In this chapter, institutional long-term care for older people is addressed from a European perspective. A short historical overview is followed by some thoughts on how long-term institutional care may develop in the future, including a consideration of the role of informal care as a competing and complementary sector. It then describes the clinical profile of nursing home residents including reason(s) for admission, access issues, and length of stay. Thereafter, the types of care offered to nursing home residents will be described, with particular attention given to staffing and financing issues. Special consideration is given to the medical care of nursing home residents. Finally, we consider quality assurance in long-term care and how this is approached in different legislations before closing with a description of relevant themes and issues for research in the nursing home setting.