Why are Texas nursing homes considered the worst in America?

As a Houston, Texas medical malpractice lawyer, from time to time clients or friends ask me for a recommendation of the good nursing homes in the Houston area. I always answer the same way, “I’ll let you know when I find one.”

Nursing home negligence

In my experience, most Texas nursing homes have inadequate staffing to take care of patient needs and largely absentee physicians.

I’ll never forget taking the deposition of the defendant physician, a Sugar Land hospitalist, in a nursing home medical malpractice case. He testified under oath that he met the standard of care so long as he saw a new patient within 21 days of admission to the nursing home.

Unfortunately, in that wrongful death case, this hospitalist had never seen the patient before, yet prescribed powerful narcotic medications that lead to her death before he ever got around to seeing her. The autopsy report showed that she died of overmedication toxicity.

From the many cases that I have handled where nursing home care was at issue, I have seen three common areas of negligence.

First, because of inadequate, disinterested, or incompetent nursing and personal care assistant staffing, patients or residents are often not cleaned or turned enough to prevent bedsores or pressure ulcers/sores from developing.

Second, many nursing home patients or residents need assistance to get out of bed or move around. Unavailable or poorly trained staff often contribute to a surprisingly high number of falls some falls are devastating, resulting in broken bones and hips. I have seen many instances where these falls were not reported or documented by the nursing staff. Some medical research suggests that patients have a lower risk of falling at home than they do in a nursing home.

Third, some nursing homes tend to over medicate their patients and residents with painkillers to keep them quiet, rather than addressing their care needs. In addition to quality of life concerns, overmedication poses specific risks. First, many nursing home patients take several medications, so adding additional painkillers pose the risk of polypharmacy or dangerous drug-drug interactions. Second, powerful painkillers can cause patients to be sleepy and nonresponsive, posing a risk of aspiration, which can develop into deadly pneumonia.

Texas nursing homes are considered the worst

The word has gotten out that Texas nursing homes are the worst in the country. The San Antonio Express-News recently published an article highlighting how Texas has more nursing homes penalized with payment suspensions than any other state.


Over the past three years alone, 260 nursing homes were hit with this severe sanction. To put that in perspective, that’s 21% of all nursing home facilities in the State of Texas. Adding to that, Texas ranked second in America for the number of serious deficiencies identified per nursing home. Over 25% of nursing homes in Texas were cited with serious deficiencies.

There could be a lot of debate over why Texas nursing homes perform so poorly. In my view, one of the big reasons has to do with the 2003 round of tort reform. Nursing home liability for noneconomic damages is limited to $250,000. Virtually all nursing home patients or residents aren’t employed. Therefore, if they die in the nursing home from poor care, the total maximum recovery in a malpractice lawsuit would be $250,000. That limited accountability and liability exposure does not incentivize nursing homes to provide quality care.

What you can do

Some families lack the physical or housing resources to be able to take care of elderly loved ones and must rely on nursing home care. In those situations, I recommend frequent family visits to monitor the nursing home care that is being provided. Make your visits at different times of the day, so the nursing home providers will not know when to expect you.

Look for things like a dirty room, whether the patient’s bed linens are clean, and talk with the patient about any problems in getting the attention of the nursing staff. Introduce yourself to the care providers and charge nurse and make sure that they know how to get in touch with you in case there is a problem.

We are here to help

If you or a loved one has been seriously injured or even died because of poor nursing home or hospital care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.


All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.