Texas Nursing Homes Are Some of the Worst in the Nation: The Data
By one advocacy group’s measure, Texas nursing homes are some of the worst in the nation: Families for Better Care’s Texas nursing home report card ranks the state No. 51 and names it the worst nursing home state for a third consecutive report card. If you think a loved one is being neglected, you can report it to Texas Health and Human Services Commission (HHSC) Complaint and Incident Intake, call the free, confidential State Long-Term Care Ombudsman Program at 800-252-2412, and keep in mind that a possible legal claim is generally subject to a two-year limitations period under Chapter 74 of the Texas Civil Practice and Remedies Code.
Rankings do not all agree on how bad things are. America’s Health Rankings places Texas 38th for nursing home quality, with 30.3% of facilities in the higher-quality group based on federal CMS data from September through November 2025. That gap is a good reason to look beyond statewide headlines at the specific facility caring for your family member.
This guide explains what these rankings actually measure and how to look up one Texas facility’s public ratings. It covers the rights Texas residents have, the red flags worth writing down, and how to report suspected abuse or neglect. It also walks through the two-year deadline, how compensation is evaluated in a Texas nursing home neglect claim, and where TortAdvisor’s independent research may help if you are weighing your options.
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Short answer: Are Texas nursing homes some of the worst in the nation?
Yes. By the measures in two national scorecards, Texas sits in the bottom tier. The two scorecards use different methods, though, and they place Texas at different spots near the bottom.
Families for Better Care is a nonprofit advocacy group. Its Texas nursing home report card ranks Texas No. 51 and calls it America’s worst nursing home state for the third consecutive report card. That report card says:
- Violations were widespread: 93 percent of Texas nursing homes were cited for violations.
- Serious problems were common: 1 in 5 Texas nursing homes was cited for one or more severe deficiencies.
- Staffing was low: residents received 2 hours and 16 minutes of direct care per day.
- Registered nurse (RN) staffing lagged: fewer than 10 percent of Texas facilities scored above average.
America’s Health Rankings offers a second view. Its nursing home quality measure for Texas uses federal star-rating data from the Centers for Medicare & Medicaid Services (CMS), collected from September through November 2025. On that measure, Texas ranks 38th, with 30.3% of facilities in the higher-quality group. The two scorecards weigh different factors, so it makes sense that their rankings differ. Both still place Texas well below the middle of the pack.
What this means for your family: These are statewide patterns. They do not mean every Texas nursing home is unsafe. They are also not evidence that any particular resident was harmed. If you are worried about someone you love, the more useful questions are how their own facility performs and what you have seen firsthand. The sections below explain how to check a specific facility and what to do if something seems wrong.
What these rankings measure, and how to check one Texas facility
A statewide ranking describes Texas nursing homes as a group. It cannot tell you how one particular facility is doing. Knowing what each scorecard measures helps you move from the headline to the home where your loved one lives.
The CMS star ratings
The federal Centers for Medicare & Medicaid Services (CMS) rates nursing homes on three areas: health inspections, quality of resident care and overall staffing. More stars mean CMS scored the facility higher. According to America’s Health Rankings’ explanation of the CMS Five-Star system, these scores are public on Medicare’s Care Compare tool. CMS intends the public ratings to push facilities toward better quality.
The Families for Better Care report card
Families for Better Care is an advocacy group, not a government agency. It grades each state on 8 statistical categories. In its Texas nursing home report card, Texas failed 5 of the 8 categories and did not score above average in any quality measure. The report card looks at state-level patterns. It does not grade individual homes.
How to look at a single facility
This is general guidance, not a rule for judging any one home:
- Look up the facility by name on Care Compare.
- Read the health inspection score and the staffing score separately. Don’t rely only on the overall star number, because a single average can hide a weak area.
- Write down any area that scores noticeably lower than the others. That gives you specific questions to ask staff or to raise at a care plan meeting.
- Compare what the ratings say with what you see in person during visits.
If you are still choosing where a parent should live, UpgradeMyHome’s nursing home placement assistance guide compares nursing homes with assisted living, sets out typical monthly costs and lists what to check in a facility’s inspection history. If a parent is staying at home for now, its overview of medical alert systems explains monitored and fall-detection options.
Texas resident rights and the red flags worth writing down
Moving into a nursing home does not mean giving up basic rights. The Texas Long-Term Care Ombudsman Program’s resident rights brochure lists protections that every resident keeps, including the right to:
- Be free from abuse, neglect, and exploitation
- Be free from chemical and physical restraints
- Complain without fear of retaliation
- Appeal a discharge
If something you see seems to conflict with one of these rights, it is worth noting, even if you are not sure yet what it means.
