This report describes what is known about quality in various kinds of long-term care (LTC) settings. The report explores ways in which the federal government and states monitor LTC performance; the effects of recent changes in financing; staffing; and infrastructure, among others.

A number of recommendations are made that could improve quality, including investigating new quality measurements; strengthening state and federal survey and sanction activities; improving staffing; and exploring the effects of changes in reimbursement.