Purpose: Nursing homes are considered to be the most restrictive housing alternative along the long-term care continuum. While improvements have been made since the Nursing Home Reform Act of 1987 was established, everyday life in many facilities remains less than optimal. For rural elders, who have fewer long-term care options than their urban counterparts, these concerns are especially cogent. The purpose of this research study was to examine the perceptions of rural older nursing home residents' ability to participate in decision-making at the facilities in which they reside. Methods: Subjects were recruited from three nursing homes in rural Iowa to participate in a focus group. Each group interview lasted about one hour. Participants provided demographic information and were asked a series of open-ended questions. Interviews were transcribed verbatim and major themes identified. Results: Twenty-one nursing home residents took part in four focus groups. There were 15 women and seven men. Their average age was 88.8 years. Participants lived in the facilities for 6 months to 14 years. Four major themes from the focus groups were identified: generativity, spiritual well-being, homelike environment, and privacy. Generativity, caring and showing concern for others, was an important behavioral motivation identified by participants. Several reported a sense of fulfillment and purpose in behaviors that benefited others. Spirituality was another important dimension of well-being for the residents in our focus groups. They spoke of both personal spiritual experiences as well as religiosity. Wanting a homelike environment resonated with virtually all of the participants of this study. Many spoke wistfully of the days when they could make decisions about the color of the walls, whether to walk outside, or what to eat for breakfast. Finally, residents placed a high value on privacy, addressing it separately from the desire for a homelike environment. One resident expressed this by saying “I would love to be by myself. It would make me feel at home. I could put my things where I want them around the room and be home.” Implications: Residents in the focus groups valued both quality of care and quality of life. While they attached importance to adequate numbers of and well-trained care-givers, they also treasured their decision making and autonomy. Results of this study underscore the importance of developing policies and procedures that promote decisional control in everyday matters of an older person's life. Staff need to be educated to approach residents from the perspective of “what does the resident want and how would she like to do it” rather than “what is good for the resident.” The NHRA provides the basis for this policy with its emphasis on quality of life. Regulatory barriers need to be handled in a holistic way, with state and federal regulatory bodies reviewing their policies together with quality of life as a guiding principle. Gerontological social workers employed in nursing homes need to advocate for policies that are based on the wants and needs of elders themselves and empower older persons to play a more active role in decision making.