Serious concerns persist about the quality of long-term care among policymakers and the public,including the users of the services and their families.Despite some improvements in recent years,nursing homes in particular remain the focus of continuing concern about the quality,cost,and accessibility of care and the adequacy of oversight and enforcement mechanisms.Debate also continues over the effectiveness and appropriate scope of state and national policies to regulate long-term care,reduce poor performance of providers,and improve the health and well-being of those receiving care.