Nursing Home Staffing in Texas

Registered-nurse staffing is one of the three primary components CMS uses to calculate a nursing home's Five-Star Overall Rating, and across 1,177 Medicare-certified facilities in Texas the 1,142 that report RN hours average 0.434 RN hours per resident per day, compared with a national average of 0.685. That metric - "RN hours per resident day" - is derived from Payroll-Based Journal (PBJ) submissions, a quarterly data feed that facilities are required to file and CMS audits against payroll records, so it is harder to game than the older self-reported staffing forms that the PBJ system replaced in 2016. This page uses 14,693 Medicare-certified nursing-home records from CMS Care Compare, with NPPES context where available. Every figure is traceable in the methodology.

Higher RN hours per resident per day generally correlate with better clinical outcomes, fewer pressure ulcers, lower rehospitalization rates, fewer falls, because registered nurses handle medication administration, wound care, and clinical assessments that licensed practical nurses and certified nursing aides cannot legally perform. But the ranking below should be read with context: facility acuity matters (a post-acute SNF taking hospital discharges needs more RN hours than a long-stay facility with stable residents), bed size creates measurement noise (small facilities can swing dramatically quarter-to-quarter), and weekend/holiday coverage patterns can lower the average even in otherwise well-staffed homes. The top 100 Texas facilities by RN hours appear below with their CMS Staffing Rating, Overall Rating, and bed count so you can weigh raw staffing against quality composite scores.

PBJ data is refreshed quarterly and lags the reporting quarter by roughly six months, so the table reflects the file CMS processed on Jul 1, 2026, not this week's staffing. Important: PlainDoctor presents CMS staffing figures exactly as published at data.cms.gov, with no custom weighting or editorial rankings. This table is a research starting point, not medical advice or a placement recommendation. Selecting a nursing home is a high-stakes healthcare decision, tour facilities in person, ask about nurse-to-resident ratios by shift, review the full CMS survey deficiency record alongside these staffing numbers, and consult licensed clinicians, hospital discharge planners, and elder-care advisors before committing.