In 2019, a new assessment tool for evaluating quality in long-term care facilities was introduced in Germany. The quality indicators are based on a linear understanding of quality, which appears obsolete in view of the many interacting influencing factors (actors, contextual factors). In the international literature, quality assurance in long-term care facilities is rather based on a systemic understanding of quality.This contribution to the discussion is to be classified against the background of the existing debate on quality assessment. Empirical results from two research projects supported by the Innovation Fund, Quality Measurement in Long-Term Care with Routine Data (QMPR) and Cross-Sector & Integrated Emergency and Care Management for the Last Phase of Life in Inpatient Long-Term Care (NOVELLE), are presented to highlight the complexity of quality in long-term care and to also point out the need to develop a systemic understanding of quality in long-term care in Germany. It is necessary to identify the diverse influencing factors in order to develop meaningful and robust quality indicators for long-term care.