Long Term Care is custodial care - it has nothing to do with medical care.
Whether on Medicaid or Medicare or even being a dual eligible has no effect on getting Medical care - but only Medicaid covers the custodial care because the beneficiaries are poor and can't pay for this. Other people can pay for it - whether by buying LTC Insurance or paying out of pocket with their own assets. Others have family that may want to do it out of some loyalty or maybe just to preserve those available assets for themselves.
Custodial care that is covered under any LTC policy are those things that everybody has to do for themselves or as provided by others if they cannot do so on their own in their DAILY LIVING - eating, dressing, bathing and other hygiene measures, using the bathroom, etc.
AARP.org - Understanding & Making Senses of your LTC Insurance options
In the case of LTC you are talking about a person needing help with doing these daily living things and that is expensive especially when we want to pay the caregivers a living wage - and that does not matter where the care is given - at home, in an assisted living facility or in a nursing home.
Quality is a personal measure - just like everything else in this society - you get what you want to pay for - car, house, long term care
The government when it pays for this LTC for people on Medicaid that need it, has certain standards that have to be met - especially if they are in a facility and not just hiring people on their own. Those standards really aren't different than what a person that is paying out of pocket is getting.
However there maybe less choices or different choices - say, like different food - steak rather than hamburger. This kind of "quality" differences are applicable for all things in the daily living care realm -
what you get based on what you pay. You can buy a Ford Escort or you can buy a Lexus LS 500. They both do the same thing - getting one from point a to point b.
It is your financial assets to do with as you please - If you have them, you can spend them all on yourself including paying for your LTC or you can have a family member take care of you and perhaps pay them with your assets or you can have a lawyer hide your assets in some irrevocable trust so you look like a pauper on paper and get Medicaid.
Personally, I like choices - choices that I can pick from based on my ability to pay - those choices may not be a Lexus LS 500 but they won't be a Ford Escort either.