Florida and Iowa have developed and initiated reward and recognition programs as part of their quality improvement efforts. The goal of these programs is to recognize facilities doing exemplary work. These programs received positive feedback from both providers and consumer advocates. Providers view them as tools for combating the negative stereotype of nursing homes so often presented to the public. Consumer advocates present them as potentially useful sources of information for elders and their families making long-term care decisions. There is concern, however, that these types of programs are focused on facilities that already deliver quality care, and may divert state attention from the facilities with the quality problems.