Texas, Louisiana Have Lowest Proportion of Nursing Home Beds with Four, Five Stars

Texas came in last place on a recent ranking of nursing home quality, an outcome that highlights the potential for overdevelopment in the Lone Star State.

Based on the percentage of certified nursing home beds at four-and five-star facilities, Texas sat last at 51 on the consumer-finance website WalletHub’s list of states — and the District of Columbia — by nursing home quality.

“The quality of nursing homes in Texas is not up to par, especially for how many older residents there are,” Jill Gonzalez, an analyst for WalletHub, told SNN.


Louisiana followed close behind at 49, with North Carolina, Oklahoma, and West Virginia rounding out the bottom five.

Hawaii, Rhode Island, and North Dakota topped the nursing home quality rankings, with Delaware and Florida tied for fourth.

The results came as part of a larger look at elder abuse protections across the country, based on a variety of factors — including nursing home quality, abuse complaints, expenditures on neglect prevention programs, and funding for long-term care ombudsmen.


On the overall calculation of elder-abuse protection strength, Massachusetts topped the list, with Wisconsin and Rhode Island following in second and third. Texas actually bested Florida, with the Lone Star State taking 12th and Florida closer to the middle of the pack at 19.

“Florida ranked in the top, so it did well when it comes to a low prevalence [of abuse], but it actually could do a lot better when it comes to resource expenditures, especially for things like long-term care ombudsman program funding. So you’ll see it ranked fourth best for prevalence, and 50th for resources, and that’s why Florida is more toward the middle of the pack overall,” Gonzalez said.

Texas’ low nursing home quality score points to a smaller share of beds at facilities with ratings of four or five stars from the Centers for Medicare & Medicaid Services (CMS). The state doesn’t have a certificate of need (CON) requirement, so developers have fewer hurdles to clear — a situation that can also bring an oversaturation of high-end Medicare beds in certain markets, with a related lack of Medicaid-certified beds as operators chase higher reimbursements.

“There’s been a lot of new development over the last five to seven years,” Scott Blount, vice president at financial services firm Lancaster Pollard, told SNN earlier this year. “Texas does not have a moratorium on new beds. There’s different ways to get beds in counties, but in general, there’s been a lot of development. So even in nicer, more populated areas, those homes are having to fight for the same [residents] — there’s only so many Medicare discharges.”

Sabra Health Care REIT (Nasdaq: SBRA) CEO Rick Matros also mentioned Texas’s lack of government restrictions on nursing homes in conversation with SNN earlier this week, making it one of the few places where new development can happen — for better or worse.

“Texas just doesn’t have any of that, so it’s simpler there,” Matros said. “And I don’t know whether you look at that as a model, with some parameters on controlling growth.”

In addition to the bed-shortage issue, the findings fit into an overall focus on nursing home quality — and its potential uneven enforcement around the country. CMS has made improvements at its State Survey Agencies, which handle regular inspections of nursing homes, a key part of its ongoing skilled nursing safety push. Meanwhile a new bill before Congress seeks to protect residents in nursing homes from abuse by demanding increased clinical hours and training.

Under the Quality Care for Nursing Home Residents Act, sponsored by Rep. Jan Schakowsky of Illinois and Sen. Richard Blumenthal of Connecticut, a nursing home could be hit with $10,000-per-day fines, amongst additional penalties such as reimbursement freezes and even government takeover of a facility.

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