Texas business
Who runs and owns Texas nursing homes?
Five affiliations accounted for 41% of certified Texas nursing-home beds. See who holds the licenses, where property ownership is visible and how staffing compares.
Five nursing-home groups accounted for 41% of Texas’s certified beds in the October 2026 federal directory. But 628 homes the federal directory classified as for-profit had a public-entity licensee in the matched Texas files. A hospital district can hold the license while a company runs the home and a real-estate investor owns the building. The affiliation is a starting point for checking each home’s staffing and inspections. CMS Care Compare provider file · Texas HHSC nursing facility directories
Five groups covered 54,365 beds
| CMS affiliation, October 2026 | Texas facilities | Certified beds |
|---|---|---|
| Creative Solutions in Healthcare | 150 | 17,731 |
| AVIR Health Group | 118 | 12,935 |
| The Ensign Group | 86 | 10,605 |
| Wellsential Health | 67 | 8,695 |
| Cantex Continuing Care | 37 | 4,399 |
| Five-group total | 458 | 54,365 |
The October file covered 1,177 homes and 133,481 certified beds. Its chain names use reported ownership and management relationships, so the group totals show affiliated capacity. Of those homes, 233 had no named chain in the file. The legal business name and operator can still be checked through enrollment and licensing records. CMS affiliation methodology · CMS skilled nursing ownership file
Texas’s Quality Incentive Payment Program recognizes non-state public facilities through the public entity’s license and Medicaid contract. Qualifying private facilities can also participate. At Monument Hill, for example, federal records name Winnie-Stowell Hospital District as the legal business, Wellsential as the chain and a Regency entity as manager. The listed relationships don’t identify who holds title to that property. Texas QIPP rules · CMS ownership data
The landlord is harder to identify
Omega Healthcare Investors disclosed 80 Texas skilled nursing properties at year-end 2025. Its property filing provides a state total. Matching an individual building to a parent requires the entity and address. At AVIR at New Braunfels, federal records list an operating LLC named for its address, and an associated property LLC appears in Welltower’s subsidiary list. The property LLC’s connection to Welltower is documented. A current deed would be needed to confirm title to that parcel. Omega 2025 annual report, Item 2 · CMS owner and additional-party file
The September 2026 enrollment extract had 20,865 owner, manager and other disclosed-party rows for Texas. The private-equity field was blank in 12,913. CMS suspended the January 1, 2026 deadline for expanded revalidation reporting. Those blanks limit what the data can show about private-equity ownership. For the same reason, the 297 affirmative REIT rows include relationships other than landlords, such as mortgage interests. CMS skilled nursing disclosure guidance
Nursing hours rose, but weekends remained thinner
Texas homes reported 3.34 nursing hours per resident-day in 2025, about five minutes more than in 2023. The 2025 weekend average was 2.93 hours, around 24 minutes below the all-days average. Registered nurses accounted for about 24 minutes of the 2025 all-days figure. CMS Payroll Based Journal
| Year | All nursing hours per resident-day | Registered nurse hours | Weekend nursing hours |
|---|---|---|---|
| 2023 | 3.249 | 0.346 | 2.828 |
| 2024 | 3.295 | 0.376 | 2.888 |
| 2025 | 3.335 | 0.399 | 2.931 |
In April–June 2026, Creative Solutions reported about 13 fewer paid nursing minutes per resident-day than comparable facilities in other named chains. Cantex reported about 11 more. AVIR’s one-star inspection share was roughly 10.5 percentage points higher than in its matched comparison. Wellsential’s share was about 13.3 points lower even though its matched staffing ran lower. The comparisons use different groups of peers, and some inspection histories reach back before today’s affiliations. CMS staffing methodology · Care Compare technical details
How we got this
Ownership uses the September 2026 enrollment file, October 2026 Care Compare affiliations and the matched state license directories. County property records were reviewed for four homes, with two parcel-to-public-parent matches and no certified title review. Staffing weights each facility’s hours by resident-days. Peer comparisons match facilities on size, metro status, nursing case mix, hospital status and federal ownership classification. These are observed gaps, with no causal attribution to an operator or landlord.
For a family choosing a home, the weekend staffing, recent inspections and changes at that address tell you more than the chain name alone. Medicare Care Compare
Sources
- CMS Care Compare provider file
- Texas HHSC nursing facility directories
- CMS affiliation methodology
- CMS skilled nursing ownership file
- Texas QIPP rules
- Omega 2025 annual report, Item 2
- CMS skilled nursing disclosure guidance
- CMS Payroll Based Journal
- CMS staffing methodology
- Care Compare technical details
- Medicare Care Compare
Supporting material
- Article table · Five groups covered 54,365 beds ↗The rows printed in this article as a CSV file.
- Article table · Nursing hours rose, but weekends remained thinner ↗The rows printed in this article as a CSV file.