Nursing Homes in Texas
1,177 Medicare- and Medicaid-certified facilities · TX · ranked on CMS Five-Star ratings, staffing, and penalties
Texas's 1,177 Medicare- and Medicaid-certified nursing homes average 2.8 of 5 CMS overall stars, below the 3.0-star national average; 154 hold the top 5-star rating while 269 sit at the 1-star floor (CMS Nursing Home Compare, March 2026).
Ratings are force-curved within each state, so Texas's averages are best read against its own facilities and the national mean, not used to rank one state's 3-star home against another's.
- 2.8 / 5
- Below average · nat'l 3.0
- 1,177
- Certified facilities
- 154
- Five-star homes (154)
- $63.0M
- Federal fines, statewide
How Texas's nursing homes are rated
Where Texas's 1,166 rated facilities fall across the CMS 1-to-5 overall star scale. Because ratings are force-curved within each state, the curve below is Texas's own - 154 sit at the 5-star ceiling and 269 at the 1-star floor.
Texas vs the national average
How Texas's averages compare with the U.S. mean across the four most outcome-correlated CMS metrics. Texas beats the national average on 0 of 4.
National average: 2.98 ★
National average: 0.68
National average: 3.89
National average: 46.4%
Bar = Texas average · vertical marker = U.S. average. Source: CMS Nursing Home Compare · March 2026.
What the Texas Nursing Home Record Reveals
Texas hosts 1,177 Medicare- and Medicaid-certified nursing facilities operating 133,480 total certified beds, with a statewide average CMS overall rating of 2.8 out of 5 stars. Rating distribution in Texas skews toward the lower end, 1-star facilities outnumber 5-star providers, a pattern typically driven by heavier urban concentrations of chain-owned facilities: 154 facilities (13%) hold the top 5-star mark, while 269 (23%) sit at the 1-star floor. The star distribution is a forced curve, CMS ratings are state-normalized, so the same absolute inspection record may place differently in Texas than in a state with a different facility mix.
Statewide staffing reports an average of 0.44 registered-nurse hours per resident day across Texas facilities, the single most outcome-correlated metric in the CMS staffing file. Nursing staff turnover statewide averages 51.5% - a level where continuity of care, medication accuracy, and resident-staff familiarity typically begin to erode measurably. Staffing levels and turnover are upstream drivers of the inspection and quality-measure scores that feed the overall star rating; states with structurally higher wages, stronger collective-bargaining coverage, and tighter state-level minimum-staffing rules tend to post better composite numbers. The Texas figures above should be read against the federal CMS 2024 minimum-staffing rule, which phases in HPRD floors over several years and will reshape this distribution for facilities currently operating below the thresholds.
For families evaluating nursing home options in Texas, the statewide averages above set the backdrop, but placement decisions ultimately turn on facility-level records: the specific deficiencies cited at the most recent inspection, the staffing hours actually logged (as opposed to budgeted), the enforcement history of fines and payment denials, and direct observation through in-person visits. Every facility listed below links to its full CMS record on this site. Data is sourced from CMS Nursing Home Compare and Provider Data; figures reflect the most recent refresh and should be verified with each facility and the Texas state survey agency before any placement decision is finalized.
Top-rated nursing homes in Texas
The 100 highest-rated of Texas's 1,177 certified facilities, ordered by CMS overall star rating. Search all 1,177 Texas facilities →
Choosing a nursing home in Texas
Texas averages 2.8 of 5 CMS stars - below the 3.0-star national mean, but the statewide number is only the backdrop to a facility-level decision.
- Open any home above for its health-inspection, staffing, and quality sub-ratings, a strong overall star can still hide a weaker sub-score. See a top-rated home
- Weigh enforcement history too: Texas's most-penalized facility carries $774K in federal fines. See its record
- Ratings are curved within each state, so read Texas against the national picture before deciding. States by rating
CMS ratings are state-normalized and refreshed quarterly; confirm current status with each facility and the Texas state survey agency before any placement decision.
Read our methodology - how this data is sourced, computed, and verified.
Related
How Texas compares on federal nursing-home metrics
The CMS Five-Star Quality Rating program scores every Medicare- and Medicaid-certified nursing facility on three independent axes: health inspections, total nurse staffing hours per resident day, and a basket of quality measures drawn from MDS (Minimum Data Set) clinical assessments. Each axis is normalized against same-state peers to produce a 1-to-5 rating, then combined into the overall star count visible on each facility's record. Because the overall star is forced into a curve, the median facility in Texas sits at 3 stars by construction, but the underlying inspection-deficiency counts, registered-nurse hours, and rehospitalization rates are not curve-adjusted and remain directly comparable across states.
State-level patterns in Texas reflect labor market conditions (registered-nurse wages, certified-nursing-assistant turnover), regulatory posture (state surveyor strictness, mandatory minimum-staffing thresholds), payer mix (Medicaid reimbursement rates set the floor for skilled nursing margins), and ownership concentration (chain-owned versus independent operators show consistently different staffing and inspection profiles in published academic work). When using Texas averages as a benchmark, treat them as the backdrop against which an individual facility's record stands, not as a substitute for reading that record in detail.
The Provider Information File (PIF), Health Deficiencies File, MDS Quality Measures File, and Penalties File are all published on a quarterly cadence at data.cms.gov; PlainNursing refreshes the Texas record within 30 days of each release. State survey agencies enforce federal certification requirements on CMS's behalf - Texas families with concerns about a specific facility should file complaints through the state's long-term-care ombudsman channel as well as through the federal CMS reporting portal. Cross-reference the figures shown here against the upstream provider record on the official Medicare Care Compare tool before drawing any individual-facility conclusion, since small differences in monthly refresh timing can shift specific star ratings between data snapshots, and the federal record carries the definitive deficiency, staffing, and penalty history for each Medicare-certified nursing home.
Source: Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare 5-Star Quality Rating, Texas · 2026 Star ratings combine health inspections, staffing, and quality measures. Updated quarterly by CMS.
