Nursing homes have been an essential environment of care for older adults for many years. However, although there has been greater emphasis on quality of care in nursing homes over the past several decades, research describing care within these environments in the United States and Ireland is sparse, leaving the potential for disparities between standards of care and care provided. In fact, available reports for both countries underscore these potential disparities. In a national survey of nursing homes conducted in Ireland (Murphy, O'Shea, Cooney, Sheil, & Hodgins, 2006), public homes, including government-funded geriatric hospitals, welfare homes, and community nursing units, were compared with private facilities, which are run by residents and families or through fund-raising efforts. The study revealed poor physical environments within many public homes and very significant differences in staffing levels between public and private facilities, with public nursing homes having higher levels of staffing and twice as many registered nurses per 100 residents as compared with private homes. In the United States, a report prepared by the House Committee on Government Reform for Representative Henry A. Waxman (D-CA) found that in the 2-year period between January 1999 and January 2001, more than 30% of the nursing homes in the United States (5,283 nursing homes) were cited for an abuse violation (Waxman, 2006). These represent approximately one third of U.S. nursing homes (National Long Term Care Ombudsman Resource Center, 2007). Nursing homes in the United States and Ireland are regulated by government agencies designed to ensure quality care delivery. In Ireland, nursing homes (both private and public) are regulated under the Health (Nursing Homes) Act of 1990. State departments of public health are also charged with nursing home survey certification in the United States through the Centers for Medicare and Medicaid Services. In both countries, the regulatory mechanisms have been criticized. In Ireland, it has been noted that the language used in the Health (NursingHomes) Act is open to differences in interpretation and that, thus, standards are difficult to enforce (National Council on Ageing and Older People, 2000). Moreover, the public sector is exempt from the quality controls and inspections that apply to the voluntary and private sectors in Ireland. This gives rise to fears of a two-tier system (O'Shea, Donnison, & Larragy, 1991). In the United States, the regulatory mechanisms are criticized for being too stringent or not stringent enough, with a general lack of consistency in survey and certification procedures and great state-by-state variation in the number and type of deficiencies and penalties imposed (White et al., 2003). The purpose of this analysis was to provide a portrait of nursing homes in the United States and Ireland to identify common problem areas with the potential to enhance nursing care delivery in both countries. The comparative variables included the following: type of facility; number of beds; occupancy rate; resident profiles; staffing patterns; average room rate; and activities of daily living (ADLs). The article concludes with a discussion of three critical differences between the nursing homes in both countries and provides a framework for improvement and potential policy implications.