Ellery Care data study
Texas nursing homes that still use physical restraints
For most of the last thirty years, American nursing homes have worked to eliminate physical restraints, and it has largely worked. Using CMS quality data (period 2025Q2-2026Q1), we found that the typical Texas home now restrains no long-stay residents at all. Then we found the homes that still do.
This is a story about a small number, and that is the point. Of 1,119 measured Texas homes, 29 still physically restrain at least one long-stay resident, and only 5 do so for 2% or more. Below are the 25 homes with the highest rates in the state. Of these, 20 are for-profit operators and 10 staff their floors below the Texas median. Tellingly, 8 of them carry a 4 or 5 star overall CMS rating, a reminder that the headline star score does not always reflect what is happening on the floor.
Why this matters
Physical restraints were once common, used with good intentions to stop falls and wandering. The research changed that. Tying a frail older person to a bed or chair does not make them safer. It weakens their muscles, breaks down their skin, worsens confusion and agitation, and strips away dignity, and residents are sometimes badly hurt or killed trying to free themselves. Federal regulations now allow a restraint only to treat a documented medical symptom, never for staff convenience. The great majority of homes have learned to keep people safe without them, which is exactly why the homes that still reach for restraints stand out.
What to do if you are worried
Ask the home directly whether it uses any physical restraints and, if so, in what situations. Ask what it does instead to keep residents with dementia or fall risk safe, such as closer supervision, low beds, alarms, or activity programs. On a visit, notice whether residents are moving freely and comfortably or held in place. If your parent is ever restrained, you have the right to see the medical order behind it and to ask that the home try alternatives first.
How we built this
We used the long-stay physical-restraint measure from CMS MDS Quality Measures (period 2025Q2-2026Q1, retrieved 2026-08-16), the four-quarter-average share of long-stay residents who were physically restrained. 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 physical restraint in a nursing home?
A physical restraint is any device or method that keeps a resident from moving freely or reaching part of their own body, such as a belt or vest that ties them to a chair or bed, side rails used to keep them in, or a lap tray they cannot remove. Federal law says restraints may only be used to treat a medical symptom, never for staff convenience or discipline. CMS tracks how often long-stay residents are physically restrained as a direct measure of care quality.
What is a normal restraint rate for a Texas nursing home?
Near zero. Restraint-free care is now the standard: the median Texas home restrains 0% of long-stay residents, the same as the national median of 0%. Of 1,119 measured Texas homes, only 29 still physically restrain any long-stay residents at all.
Are physical restraints a sign of neglect?
Decades of research show restraints do more harm than good. Instead of preventing falls, they cause muscle weakness, pressure ulcers, incontinence, agitation, and a loss of dignity, and residents can be seriously injured trying to get free. Because good homes have found ways to keep residents safe without them, ongoing restraint use is a recognized red flag for understaffing and outdated care. It is a fair and specific thing to ask a home about directly.
Checking on a specific home?
Every Texas nursing home report card shows its safety record, staffing, inspection findings, and fines next to plain-English context, so you can see past the star rating.
Source: CMS MDS Quality Measures, long-stay physical-restraint measure, period 2025Q2-2026Q1, retrieved 2026-08-16. Ellery Care accepts no payment from any facility and is not affiliated with CMS. Educational information, not medical advice. Related: Texas nursing homes with the most resident falls and the most bedsores.