Texas PBJ Nursing Home StaffingTexas PBJ Staffing
Texas's statewide staffing ratio is 3.33 HPRD in Q1 2026. Texas's statewide staffing ratio is up slightly (+0.02) since Q1 2025. This level is below the national ratio of 3.75 HPRD and ranks #50 out of 51 states.
- Q2 2025: 3.34
- Q3 2025: 3.35
- Q4 2025: 3.34
- Q1 2026: 3.33
Texas
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
Texas
Texas
Texas
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PBJ320 High-risk facilities in Texas PBJ320 high-risk uses CMS-assigned indicators only (PBJ320 does not assign them): Special Focus Facility or SFF Candidate; abuse icon; one-star overall; one-star staffing.
366 facilities flagged for staffing or quality concerns.
| Facility | City | CMS ratings | Risk flags | Total HPRD |
|---|---|---|---|---|
| Accel at Willow BendPlano | Plano | 1★1★S | 3.62 HPRD | |
| Advanced Health & Rehab Center of GarlandGarland | Garland | 1★ | 2.97 HPRD | |
| Advanced Rehabilitation and Healthcare of AthensAthens | Athens | SFF cand.c.⚠1★1★S | 3.19 HPRD | |
| Afton Oaks Nursing and Rehabilitation CenterHouston | Houston | SFF cand.c.⚠1★ | 3.59 HPRD | |
| Alfredo Gonzalez Texas State Veterans HomeMcallen | Mcallen | ⚠ | 3.58 HPRD |
Staffing snapshot
Latest state staffing metrics for Texas.
| Metric | Texas | CMS Region 6CMS Region 6 includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.Regional figures are calculated from facility-level data using the same methodology as the state figures. | U.S. | State rankRanks compare the 50 states and D.C. by the displayed metric value. A higher or lower rank is not inherently positive or negative for every metric, including contract staffing share and rural-facility share. |
|---|---|---|---|---|
| Total Nurse Staffing HPRD | 3.33 | 3.52+0.19 vs TX | 3.75+0.41 vs TX | #50 of 51 |
| Direct Care Nurse HPRD | 3.06 | 3.23+0.18 vs TX | 3.48+0.42 vs TX | #51 of 51 |
| RN HPRD | 0.40 | 0.38-0.03 vs TX | 0.62+0.22 vs TX | #47 of 51 |
| RN Direct Care HPRD | 0.28 | 0.24-0.03 vs TX | 0.44+0.16 vs TX | #47 of 51 |
| Nurse Aide HPRD | 2.00 | 2.18+0.19 vs TX | 2.26+0.27 vs TX | #49 of 51 |
| Contract Staff Percentage | 2.2% | 2.9%+0.7 pts vs TX | 5.3%+3.1 pts vs TX | #48 of 51 |
| Median Case-Mix HPRD (Acuity) | 3.67 | 3.58-0.09 vs TX | 3.74+0.06 vs TX | #20 of 51 |
| Rural Facilities (Share) | 27% | 34%+6.7 pts vs TX | 27%Same as TX | #32 of 51 |
State rank reflects the displayed value, not necessarily stronger or weaker performance.
Ownership groups in Texas
Largest organizations linked to facilities in CMS owner data.
Most facilities linked in CMS owner data (Texas).
Ownership changes in Texas
Recent CMS change-of-ownership activity.
700 ownership changes at 700 Texas facilities · 01/01/2016 – 02/01/2026.
Showing 10 of 40
Showing the most recent 40 of 700 indexed changes. Browse full TX ownership & CHOW search.
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How these figures are calculatedMethods, definitions, and data sources
Staffing from CMS Payroll-Based Journal (PBJ) public files (2017–2026), plus Provider Information and chain data where shown. State staffing context via MACPAC (2022). Methodology · PBJ explained.
Metrics
- Hours Per Resident Day (HPRD): Total staff hours ÷ average residents. Example: 350 hours for 100 residents = 3.5 HPRD.
- Direct Care (excl. Admin, DON): Hours per resident day for direct care staff only (RN, LPN, CNA, NAtrn, MedAide), excluding administrative and supervisory roles.
- Contract Staff %: Share of hours provided by contract staff.
- Census: Average number of residents during the period.
Note: Some states set minimums (e.g., NJ, CA, NY at 3.5 HPRD); a federal 3.48 minimum was recently overturned (2025). A 2001 federal study linked 4.1 HPRD to better outcomes in that study. Staffing needs vary by resident acuity (case-mix), day, and shift. Estimates on PBJ Takeaway assume roughly 60% of staff are CNAs.
Data transparency
The PBJ Dashboard pulls directly from CMS data and is carefully vetted for accuracy. Still, sometimes a bug sneaks into the jelly. That could mean: a systemic CMS data reporting issue (e.g., Q2 2017 contract staffing, missing data in 2020 due to COVID) or there could be a coding error on our part. If you spot something that looks off, please let me know via the contact form so I can set things right.
Trend charts omit quarters with implausible submitted HPRD (total/direct below 0.25; RN, LPN, and aide use role floors and neighbor-quarter rules). Full criteria.
Rankings, within-state percentiles, CMS flags (including abuse icon): How metrics are calculated.