Nursing Homes in Texas

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.