What Are Nursing Homes?

Nursing homes, also called skilled nursing facilities (SNFs), provide round-the-clock medical care from registered nurses (RNs) and licensed vocational nurses (LVNs). They serve older adults with complex medical conditions, individuals recovering from surgery or hospitalization who need short-term rehabilitation, and residents who require ongoing long-term care that cannot be safely provided in an assisted living setting.

Unlike assisted living communities, nursing homes are equipped to handle medical interventions such as wound care, IV therapy, ventilator management, and post-surgical rehabilitation. Physical, occupational, and speech therapy are available on-site at most facilities.

How Texas Regulates Nursing Homes

The Texas Health and Human Services Commission (HHSC) regulates nursing homes through its Long-Term Care Regulatory (LTC-R) program, which is separate from the ALF licensing system used for assisted living and memory care. HHSC conducts annual surveys of every licensed nursing home in the state and investigates complaints filed by residents, families, or staff. Federal oversight from the Centers for Medicare and Medicaid Services (CMS) adds another layer of accountability for Medicare- and Medicaid-certified facilities.

CMS Five-Star Quality Ratings

Every Medicare-certified nursing home in the United States receives a Five-Star Quality Rating from CMS. The rating system evaluates four dimensions:

  • Overall Rating: A combined score from 1 to 5 stars that summarizes the other three categories
  • Health Inspections: Based on deficiency findings from the most recent three years of state surveys
  • Staffing: Measures registered nurse hours and total nursing hours per resident per day, adjusted for case mix
  • Quality Measures: Tracks clinical outcomes such as falls, pressure ulcers, use of restraints, and hospital readmission rates

Families can look up any nursing home's current star rating, inspection history, and staffing data on the CMS Care Compare website.

Medicare vs. Medicaid Coverage

Medicare Part A covers up to 100 days of skilled nursing care following a qualifying 3-day hospital stay. Days 1 through 20 are covered in full; days 21 through 100 require a daily copayment. Medicare does not cover long-term custodial stays.

Texas Medicaid covers long-term nursing home care for individuals who meet both financial and medical eligibility requirements. The application process includes an income and asset review plus a medical necessity determination. Because Medicaid reimbursement rates are lower than private-pay rates, not all facilities accept Medicaid residents for new admissions. Confirming Medicaid acceptance during the initial inquiry is important.

Nursing Home Costs in Houston

Private-pay nursing home costs in the Greater Houston area typically range from $6,000 to $9,000 per month for a private room, based on Genworth Cost of Care Survey data for Texas. Semi-private rooms cost less but are increasingly difficult to find as many facilities convert to all-private configurations. Costs vary by location, with facilities near the Texas Medical Center and inner-loop neighborhoods generally priced higher than those in suburban areas.

Evaluating Nursing Homes in Houston

Start with the CMS Five-Star ratings and the HHSC inspection reports to narrow your list. During tours, observe cleanliness, staff attentiveness, and how residents are engaged during common activities. Ask about RN staffing on nights and weekends, the ratio of nursing hours per resident per day, and how the facility handles transitions between short-term rehab and long-term care. Speaking with current families and reading Google reviews can add perspective that official ratings do not capture.