For several decades, there have been efforts to "reform" nursing homes. Despite this, the calls for such reform continue unabated. Therefore, it might lead us to ask just what has been accomplished to date, and whether it is on the right track. True reform of health care-including long-term care-requires a strategy. A key part of that strategy is that the care must conform to some universal and enduring biological and philosophical principles. Otherwise, alleged reform is likely to be a misnomer and an illusion. This article-the first in a series-identifies those key principles and their relationship to improving attributes of care quality; especially, whether care is safe, effective, and person-centered. It considers the implications for nursing homes as well as the disciplines and individuals who provide care. It then suggests broader implications for public policy-including initiatives to oversee and improve the care-and for evaluating the relevance and effectiveness of those efforts.