In Germany, quality assurance has enjoyed an important role in long-term care since the Act on Long-Term Care Insurance was introduced in 1995. The Act distinguishes three dimensions of quality, namely quality of the structure, the process and the outcome. Quality assurance is regulated by law at the national level and is differentiated into internal and external quality-assurance measures. The operators of care facilities have to ensure an appropriate level of quality in their services, facilities, staff and equipment. They are obliged to apply measures for quality assurance, to introduce a quality management system and to use expert standards. The providers of the benefits (the long-term care insurance funds and their Medical Advisory Boards) are responsible for external control, reporting and publishing the results of audits. The experiences so far with the external control system and the published transparency reports reveal some misleading results, however. The focus of the quality indicators on structure and process, and the procedures for compiling the results of the transparency reports have been at the centre of the criticism. A new reform of the long-term care system is planned, which must also take into account a new definition of being in ‘need of care’.