing home in CMS Care Compare (Nursing Homes), dataset 4pq5-n9py (retrieved 2026-09-05) and sorted it into the three federal ownership categories. For each sector we computed the median total nurse staffing hours per resident per day, the average CMS overall star rating, the share of homes carrying the abuse-warning icon, and the average total federal fine (a home with no recorded fine counts as $0). Only homes with a real CMS rating and a real staffing figure are included, the same publish gate used across the site, so no partially-empty record distorts an average. A sector average can hide a strong home inside a weak group, and the reverse, so always check the individual report card. Full details on our methodology page.
Common questions
Are for-profit nursing homes worse than non-profit ones in Texas?
On average, the data shows a consistent gap. Across the 1,135 rated Texas homes, for-profit homes are about 2.1 times as likely to carry a federal abuse flag as non-profits (12.2% versus 5.9%), they staff below non-profits, and they average 2.51 CMS stars against 3.69 for non-profits. This is a pattern across a whole sector, not a verdict on any single home. Plenty of for-profit homes score well, and some non-profits score poorly, so always read the individual home's own record.
Why would ownership affect the quality of care?
A nursing home's owner decides how much of its revenue goes back into care and how much is taken out as profit. Non-profit and government homes have no shareholders to pay, so more of each dollar tends to reach the bedside as nurse staffing, which is the single strongest predictor of safety. The figures here describe that association in Texas; they do not prove that ownership alone causes a home's record.
Most Texas nursing homes are for-profit. Should I avoid them?
No. For-profit homes make up 71% of rated Texas homes (804 of 1,135), so ruling them all out is neither practical nor fair. Many are excellent. The point is to weigh ownership as one signal among several, then check the specific home's staffing, inspection record, and fines on its report card before you decide.
How was this measured?
We grouped every rated Texas nursing home on CMS Care Compare (retrieved 2026-09-05) by its federal ownership category, then computed each sector's median nurse staffing hours per resident per day, average CMS overall star rating, share of homes carrying the abuse-warning icon, and average federal fines. A home with no recorded fine counts as $0. Only homes with a real CMS rating and staffing figure are included.
Checking a specific home?
Every Texas nursing home report card shows its ownership next to its ratings, staffing, fines, and inspection record, in plain English, so you can weigh the sector pattern against the home's own record.
Methodology & how to cite
Texas nursing homes compared by ownership sector (for-profit, non-profit, government) on CMS staffing, star ratings, abuse flags, and federal fines. Data as of 2026-09-05. Full method and sources are on our methodology page.
Cite this analysis (APA):
Ellery Care Research Team. (2026). For-Profit vs. Non-Profit Nursing Homes in Texas (2026 Data). Ellery Care. https://ellerycare.com/studies/for-profit-vs-nonprofit-nursing-homes-in-texas/
Journalists and researchers are welcome to cite these figures with a link back. Downloads, the data dictionary, and citation formats for every study are on our data & press resources page. For a custom data pull or a quote, contact [email protected].
Source: CMS Care Compare (Nursing Homes), dataset 4pq5-n9py, retrieved 2026-09-05. Ellery Care accepts no payment from any facility and is not affiliated with CMS. Educational information, not advice. Related: Texas nursing homes flagged for abuse.