Nursing Homes in Texas: Staffing, Turnover, and Penalties
Texas has 1,177 Medicare- or Medicaid-certified nursing homes in 440 cities. On CMS's August 2026 figures, nurse aides there log 2.00 hours per resident per day, 14% below the US average of 2.32, and 55.3% of nursing staff leave in a year (US 45.8%).
Texas averages
Aide hours per resident per day is the nurse aide time a home logged for each resident across a whole day, from the payroll records every home submits to CMS. More hours per resident means more hands on the floor for the same number of residents. Turnover is the share of nursing staff who left over a year. Fines and payment denials are CMS penalties from the last three years.
Aide hours per resident a day
2.00
US 2.32
All nursing hours per resident a day
3.39
US 3.86
Nursing staff turnover
55.3%
US 45.8%
Fines per home, 3 years
1.5
US 0.9
CMS Care Compare State and US Averages, August 2026 release
Nursing homes by city
The most nursing homes are in Houston (60), San Antonio (58), Dallas (33). Each city page compares every home on staffing, turnover, CMS stars, and fines.
- Abilene (11)
- Alamo (1)
- Alice (3)
- Allen (2)
- Alvarado (1)
- Alvin (2)
- Amarillo (12)
- Amherst (1)
- Andrews (1)
- Angleton (2)
- Arlington (9)
- Aspermont (1)
- Athens (3)
- Atlanta (2)
- Austin (25)
- Azle (1)
- Baird (1)
- Balch Springs (1)
- Ballinger (2)
- Bandera (2)
- Bangs (1)
- Bartlett (1)
- Bastrop (3)
- Bay City (3)
- Baytown (5)
- Beaumont (9)
- Bedford (4)
- Bee Cave (1)
- Beeville (2)
- Bellmead (1)
- Bellville (1)
- Belton (2)
- Benbrook (1)
- Bertram (1)
- Big Lake (1)
- Big Spring (3)
- Boerne (5)
- Bonham (3)
- Booker (1)
- Borger (2)
- Bowie (1)
- Brady (1)
- Breckenridge (1)
- Bremond (1)
- Brenham (3)
- Bridgeport (1)
- Bronte (1)
- Brookshire (1)
- Brownfield (2)
- Brownsville (7)
- Brownwood (6)
- Bryan (4)
- Bullard (1)
- Burkburnett (2)
- Burleson (3)
- Burnet (1)
- Caldwell (2)
- Cameron (2)
- Camp Wood (1)
- Canadian (1)
- Canton (1)
- Carrizo Springs (1)
- Carrollton (5)
- Carthage (3)
- Castroville (1)
- Cedar Hill (2)
- Cedar Park (4)
- Celina (1)
- Center (3)
- Centerville (1)
- Chandler (1)
- Childress (1)
- Cisco (1)
- Clarendon (1)
- Clarksville (2)
- Claude (1)
- Cleburne (3)
- Cleveland (1)
- Clifton (2)
- Clute (1)
- Clyde (1)
- Coleman (2)
- College Station (3)
- Colorado City (1)
- Columbus (2)
- Comanche (2)
- Comfort (1)
- Commerce (1)
- Conroe (4)
- Converse (1)
- Cooper (1)
- Coppell (1)
- Copperas Cove (2)
- Corinth (1)
- Corpus Christi (13)
- Corrigan (1)
- Corsicana (5)
- Cotulla (1)
- Crane (1)
- Crockett (3)
- Crosbyton (1)
- Crowell (1)
- Crowley (2)
- Cuero (2)
- Cypress (1)
- Daingerfield (1)
- Dalhart (1)
- Dallas (33)
- Dayton (1)
- Decatur (3)
- De Leon (1)
- Del Rio (3)
- Denison (5)
- Denton (6)
- Denver City (1)
- Desoto (5)
- Devine (1)
- Diboll (1)
- Dimmitt (2)
