The state of Texas nursing homes

How many homes, and how they rate

CMS certifies 1,177 nursing homes in Texas and publishes a full quality record for 1,135 of them. The rating spread is the first thing worth knowing, because it runs the wrong way: there are more of the government's lowest-rated homes than its highest-rated ones.

• One star: 309 homes (about 27%)
• Two stars: 238 homes
• Three stars: 250 homes
• Four stars: 205 homes
• Five stars: 133 homes (about 12%)

A rating is a useful starting point, but it hides as much as it shows, which is the subject of our transparency scorecard: of the 133 five-star homes, 50 (about 38%) still carry a serious federal red flag the star rating does not surface.

Staffing: below the federal line

Nurse staffing is the strongest predictor of whether residents stay safe, and Texas sits below the federal target. The statewide median is 3.27 nurse hours per resident per day against a target of 3.48, so more than half of homes staff under the standard. We ranked every rated home from the bottom in the worst-staffed nursing homes in Texas, and found a further gap at weekends in the weekend staffing gap.

Safety: where Texas does better, and worse

On the clinical harm measures CMS tracks, Texas is a mixed story rather than a uniform one. It does better than the national median on two, and worse on another.

• Antipsychotic drugging: Texas median 8.3% versus the national 13.4%, better than average, though 43 homes still drug more than a quarter of their long-stay residents. See the antipsychotic study.
• Pressure ulcers (bedsores): Texas median 3.3% versus 4.2% nationally, slightly better. See the bedsore study.
• Falls with major injury: Texas median 3% versus 2.8% nationally, slightly worse, with 122 homes running at more than double the state median. See the falls study.

A federal abuse flag is the most serious signal of all, and about 1 in 9 Texas homes (128) carries one. The full list is in Texas nursing homes flagged for abuse, and the homes still using physical restraints are rarer but worth knowing.

Money, ownership, and chains

Texas homes carry $50,644,126 in federal fines between them, and 783 of them (about 69%) have been fined at least once; the largest penalties are in the homes with the most fines. Ownership tracks with quality: 71% of Texas homes are for-profit, and for-profit homes are about 2.1 times as likely to carry multiple abuse flags, which we break down in for-profit versus non-profit. Most homes are not independent either: 37 chains run 863 of them (about 76%), at a chain-average of 2.66 stars, detailed in the largest nursing-home chains.

So where does that leave a family?

The state average is not your answer. It hides homes that are genuinely excellent and homes that are genuinely dangerous, often in the same city. The useful move is to ignore the headline and read one home's full record: its staffing, its inspection history, its abuse flags, and its fines. Our best nursing homes in Texas is a good place to start, and every home in the state has a report card below.

How we built this report

Every figure above comes from CMS Care Compare (Nursing Homes), dataset 4pq5-n9py (retrieved 2026-10-05), plus CMS MDS Quality Measures for the clinical harm rates. We count a home as rated when CMS publishes a full overall star rating for it. Ellery Care accepts no payment from any facility and does not rate homes ourselves; the star ratings are CMS's own. Full detail is on our methodology page.