Ellery Care data study
The 25 worst-staffed nursing homes in Texas
Nurse staffing is the strongest predictor of nursing home safety. Using CMS's payroll-based staffing data (2026-09-05), we ranked every rated Texas nursing home by total nurse hours per resident per day. These 25 report the fewest, all well below the Texas median of 3.27 hours and the federal target of 3.48.
How we built this
We used the total reported nurse staffing hours per resident per day from CMS Care Compare (Nursing Homes), dataset 4pq5-n9py (retrieved 2026-09-05), a payroll-based measure CMS collects from every certified nursing home. We ranked all 1,135 rated Texas facilities from lowest to highest.
To keep the ranking credible we excluded reporting artifacts: continuing-care retirement communities (whose per-resident math is distorted by large independent-living populations), facilities with fewer than 25 average residents, and any facility reporting below 1.5 hours per resident per day, a level no real skilled-nursing facility operates at, indicating an incomplete payroll submission rather than genuine staffing. Full details on our methodology page.
Methodology & how to cite
Texas nursing homes ranked by reported nurse-staffing hours per resident day, 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 25 Worst-Staffed Nursing Homes in Texas (2026 Data). Ellery Care. https://ellerycare.com/studies/worst-staffed-nursing-homes-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].
Ellery Care accepts no payment from any care facility and is not affiliated with CMS. This is educational information, not advice. If a family member lives in one of these facilities, staffing is one factor among many. Review the full facility report card and speak with the facility directly. Related: the weekend staffing gap → · 128 Texas nursing homes flagged for abuse →
Common questions
What is a good nurse staffing level for a nursing home?
CMS sets a federal target of 3.48 total nurse hours per resident per day. The median Texas home reports 3.27. Homes well below that, and especially below about 2.5 hours, are understaffed for the care most residents need.
Why does nurse staffing matter so much?
Nurse staffing is the single strongest predictor of nursing home safety. Homes with too few nurses have more falls, pressure sores, infections, and avoidable hospitalizations. It is the number pay-to-play referral sites rarely show.
Where does this staffing data come from?
It is the payroll-based staffing that every certified nursing home reports to CMS, retrieved 2026-09-05. We rank homes with at least 25 residents so the hours-per-resident figure is stable.