Start the Search Before You Need It
The hardest nursing home decisions are made under pressure — after a hospital discharge, a sudden fall, or a rapid health decline. Families who have researched options in advance are far better positioned to make a clear-headed, informed choice. If at all possible, begin your research before a crisis forces your hand.
In Texas, with 1,176 certified nursing homes across 216 counties, the options can feel overwhelming. This guide gives you a systematic framework to narrow the field, ask the right questions, and avoid costly mistakes.
Step 1 — Define Your Loved One's Care Needs
Nursing homes are not all the same. Before comparing facilities, clarify what level and type of care is actually required:
- Skilled nursing care: Post-surgical recovery, wound management, IV therapy, physical/occupational/speech therapy — typically short-stay.
- Long-term custodial care: Assistance with activities of daily living (ADLs) — bathing, dressing, eating — for residents who cannot live independently.
- Memory care: Specialised units for residents with Alzheimer's or other forms of dementia, with secured environments and staff trained in dementia care.
- Hospice care: Comfort-focused care for residents with terminal diagnoses. Can be provided within a nursing home setting.
Ask the hospital discharge planner or your loved one's physician for a formal care needs assessment before touring facilities. This document will also determine what Medicare and Medicaid will cover.
Step 2 — Use Data to Build Your Shortlist
Once you know what you need, use objective data to eliminate poor performers and build a shortlist of 4–6 facilities worth visiting:
- Start with our Texas directory. Filter by county, star rating, and penalty history to see which facilities in your area have the strongest records.
- Eliminate any facility with an abuse icon or SFF status unless there are no other options. These flags represent serious, documented failures.
- Prioritise facilities with 3+ stars on health inspections. The health inspection rating is the hardest to game — it comes from state surveyors, not self-reported data.
- Check staffing hours. CMS reports RN hours per resident per day. Look for at least 0.6 hours; 0.8+ is good. Low RN staffing is directly correlated with worse outcomes.
- Don't rely on the overall rating alone. A facility can have a high overall rating but a 1-star health inspection — drill into the component scores.
Step 3 — Visit and Ask the Right Questions
Data tells you what has happened in the past. A visit tells you what is happening now. Schedule an initial tour, then return unannounced at a different time of day — ideally during a meal service or evening when staffing is typically lower.
What to observe during a visit
- Are residents clean, dressed appropriately, and groomed?
- Does the facility smell clean, or are there persistent odours of urine or faeces?
- Are call lights answered promptly — within a few minutes?
- Do staff interact warmly with residents, using their names?
- Are residents engaged in activities, or sitting alone and unattended for long periods?
- Does the dining room look and smell appealing? Is food served at appropriate temperatures?
- Are there residents in the hallways who appear confused, distressed, or unsupervised?
Questions to ask the admissions team
- What is your current staff-to-resident ratio, and how does it change on nights and weekends?
- What is your annual nursing staff turnover rate?
- How many of your nurses are certified nursing assistants versus licensed nurses?
- What is your policy for notifying families about health changes, incidents, or hospitalisation?
- Do you have a dedicated memory care unit, and what training do those staff receive?
- What is your policy on residents leaving — temporarily or permanently?
Already in a facility that isn't meeting expectations?
If your loved one is experiencing neglect or inadequate care, you have rights — including the right to transfer and the right to legal remedy. Our attorney network can help.
Step 4 — Understand the Costs and Payment Options
Nursing home costs in Texas vary significantly by location and care level. Understanding payment options early prevents financial surprises:
- Medicare: Covers skilled nursing facility care for up to 100 days following a qualifying hospital stay of 3+ days. Days 21–100 have a significant daily co-pay. Medicare does not cover long-term custodial care.
- Medicaid (STAR+PLUS in Texas): Covers long-term nursing home care for residents who meet both medical and financial eligibility criteria. Many Texas nursing homes accept Medicaid, but beds may be limited.
- Long-term care insurance: If your loved one has a policy, review its terms carefully — there are often waiting periods and coverage limits.
- Private pay: Average nursing home costs in Texas range from approximately $5,000–$8,000 per month depending on location and level of care.
Step 5 — Stay Engaged After Admission
Choosing the right facility is only the beginning. Research consistently shows that residents with engaged, visiting families receive measurably better care. After admission:
- Visit frequently, including unannounced visits at different times of day
- Attend care plan meetings and ask for copies of care plans
- Introduce yourself to the Director of Nursing and primary care staff
- Monitor your loved one's condition at each visit using the red flags in our warning signs guide
- Know your rights — and your loved one's rights — under the Texas Nursing Home Residents' Bill of Rights