Texas has more nursing homes than any state except California — and zero state-level HPRD requirements. With the federal mandate repealed in December 2025, Texas facilities operate with no regulatory staffing floor whatsoever. Our data shows 80% fall below the RN benchmark that investors and ratings agencies use to evaluate quality.
Texas does not mandate a minimum number of nursing hours per resident per day. Facilities self-determine staffing levels.
The only enforceable standard: an RN must be on-site for at least 8 consecutive hours/day, 7 days/week. 42 U.S.C. §1395i-3.
CMS surveyors can cite Texas facilities for inadequate staffing during inspections. Penalties include CMPs up to $25,847/day and denial of payment for new admissions.
| County | Facilities | Avg HPRD | RN HPRD | Below 3.48 | Below 0.55 RN | Zero-RN Days | Stability Score |
|---|---|---|---|---|---|---|---|
| Harris | 95 | 3.58 | 0.528 | 64 (67%) | 72 (75%) | 1.5 | 82.0 |
| Dallas | 80 | 3.35 | 0.448 | 60 (75%) | 58 (72%) | 0.9 | 83.3 |
| Tarrant | 70 | 3.40 | 0.487 | 48 (68%) | 52 (74%) | 0.1 | 83.5 |
| Bexar | 61 | 3.39 | 0.385 | 40 (65%) | 51 (83%) | 0.9 | 81.2 |
| Travis | 28 | 3.51 | 0.503 | 19 (67%) | 19 (67%) | 0.9 | 81.6 |
| Collin | 22 | 3.43 | 0.487 | 72% | 77% | 0.1 | 83.9 |
| Hidalgo | 22 | 3.34 | 0.322 | 72% | 100% | 0.0 | 84.7 |
| El Paso | 21 | 3.38 | 0.408 | 66% | 80% | 0.0 | 83.1 |
| Denton | 18 | 3.51 | 0.554 | 66% | 66% | 0.3 | 82.3 |
| McLennan | 17 | 3.41 | 0.352 | 52% | 94% | 0.2 | 82.3 |
| Smith | 17 | 3.64 | 0.466 | 52% | 88% | 0.2 | 82.2 |
| Bell | 16 | 3.64 | 0.673 | 68% | 81% | 1.9 | 78.1 |
| Fort Bend | 15 | 3.48 | 0.620 | 53% | 40% | 0.1 | 81.4 |
| Lubbock | 15 | 3.38 | 0.292 | 86% | 100% | 1.1 | 81.7 |
| Williamson | 15 | 3.42 | 0.426 | 73% | 80% | 0.0 | 84.2 |
Texas has the widest staffing gap in the country and the lowest contract utilization at 2.14%. Massive deployment opportunity for agencies that know where to look.
No state staffing mandates means no risk of surprise fines post-acquisition. Improve staffing, improve stars, improve valuation — with data showing exactly where the gaps are.
With no state standard to measure against, operators need market-level benchmarks. Our data shows how every Texas facility compares to its county peers.
