San Antonio, Texas's Bexar County seat, has 59 Medicare-certified nursing homes with approximately 7,344 beds. Families should research carefully—quality varies significantly from one facility to the next.

San Antonio vs. Texas: A Concerning Gap

San Antonio nursing homes fall below the state average on key quality metrics. The city's average CMS rating of 2.39 stars trails Texas's statewide average of 2.79 stars by nearly 0.4 stars—a significant gap that families should take seriously. The below-average performance is somewhat surprising for a major urban area, where competition and workforce availability typically drive higher quality.

Federal inspection data reveals 23 facilities classified as high-risk based on patterns of serious deficiencies, complaints, or CMS enforcement actions. Only 7 of 59 facilities earn a B grade or better, meaning families should be prepared to look beyond the closest option to find quality care.

Understanding Our Trust Score System

The Trust Score is a 0-100 rating calculated from CMS's official nursing home database. The score combines five data categories:

• Health Inspection Results — Recent deficiencies, their severity, and patterns over time
• Staffing Levels — RN hours, total nursing hours, and weekend staffing
• Quality Measures — Clinical outcomes like falls, pressure ulcers, and rehospitalizations
• Penalties — Fines, payment denials, and enforcement actions
• Complaints — Substantiated complaints and their severity

In San Antonio, 7 facilities score a B grade or better, indicating they meet quality benchmarks across these categories. We recommend families prioritize these facilities and carefully research any facility rated C or below before visiting.

Staffing: A Significant Concern in San Antonio

Staffing levels are among the most important predictors of nursing home quality. Research consistently shows that facilities with more nursing staff—especially registered nurses—have better outcomes for residents.

San Antonio facilities average 0.38 RN hours per resident day, which falls below the CMS-recommended threshold of 0.75 hours. The typical San Antonio resident receives approximately 23 minutes of RN attention daily—compared to the 45 minutes experts recommend.

7 San Antonio facilities exceed CMS staffing recommendations. Families prioritizing staffing should look for facilities with the "Top Staffing" badge and ask specifically about RN hours during facility visits.

Ownership: Mix of For-Profit and Non-Profit

San Antonio has 8 non-profit nursing homes and 41 for-profit facilities. 45 of 59 facilities are chain-owned, with the remainder independently operated.

Research suggests non-profit facilities often have higher staffing levels and fewer deficiencies on average, though ownership type alone does not guarantee quality. Families should evaluate each facility individually using inspection data, staffing levels, and recent deficiency reports.

Nearby Alternatives Worth Considering

San Antonio's below-average ratings mean families may benefit from expanding their search to nearby cities. The following Texas cities offer multiple nursing home options:

• Houston — 61 facilities
• Dallas — 35 facilities
• Fort Worth — 30 facilities
• Austin — 25 facilities
• El Paso — 21 facilities
• Lubbock — 14 facilities