How to choose a nursing home

Public records are a starting point, not a substitute for walking the building and talking with staff. This page is a sequence, not a ranking and not advice about a particular home.

1. Confirm the license

Check that the home is on the current HHSC roster, whether it is Medicare- or Medicaid-certified, how many licensed beds it has, and whether it holds an Alzheimer certificate if that matters for the person who would live there. Verify the same facts on TULIP. Licensed-only homes (not federally certified) are still legal nursing facilities in Texas; they will not have Medicare Five-Star ratings.

2. Read the inspection record

Look at recent citations, whether they came from standard or complaint surveys, the scope-and-severity letters, and whether CMS recorded a correction. Read the official text on TULIP or Medicare.gov. See how inspection reports work. A home with citations is not automatically a poor choice, and a home with a clean recent file is not automatically a good one. Ask staff how they responded.

3. Read published ratings, if they exist

For certified homes, CMS overall and domain stars are a compact snapshot. Read footnotes. Do not treat a one-star difference as a decisive grade. See how to read ratings.

4. Visit, more than once if you can

Go at different times of day, including a meal and, if possible, a weekend or evening. Notice staffing, how call lights are answered, odors, whether residents are up and dressed if they want to be, and how staff speak to residents when they do not know you are listening. Tour the specific unit, not only the lobby.

5. Ask about payment and the actual bed

Medicare’s skilled-nursing benefit is short-term and has conditions. Long-term custodial care is usually paid by Medicaid (if eligible), private funds, or insurance — not by standard Medicare. See paying for care. Confirm whether a bed is actually available for the needed level of care.

Take a printed list of questions: Questions to ask on a visit.