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States should require that all beds in a nursing facility be certified for Medicaid and Medicare as a condition for the facility’s participation in Medicaid.

States should require adequate numbers of appropriately trained staff to ensure a high quality of care.

Quality measures: Participant preferences and satisfaction should be used as key quality measures.

The federal government should assume a much stronger role in ensuring the quality of services paid for by Medicaid in residential care settings.

Federal agencies should monitor the progress of state efforts in developing common definitions of, and minimum standards for, services and facilities in assisted living resi

The Centers for Medicare & Medicaid Services, the states, and all other regulators should vigorously enforce all regulations in long-term services and supports (LTSS) facilities and home care w

The federal government and the states should provide incentives (including, but not limited to, grants and loans) for new, affordable models of LTSS.