Ellery Care data study
Texas nursing homes with the most resident falls
A serious fall is one of the most feared events for a family with a parent in care: a broken hip or a head injury can change everything. Using CMS quality data (period 2025Q2-2026Q1), we looked at how often every rated Texas home reports a long-stay resident suffering a fall with major injury.
Texas runs a shade above the national norm on serious falls, and 123 homes report rates at least double the state median. Below are the 25 highest rates in the state among homes large enough for the percentage to be meaningful. Of these 25 worst performers, 8 staff their floors below the Texas median and 17 are for-profit operators, the pattern researchers most often tie to thin supervision.
Why this matters
For an older adult, a single serious fall can be the turning point. A broken hip often means surgery, a long recovery, and a real drop in independence, and the risk of dying in the year after a hip fracture is high. Many of these falls are preventable. Homes lower the risk by assessing each resident's fall risk, keeping call lights answered, managing medications that cause dizziness, and having enough staff on the floor to help people move safely, especially at night when staffing is thinnest.
What to do if you are worried
A high fall rate is a reason to ask questions, not to panic. Ask the home how it assesses fall risk when a resident moves in and after any change in health. Ask how quickly call lights are answered, how the home staffs overnight, and what it changed after its most recent falls. If your parent is already in a home with a high rate, ask for a fresh fall-risk assessment and a written care plan.
How we built this
We used the long-stay falls-with-major-injury measure from CMS MDS Quality Measures (period 2025Q2-2026Q1, retrieved 2026-08-09), the four-quarter-average share of long-stay residents who had at least one fall causing major injury. We ranked Texas homes with at least 25 residents, so the percentage reflects a real pattern rather than one or two cases. Full details on our methodology page.
Common questions
What counts as a fall with major injury in nursing home data?
CMS defines it as a fall that resulted in bone fractures, joint dislocations, closed head injuries with altered consciousness, or subdural hematomas. It is the most serious category of fall, not a minor stumble. The measure is the share of long-stay residents who had at least one such fall.
What is a normal fall rate for a Texas nursing home?
The median Texas home reports that about 3% of long-stay residents had a fall with major injury, close to the national median of 2.8%. Rates at or above double the state median, roughly 6% and up, stand out as well above typical.
Are falls the nursing home's fault?
Not always. Some residents are frail or have conditions that make falls more likely. But research ties serious-fall rates to staffing levels and supervision, and CMS treats them as a quality signal. A high rate is a reason to ask how a home assesses fall risk and staffs its floors, especially overnight.
Checking on a specific home?
Every Texas nursing home report card shows its serious-fall and pressure-ulcer rates next to its staffing, inspection findings, and fines, with plain-English context.
Source: CMS MDS Quality Measures, long-stay falls-with-major-injury measure, period 2025Q2-2026Q1, retrieved 2026-08-09. Ellery Care accepts no payment from any facility and is not affiliated with CMS. Educational information, not medical advice. Related: the worst-staffed nursing homes in Texas.