What Texas treats as reportable
Texas Health and Human Services Commission guidance on reporting abuse, neglect, and exploitation incidents lists the types of incidents nursing facilities must report. These include:
- Abuse
- Neglect
- Exploitation
- A missing resident
- Misappropriation of a resident’s property
- Drug theft
- A death under unusual circumstances
These categories give families a practical reference point. If what worries you fits one of them, the state already treats that kind of event as serious.
Keeping a simple log
The ombudsman program suggests three habits that help families stay involved:
- Keep a log of your concerns and the actions taken in response.
- Attend care plan meetings so you know what care is planned and can ask questions.
- Talk with staff about your concerns as they come up.
A useful log entry is short and factual. Write down the date, what you saw or were told, who you spoke with, and what happened next. Stick to what you observed rather than guesses about the cause.
A log does not prove anything on its own and does not predict how a complaint or claim will turn out. What it does is give staff, an ombudsman, state investigators, or anyone else reviewing the situation a clear record of what happened and when. Months later, that kind of record is much easier to rely on than memory alone.
How to report suspected abuse or neglect in a Texas nursing home
If anyone is in immediate danger, call 911 first. This is basic safety advice, not a legal requirement. Once the person is safe, Texas offers two main routes. One is a regulatory report to the state. The other is free advocacy through the ombudsman. You can use both at the same time.
Regulatory reports: HHSC Complaint and Incident Intake
Texas Health and Human Services says that all alleged or suspected abuse, neglect and exploitation in nursing homes must be reported to HHSC Complaint and Incident Intake. Reports must also go to other bodies, such as law enforcement, when required. The same HHSC guidance, which is tied to Provider Letter 2024-14, lists the incident types that must be reported. It also sets the time frames within which facilities must make those reports.
If you raise a concern with staff, you can ask whether the facility has reported it to HHSC, and when. Write down the answer, the name of the person who gave it, and the date.
Advocacy: the Texas Long-Term Care Ombudsman
The Texas Long-Term Care Ombudsman Program can be reached at 800-252-2412. Its services are free and confidential, and ombudsmen are separate from HHS. An ombudsman works on the resident’s behalf. That can help when a family wants support raising a problem with the facility.
| Route | What it is for | How to reach it |
|---|---|---|
| 911 | Immediate danger to the resident | Call 911 |
| HHSC Complaint and Incident Intake | Required reports of suspected abuse, neglect or exploitation | See the HHSC guidance linked above |
| Long-Term Care Ombudsman | Free, confidential advocacy for the resident | 800-252-2412 |
The Texas deadline: two years under Chapter 74
In most cases, Texas gives you two years. Under Texas Civil Practice and Remedies Code Chapter 74, Section 74.251, a health care liability claim must be filed within two years from when the breach or tort occurred, or from the date the treatment or hospitalization the claim is about was completed.
This deadline can apply to nursing homes. The same chapter’s definition of “health care provider” in Section 74.001 includes nursing homes, so claims about care a resident received there may fall under these rules.
Two time limits to know
- The two-year limitations period: This runs from the breach or tort, or from the completion of the treatment or hospitalization at issue.
- The 10-year outer limit: Section 74.251 also says a claim must be brought no later than 10 years after the act or omission that gave rise to it. This applies even when other rules might otherwise extend the time.
Why your exact deadline needs a professional look
The statute’s wording is short, but applying it is not always simple. Which date starts the clock, whether an exception applies, and how ongoing care affects the count all depend on the facts of a resident’s situation. A licensed Texas attorney should review any specific deadline before you rely on it. If you are unsure, it is safer to ask early than to assume you have time.
Not every Texas injury claim follows Chapter 74. Other types of cases have their own rules. For an example from a different area, see how Texas filing rights and deadlines work in the Depo-Provera litigation.
How compensation is evaluated in a Texas nursing home neglect claim
There is no standard value for a nursing home neglect claim, and we will not give you a number. Every case is different. What a claim may be worth depends on what happened to the resident, what the records and other evidence show, and how Texas law applies to those facts.
What usually shapes a claim’s value
- The facts: the type of harm, how serious it was, and how it changed the resident’s health and daily life.
- The evidence: care records, photos, your written log of concerns, and any reports made to the state.
- The law: which statutes apply and what they allow or limit.
Chapter 74 limits some damages
Texas treats many nursing home neglect cases as health care liability claims. The definition of a health care provider in Texas Civil Practice and Remedies Code Chapter 74 includes nursing homes, and Subchapter G of that chapter places limits on noneconomic damages in these claims. Because those limits can affect what a family may recover, it helps to have someone review how the statute applies to your situation. For a broader overview, see our guide on how lawsuit value and claim worth are evaluated.