- Dripping Springs (1)
- Dumas (2)
- Duncanville (2)
- Eagle Lake (1)
- Eagle Pass (3)
- Eastland (1)
- Eden (1)
- Edinburg (4)
- Edna (1)
- El Campo (2)
- Eldorado (1)
- Electra (1)
- Elgin (1)
- Elkhart (1)
- El Paso (21)
- Emory (1)
- Ennis (3)
- Euless (1)
- Fairfield (2)
- Falfurrias (1)
- Farmersville (2)
- Farwell (1)
- Flatonia (1)
- Floresville (3)
- Flower Mound (2)
- Forney (1)
- Fort Stockton (1)
- Fort Worth (31)
- Franklin (1)
- Fredericksburg (4)
- Friendswood (1)
- Friona (1)
- Frisco (3)
- Gainesville (4)
- Galveston (2)
- Ganado (1)
- Garland (6)
- Garrison (1)
- Gatesville (2)
- Georgetown (2)
- George West (1)
- Giddings (2)
- Gilmer (2)
- Gladewater (2)
- Glen Rose (2)
- Goldthwaite (2)
- Goliad (1)
- Gonzales (2)
- Graham (2)
- Granbury (4)
- Grand Prairie (1)
- Grand Saline (3)
- Grandview (1)
- Grapevine (3)
- Greenville (4)
- Groesbeck (2)
- Groves (2)
- Groveton (1)
- Hallettsville (2)
- Hamilton (2)
- Hamlin (1)
- Harker Heights (1)
- Harlingen (7)
- Haskell (1)
- Hearne (1)
- Hebbronville (1)
- Hemphill (2)
- Henderson (2)
- Henrietta (1)
- Hereford (1)
- Hewitt (1)
- Hico (1)
- Highland Village (1)
- Hillsboro (2)
- Hondo (1)
- Honey Grove (1)
- Horseshoe Bay (1)
- Houston (60)
- Hughes Springs (1)
- Humble (6)
- Huntington (1)
- Huntsville (3)
- Hurst (2)
- Hutto (1)
- Irving (6)
- Italy (1)
- Itasca (1)
- Jacksboro (1)
- Jacksonville (3)
- Jasper (2)
- Jayton (1)
- Jefferson (1)
- Johnson City (1)
- Jourdanton (1)
- Justin (1)
- Karnes City (1)
- Katy (7)
- Kaufman (2)
- Keene (1)
- Keller (3)
- Kemp (2)
- Kenedy (2)
- Kennedale (1)
- Kerens (1)
- Kerrville (4)
- Kilgore (2)
- Killeen (2)
- Kingsland (1)
- Kingsville (2)
- Kingwood (1)
- Kirbyville (1)
- Knox City (1)
- Kountze (1)
- Kyle (1)
- La Grange (2)
- Lake Jackson (2)
- Lakeway (1)
- Lake Worth (1)
- La Marque (1)
- Lamesa (1)
- Lampasas (3)
- Lancaster (4)
- La Porte (2)
- Laredo (6)
- La Vernia (1)
- League City (3)
- Levelland (2)
- Lewisville (2)
- Liberty (2)
- Lindale (2)
- Linden (1)
- Littlefield (1)
- Live Oak (1)
- Livingston (3)
- Llano (1)
- Lockhart (2)
- Longview (9)
- Lubbock (14)
- Lufkin (6)
- Luling (3)
- Lumberton (1)
- Lytle (1)
- Mabank (1)
- Madisonville (2)
- Magnolia (1)
- Malakoff (1)
- Manchaca (1)
- Mansfield (3)
- Marble Falls (1)
- Marlin (1)
- Marshall (3)
- Matador (1)
- Mathis (1)
- Mcallen (8)
- McCamey (1)
- Mc Gregor (1)
- McGregor (1)
- McKinney (5)
- Mclean (1)
- Memphis (1)
- Menard (1)
- Mercedes (1)
- Meridian (1)
- Merkel (1)
- Mesquite (8)
- Mexia (3)
- Midland (5)
- Midlothian (2)
- Mineola (2)
- Mineral Wells (2)
- Mission (2)
- Missouri City (4)
- Monahans (1)
- Mont Belvieu (1)
- Moulton (1)
- Mount Pleasant (3)
- Mount Vernon (1)
- Muleshoe (1)
- Munday (1)
- Nacogdoches (3)
- Navasota (2)
- Needville (1)
- New Braunfels (5)
- Newton (1)
- Nocona (1)
- North Richland Hills (2)
- Odessa (6)
- Olney (1)
