My Disclaimer

I have been battling nursing homes and assisted living facilities since the early 1990s. If I have learned anything, it is that families struggle – and for good reason – to find ‘the best’ nursing home out there. Who doesn’t want the best? But as I am going to offer you some insight, just know that there is no specific and dependable criteria upon which you can rely in making that decision. But, maybe what I tell you here will help you get started and have a better overall experience.

Who Runs These Homes?

So there is no confusion, when I say ‘nursing home,’ I am referring to all long-term care facilities, including skilled nursing, rehab and assisted living facilities. So, let’s just jump right to the bad news. To protect nursing homes from facing juries for their neglect – which at times can be just plain awful – the Texas legislature has created a system that permits ownership to be in hospital districts, which enjoy immunity from litigation due to their being governmental, even if by name only. As of the date of this blog in 2026, of the 1177 skilled nursing facilities licensed and operating in Texas, 904 are owned by these districts. At the same time, however, they are often managed by a corporation, LLC, or some other type of entity. If these management companies are not government-affiliated, they can be held liable through private lawsuits. To see every such facility in Texas and your particular county, visit the HHS website at:  Nursing Facilities (NF) | Texas Health and Human Services.

So How Do We Know Which Ones Are Best?

First, since you are probably going local, do what I do when I have to choose a doctor: ask a family member or trusted friend. I have handled and investigated a lot of potential medical malpractice cases. So, if I have never heard anything bad about a doctor, that is probably a good start. And of course, if I have heard the good news about one, that is a good start as well.

The same applies to nursing homes. Consider the sources. Do you know them to actually be a good judge of the same issues that may arise with your family member, or was their loved one there for mere rehab for only a couple of weeks? If you hear absolutely nothing but glowing reports, it is probably as good as it is going to get.

Walk in the facility. Does it stink like urine? If it does, walk out and don’t come back unless you have to. Most all facilities are understaffed, and the staffs are undertrained and underpaid. The actual daily care is given 95% of the time by nurse aides who have two weeks of basic training. So, just know that going in and be prepared to visit.

Another good place to start is with ‘Nursing Home Compare,’ and here is the link: Find Healthcare Providers: Compare Care Near You | Medicare. The CMS also uses a 5-Star system to rate facilities. The latest guide explaining how it works is linked here.

Concluding Remarks

Entities have to make a profit to stay in business. When I do this work, it is not my goal to put them out of business. I understand that businesses are only as good as the people who run them, and that we can only hope the nursing home we choose is not in it just for the money. But when you find the home you hope will be ‘the one’ and the only one you have to choose, consider these simple rules to live by:

• Again, if it stinks, does it ‘always’ stink and why? I can almost guarantee it is due to a lack of staffing and poor administrative management;
• Come and go at varying times so the staff does not learn your routine. Surprise visits will often be a surprise to the staff that exposes some neglect you can discover and ensure it is addressed as needed. They will learn the routines of family visits;
• If bed-bound or if you expect poor hygiene, put a little mark on a certain location of the sheets and see if they are changed as they should be;
• If wheelchair-bound, put a little chalk mark on the belt or place something on them that will have to disappear if your loved one is moved at least every two hours as required;
• Know what the ‘care plan’ says about the need for assistance with different tasks, like walking, eating, restroom, whatever it may be. Have they digressed to the point they need assistance now, or perhaps two people assisting instead of one? Be on top of that;
• Put in a ‘granny cam’ to help keep an eye on them. Facilities absolutely hate these;
• Watch where they put water for immobile residents. It is often out of reach of the resident so that dehydration occurs;
• Be there when they weigh them so that you can ensure they are eating. Don’t trust the aide when they say they are eating well;
• If they have bedsores, ensure they are rotated as required to keep them off pressure points. Also, schedule to watch a treatment so that you can see them unbandaged and judge for yourself whether they are getting better;
• If the resident likes fast food or certain things they don’t provide – assuming they can eat or drink without violating doctor’s orders – bring as much as they want. The little things in life are now the big things, and let them dictate if possible. Help them feel like they are not stuck in a nursing home!

Just understand that no nursing home will be perfect. Get to know the aides and the licensed nurses that oversee them. Don’t be mean – you get more with honey that you do with vinegar – but know your rights and constantly remind them if you need. The elderly often will love their nurse assistants and staff, even when they are being abused due to it being subtle abuse that I often see with the most vulnerable, and often because they are the most vulnerable. They often don’t understand and will fight your attempt to remove them to another facility, so try to make this one work if at all possible.

Over 75% of all residents never have a visitor, and as such, some of them never stand a chance. Don’t let your family member be one of them. As much as possible, let them control their existence or at least believe they are, and I know that most will appreciate you and understand that you did right by them to the extent you could.

Call us at (903) 819-0720 or Email today for your free consultation, and let us stand up for you — so you can focus on healing and getting your life back.