The effort to provide more long-term care in community-based settings has caused an expansion in the supply of assisted living beds, yet little is known about the interrelationship between this expansion and nursing home quality. This paper studies data from the State of Ohio to determine if nursing home market structure and the expansion in the supply of assisted living beds impact the quality of care provided by nursing homes. The findings suggest that nursing home quality can be lower in markets with a greater supply of nursing homes. Further, assisted living facility market structure is found to have a mixed effect on nursing home quality. The results of this paper suggest a need for a more integrated approach to regulating long-term care providers. Copyright 2012, Oxford University Press.