- Olton (1)
- Orange (1)
- Overton (1)
- Ozona (1)
- Palestine (4)
- Pampa (2)
- Paris (5)
- Pasadena (8)
- Pearland (4)
- Pearsall (1)
- Pecos (1)
- Penitas (1)
- Perryton (1)
- Pflugerville (2)
- Pharr (1)
- Pilot Point (2)
- Pittsburg (1)
- Plainview (2)
- Plano (9)
- Pleasanton (3)
- Port Arthur (3)
- Porter (1)
- Portland (1)
- Port Lavaca (2)
- Post (1)
- Princeton (1)
- Quitman (1)
- Ralls (1)
- Ranger (1)
- Raymondville (1)
- Red Oak (1)
- Refugio (1)
- Richardson (6)
- Richland Hills (1)
- Richmond (4)
- Richwood (1)
- Rio Grande City (2)
- Rising Star (1)
- Robert Lee (1)
- Robstown (1)
- Rockdale (1)
- Rockport (2)
- Rockwall (4)
- Rosebud (1)
- Rosenberg (2)
- Round Rock (5)
- Rowlett (1)
- Royse City (1)
- Rusk (2)
- Saginaw (1)
- San Angelo (8)
- San Antonio (58)
- San Augustine (3)
- San Diego (1)
- San Juan (1)
- San Marcos (3)
- San Saba (1)
- Savoy (1)
- Schertz (2)
- Schulenburg (2)
- Seagoville (1)
- Sealy (1)
- Seguin (5)
- Selma (1)
- Seminole (1)
- Seymour (1)
- Shavano Park (1)
- Shepherd (1)
- Sherman (4)
- Shiner (1)
- Silsbee (3)
- Slaton (1)
- Smithville (1)
- Snyder (1)
- Socorro (1)
- Southlake (2)
- Spearman (1)
- Spring (1)
- Spring Branch (1)
- Springtown (1)
- Stamford (1)
- Stephenville (3)
- Sterling City (1)
- Stratford (1)
- Sugar Land (3)
- Sulphur Springs (4)
- Sweeny (1)
- Sweetwater (2)
- Taylor (1)
- Teague (1)
- Temple (10)
- Terrell (3)
- Texarkana (7)
- Texas City (5)
- The Woodlands (4)
- Tomball (5)
- Trinity (2)
- Tyler (13)
- Uvalde (2)
- Van (1)
- Van Alstyne (1)
- Vernon (1)
- Victoria (4)
- Vidor (2)
- Waco (13)
- Watauga (1)
- Waxahachie (3)
- Weatherford (7)
- Webster (3)
- Weimar (1)
- Wellington (1)
- Wells (1)
- Weslaco (3)
- West (1)
- Wharton (2)
- Wheeler (1)
- Whitehouse (1)
- Whitesboro (1)
- White Settlement (2)
- Whitney (1)
- Wichita Falls (7)
- Willis (1)
- Willow Park (1)
- Wills Point (1)
- Wimberley (1)
- Windcrest (1)
- Winnie (1)
- Winnsboro (2)
- Woodville (2)
- Wylie (2)
- Yoakum (2)
- Yorktown (1)
- Zapata (1)
Largest nursing home chains in Texas
CMS links 694 of Texas's homes to these 15 chains. A chain is a group of homes under common ownership or management, as CMS records it.
| Chain | Homes in TX | Homes nationwide |
|---|---|---|
| Creative Solutions in Healthcare | 149 | 149 |
| Avir Health Group | 116 | 116 |
| The Ensign Group | 83 | 342 |
| Wellsential Health | 67 | 67 |
| Cantex Continuing Care | 37 | 37 |
| HMG Healthcare | 29 | 31 |
| Advanced Healthcare Solutions | 28 | 28 |
| Opco Skilled Management | 27 | 66 |
| Nexion Health | 26 | 51 |
| Focused Post Acute Care Partners | 25 | 25 |
| Touchstone Communities | 25 | 25 |
| Fundamental Healthcare | 24 | 66 |
| Eduro Healthcare | 20 | 34 |
| Gulf Coast LTC Partners | 20 | 20 |
| Priority Management | 18 | 38 |
Chain as recorded in the CMS Provider Information file, August 2026 release