When the harm may come from a product, not the care
Sometimes a resident’s illness may not be caused by the nursing home at all. A disease such as mesothelioma may be linked to exposure to a product earlier in life. That would be a separate kind of claim against a different party, and different rules may apply. If this sounds familiar, our guide explains who qualifies for a talcum powder mesothelioma claim.
Where TortAdvisor fits as a next step
TortAdvisor is an independent research site. We are not a law firm, we do not represent anyone, and nothing here is legal advice. What we can offer is clear background reading, so you can understand your options and go into conversations with a lawyer or the state better prepared.
If you are worried about someone in a Texas nursing home, this order of steps tends to work well:
- Write down what you have seen. Note dates, times, names and what happened. The state ombudsman program suggests keeping a log of concerns and attending care plan meetings. Its ombudsmen are free and confidential and can be reached at 800-252-2412.
- Report it. Contact HHSC Complaint and Incident Intake or the ombudsman, as described in the reporting section above.
- Keep your records together. Save copies of your log, photos, medical records, discharge papers and any replies from the facility or the state.
- Know the time limit. Texas generally allows two years to bring a health care liability claim under Chapter 74, which covers nursing homes. That deadline is real, but there is no reason to rush past the steps above to meet it.
If you want to understand how money is handled in these cases, our guide to settlement amounts and how payouts are reported explains what published figures do and do not tell you. You can also try our settlement calculators that explain which factors affect injury claim estimates. Please treat any number they give as a rough estimate based on general factors. It is not a prediction of what your family’s case is worth.
No website can tell you whether you have a claim. A Texas lawyer who reviews your records can, and our research is there to help you ask good questions when you speak with one.
Frequently asked questions
Are Texas nursing homes really the worst in the U.S.?
It depends on which ranking you use. The advocacy group Families for Better Care ranked Texas No. 51 in its Texas nursing home report card and called it the worst nursing home state for a third consecutive report card. The group found that 93% of Texas facilities were cited for violations and that 1 in 5 were cited for severe deficiencies.
Other measures paint a less extreme picture. America’s Health Rankings placed Texas 38th for nursing home quality, with 30.3% of facilities in the higher-quality group based on CMS data from September to November 2025. Both point to real problems, but neither tells you how one specific home performs.
Who do I contact about suspected nursing home neglect in Texas?
Texas Health and Human Services says all alleged or suspected abuse, neglect, and exploitation in nursing homes must be reported to HHSC Complaint and Incident Intake. That is the state office that receives these reports. If you believe someone is in immediate danger, call 911 first.
For help speaking up for a resident, you can call the Texas Long-Term Care Ombudsman Program at 800-252-2412. An ombudsman can help a resident or family raise concerns with the facility and understand the resident’s rights.
Does it cost anything to talk to a Texas long-term care ombudsman?
No. According to the state ombudsman brochure linked above, ombudsman services are free and confidential. The brochure also notes that ombudsmen are separate from HHS, the agency that licenses and inspects nursing homes. A family can talk through a concern with an ombudsman before deciding whether to file a formal complaint or take any other step.
Can a Texas nursing home retaliate if my family complains?
Residents should not face retaliation for complaining. The same ombudsman brochure lists the right to complain without retaliation among Texas residents’ rights, along with the rights to be free from abuse, neglect, exploitation, and restraints and to appeal a discharge. If staff treat your loved one worse after you speak up, that is itself worth reporting.
The brochure suggests keeping a log of concerns and attending care plan meetings. A dated record of what you saw, who you told, and how the facility responded can help an ombudsman, a state investigator, or later a lawyer understand what happened.
How long do I have to file a nursing home neglect lawsuit in Texas?
Generally two years. Texas treats nursing homes as health care providers under Chapter 74 of the Civil Practice and Remedies Code. Section 74.251 sets a two-year limitations period for health care liability claims and a 10-year outer limit, called a statute of repose. When the clock starts can depend on the facts, so families who suspect neglect may want to have a lawyer review the dates soon.
Sources
- Texas Details – Nursing Home Report Card · Families for Better Care
- Explore Nursing Home Quality in Texas · America's Health Rankings (United Health Foundation) · 2026-01-28
- Reporting and Response: Incidents of Abuse, Neglect and Exploitation · Texas Health and Human Services Commission
- Protecting Residents' Rights – State Long-Term Care Ombudsman Program brochure · Texas State Long-Term Care Ombudsman Program · 2024-10-01
- Civil Practice and Remedies Code Chapter 74, Medical Liability · Texas Legislature
This article is general information, not legal advice. Laws and deadlines vary by state and change over time; check the linked sources or speak with a licensed attorney about your situation.
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