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Census 2025 estimates · CMS September 2026 · CDC 2020

Senior housing development in Texas

Texas had 1,938,615 residents aged 75 and older in July 2025, +28.1% since April 2020 (US +23.4%), and 461,222 aged 85 and older (+16.1%). Its 1,177 certified nursing homes hold 133,493 beds, 289.4 for every 1,000 people 85 and older, more than the US ratio of 222.6. Certificate of need for nursing home beds: no; for assisted living: no.

Age 75+ (2025)
1,938,615
Growth since 2020
+28.1%
Nursing beds per 1,000 aged 85+
289.4
Assisted living beds per 1,000 aged 75+
31.6

Demand: the older population

Age groupApril 2020July 2025ChangeUS change
75 and older1,513,5401,938,615+28.1%+23.4%
85 and older397,122461,222+16.1%+11.3%

Nationally, the Census Bureau's 2023 projections have the 75+ population growing 21% from 2025 to 2030 and the 85+ population 59% from 2025 to 2035. The bureau publishes those projections for the US only, not by state.

Supply: licensed beds

SettingBedsPer 1,000 aged 75+Per 1,000 aged 85+Source
Nursing homes (Medicare or Medicaid certified)133,49368.9289.4CMS, September 2026
Residential care / assisted living61,20031.6132.7CDC survey, 2020

US: 222.6 nursing beds and 170.1 assisted living beds per 1,000 aged 85+. Assisted living beds are CDC's 2020 survey estimate, its latest with state detail, set against 2025 population, so the ratio understates any supply added since.

Certificate of need

Nursing home beds
No
Assisted living
No
Notes
Texas controls Medicaid nursing bed certification separately

From NCSL's certificate of need table (updated April 29, 2025, covering January 2025) with later changes checked on state sites on October 24, 2026. "Not listed" means NCSL does not name assisted living, not that it is exempt. Confirm with the state health planning agency before relying on it. HUD requires a state CON for nursing home beds where the state has one (Handbook 4232.1, 2.5.EE).

Counties

The 25 counties with the most residents aged 75+, with certified nursing home beds per 1,000 aged 85+.

CountyAge 75+Since 2020Share of populationAge 85+Nursing homesBeds per 1,000 aged 85+
Harris County261,031+32.1%5.2%61,89297187.8
Dallas County138,700+22.4%5.2%33,85582316.6
Bexar County130,367+26.0%6%31,54862243.4
Tarrant County125,486+28.5%5.6%29,66472306
Collin County67,917+48.9%5.2%15,37722171.7
Travis County65,222+39.1%4.7%15,35128208.7
El Paso County56,464+16.8%6.4%14,76622175.1
Denton County54,381+53.9%5.1%11,92918164.1
Fort Bend County52,444+61.9%5.4%10,73015140.9
Hidalgo County52,161+23.7%5.7%12,50922221.6
Montgomery County47,172+45.9%6%10,20812163.9
Williamson County44,804+46.8%6%9,99815180.5
Cameron County29,701+22.2%6.8%7,27014230.1
Galveston County26,848+33.1%7.2%6,43112229.8
Nueces County26,026+21.9%7.4%6,50814268.1
Brazoria County23,775+34.7%5.7%5,50413274.3
Bell County22,255+34.0%5.5%5,32916339.7
Smith County21,697+21.0%8.6%5,68217349.3
Lubbock County20,418+18.7%6.2%5,13815341
McLennan County19,912+21.4%7.3%5,29918455.6
Jefferson County17,774+12.7%7%4,76014366.6
Comal County17,483+43.7%8.4%3,9046209
Hays County16,279+60.9%5.3%3,4646209.9
Guadalupe County13,447+38.5%6.7%3,1028314.6
Johnson County13,361+29.1%6.1%2,9929379.3

Fastest growth in the 75+ population

  1. Fort Bend County: +61.9% (52,444)
  2. Hays County: +60.9% (16,279)
  3. Chambers County: +55.8% (2,992)
  4. Denton County: +53.9% (54,381)
  5. Collin County: +48.9% (67,917)
  6. Rockwall County: +48.4% (8,252)
  7. Williamson County: +46.8% (44,804)
  8. Montgomery County: +45.9% (47,172)
  9. Bastrop County: +45.2% (7,715)
  10. Comal County: +43.7% (17,483)

Counties with at least 2,000 residents aged 75+.

Fewest nursing beds per 1,000 aged 85+

  1. Fort Bend County: 140.9 (1,512 beds, 10,730 aged 85+)
  2. Randall County: 142.4 (346 beds, 2,429 aged 85+)
  3. Montgomery County: 163.9 (1,673 beds, 10,208 aged 85+)
  4. Denton County: 164.1 (1,957 beds, 11,929 aged 85+)
  5. Collin County: 171.7 (2,640 beds, 15,377 aged 85+)
  6. San Patricio County: 174.4 (187 beds, 1,072 aged 85+)
  7. El Paso County: 175.1 (2,585 beds, 14,766 aged 85+)
  8. Williamson County: 180.5 (1,805 beds, 9,998 aged 85+)
  9. Walker County: 184.7 (246 beds, 1,332 aged 85+)
  10. Harris County: 187.8 (11,621 beds, 61,892 aged 85+)

Counties with at least 1,000 residents aged 85+.

HUD Section 232 construction in Texas

Since fiscal 2001 HUD has insured 39 new construction or substantial rehabilitation loans on care facilities in Texas (30 assisted living, 8 nursing homes), $285.5 million of original principal, 3 of them since fiscal 2016.

  • FY2022: Legacy Nursing and Rehabilitation, Bryan, nursing home, $9 million
  • FY2020: Worthington Manor, CONROE, assisted living, $29 million
  • FY2017: Sundara of Round Rock, Round Rock, assisted living, $3.7 million

Planning a building in Texas? Model the budget, lease-up and a HUD 232 construction loan.

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Sources: Census Bureau Vintage 2025 county population estimates; CMS Nursing Home Provider Information (September 2026); CDC/NCHS National Post-acute and Long-term Care Study (2020); HUD Office of Healthcare Programs endorsement database (data run 07/08/2026); NCSL. Absorption is operated by Janover Capital LLC and is not affiliated with any of them. Methodology.