Ellery Care data study
The largest nursing home chains in Texas
Most Texas nursing homes are not independent. They belong to large operators, and the company behind a home shapes its staffing, its budget, and its culture. Using CMS data (2026-09-05), we grouped every rated Texas home by its operator and measured how each chain performs across all of its facilities.
The operators vary sharply. Among these larger chains, Methodist Retirement Communities posts the highest average rating (4.67★), while Harmony Care Group posts the lowest (1.6★). Ranked below by the number of Texas homes each one runs.
| # | Operator | TX homes | Avg rating | Avg staffing | Antipsychotic | Total fines | Abuse flags |
|---|---|---|---|---|---|---|---|
| 1 | Creative Solutions In Healthcare | 143 | 2.13★ | 3.13 | 9.14% | $7,809,491 | 20 |
| 2 | Avir Health Group | 116 | 2.33★ | 3.19 | 9.72% | $6,811,835 | 19 |
| 3 | The Ensign Group | 83 | 2.66★ | 3.3 | 5.66% | $2,720,160 | 8 |
| 4 | Wellsential Health | 67 | 2.72★ | 3.13 | 9.14% | $2,405,704 | 8 |
| 5 | Cantex Continuing Care | 36 | 3.08★ | 3.35 | 5.52% | $1,397,805 | 3 |
| 6 | Hmg Healthcare | 29 | 3.28★ | 3.35 | 6.93% | $1,206,251 | 2 |
| 7 | Advanced Healthcare Solutions | 28 | 2.86★ | 3.15 | 8.64% | $1,426,020 | 3 |
| 8 | Opco Skilled Management | 27 | 2★ | 3.07 | 13.2% | $1,560,247 | 3 |
| 9 | Nexion Health | 25 | 2.64★ | 3.63 | 11.6% | $820,853 | 3 |
| 10 | Focused Post Acute Care Partners | 25 | 1.88★ | 2.97 | 12.95% | $1,730,988 | 7 |
| 11 | Fundamental Healthcare | 24 | 2.88★ | 3.28 | 9.87% | $733,489 | 2 |
| 12 | Touchstone Communities | 24 | 2.92★ | 3.27 | 5.8% | $696,390 | 0 |
| 13 | Eduro Healthcare | 20 | 2.35★ | 2.99 | 10.38% | $1,136,824 | 1 |
| 14 | Gulf Coast Ltc Partners | 19 | 2.42★ | 3.21 | 17.76% | $490,222 | 1 |
| 15 | Priority Management | 18 | 3.33★ | 3.28 | 6.08% | $321,801 | 1 |
| 16 | Paradigm Healthcare | 14 | 1.86★ | 3.21 | 12.7% | $778,264 | 5 |
| 17 | Caring Healthcare Group | 13 | 3★ | 3.76 | 11.03% | $367,142 | 1 |
| 18 | Stonegate Senior Living | 13 | 2.77★ | 3.34 | 7.05% | $818,955 | 1 |
| 19 | Hamilton County Hospital District | 10 | 2.3★ | 3.17 | 12.05% | $373,882 | 1 |
| 20 | Health Services Management | 10 | 3★ | 3.67 | 9.5% | $391,016 | 2 |
| 21 | Foursquare Healthcare | 10 | 3.5★ | 3.19 | 8.74% | $107,993 | 0 |
| 22 | Momentum Skilled Services | 9 | 2★ | 3.44 | 6.78% | $496,331 | 1 |
| 23 | Caraday Healthcare | 8 | 2.75★ | 3.08 | 13.51% | $325,621 | 0 |
| 24 | Coryell County Memorial Hospital Authority | 8 | 2.88★ | 3.19 | 16.46% | $394,377 | 1 |
| 25 | Paramount Healthcare | 8 | 3★ | 3.36 | 11.9% | $367,141 | 0 |
| 26 | Texvet | 8 | 2.88★ | 4 | 11.75% | $493,607 | 2 |
| 27 | Ruby Healthcare | 7 | 2.86★ | 3.68 | 6.44% | $430,793 | 1 |
| 28 | Life Care Centers Of America | 7 | 2.86★ | 3.86 | 9.44% | $415,693 | 0 |
| 29 | Slp Operations | 7 | 2.14★ | 2.92 | 8.93% | $424,545 | 1 |
| 30 | Ignite Medical Resorts | 7 | 2.57★ | 3.92 | 13.1% | $461,827 | 0 |
| 31 | Chambers County Public Hospital District No. 1 | 6 | 3★ | 3.59 | 6.77% | $93,084 | 1 |
| 32 | Purehealth | 6 | 3.67★ | 4.16 | 3.58% | $194,297 | 1 |
| 33 | Cross Healthcare Management | 6 | 2.83★ | 3.28 | 7.53% | $68,359 | 1 |
| 34 | Methodist Retirement Communities | 6 | 4.67★ | 4.61 | 7.88% | $62,686 | 0 |
| 35 | Ml Healthcare | 6 | 2.33★ | 2.85 | 8.4% | $224,599 | 2 |
| 36 | Dallas County Hospital District | 5 | 3★ | 3.68 | 4.3% | $190,476 | 2 |
| 37 | Harmony Care Group | 5 | 1.6★ | 3.5 | 14.26% | $392,771 | 1 |
Why the operator matters
A nursing home does not set its own budget in a vacuum. The company that owns it decides how many nurses it can hire, how it is run, and whether profit is pulled out or reinvested in care. That is why two homes under the same operator often share the same strengths and the same weaknesses. When you find a home you like, it is worth knowing how the rest of its operator's homes score, because the pattern tends to hold.
How we built this
We grouped every rated Texas nursing home in CMS Care Compare (Nursing Homes), dataset 4pq5-n9py (retrieved 2026-09-05) by the chain CMS records for it, and included operators with at least 5 Texas homes so the averages are stable. For each, we averaged the CMS overall star rating, the nurse staffing hours per resident, and the long-stay antipsychotic rate, and we summed the federal fines and abuse flags across all of that operator's Texas homes. Averages can hide a strong home inside a weak chain, and the reverse, so always check the individual report card. Full details on our methodology page.
Common questions
Are chain-owned nursing homes worse than independent ones?
Not automatically. Some of Texas's largest operators score above the state average of 2.66 stars, and others score well below it. Ownership is a useful signal, not a verdict. Always read the specific home's own record alongside its operator's overall pattern.
Which company owns the most nursing homes in Texas?
Creative Solutions In Healthcare operates the most rated Texas homes (143), followed by Avir Health Group (116).
How do I find out who owns a specific nursing home?
Every Ellery Care report card shows the home's ownership and its chain, right next to its ratings, staffing, fines, and inspection record. Look up any Texas home to see who runs it.
Checking a specific home?
Every Texas nursing home report card shows its owner and chain next to its ratings, staffing, fines, and inspection record, in plain English.
Methodology & how to cite
Texas nursing-home chains ranked by facility count, with chain-level average ratings, staffing, and fines from CMS data. Data as of 2026-09-05. Full method and sources are on our methodology page.
Cite this analysis (APA):
Ellery Care Research Team. (2026). The Largest Nursing Home Chains in Texas (2026). Ellery Care. https://ellerycare.com/studies/largest-nursing-home-chains-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, plus CMS MDS Quality Measures for antipsychotic use, retrieved 2026-09-05. Ellery Care accepts no payment from any facility and is not affiliated with CMS. Educational information, not advice. Related: antipsychotic drugging in Texas nursing homes.