The Texas nursing home transparency scorecard

Why this matters

Star ratings are meant to help, and mostly they do. The problem is what a single number hides. Around the country, families and reporters keep finding the same thing: official sources can make a home look clean while the underlying records tell a harder story. A Tennessee investigation in 2026 found the state showing homes as having no disciplinary action even when they carried six-figure federal fines. When the reassuring surface and the real record disagree, a family that stops at the surface can make the wrong call.

That is the whole reason we exist. We take no money from any facility, so we have no reason to smooth over an unfavorable record. This scorecard puts the star rating next to the flags in the same view, so you can see both at once.

What to do with this

A flag is a reason to look closer, not proof a home is bad. Some of these are strong homes that had a serious finding and corrected it. Look up the specific home, read its inspection findings and fines, and if it carries a flag, ask the staff directly what happened and what changed. The goal is to walk in informed rather than reassured by a number alone.

How we built this

We started with every Texas home CMS rates four or five stars overall (336 homes) and checked each against six serious markers in its federal record: a federal abuse-warning icon, an immediate-jeopardy deficiency in recent inspection 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, so a small facility's percentage cannot trip them. The table shows homes carrying two or more flags at once. Every figure comes from CMS. Full details on our methodology page.