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This paper provides an analysis of the current long-term care environment based on the concept of the Iron Triangle of Health care: Quality, access, and cost-containment. These are evaluated and examined in relation to stakeholders in long-term care, including Hawaii. Analyzing this relationship provides greater understanding to appropriate decision making made by long-term care stakeholders. This analysis discusses the importance of each factor and its influence on outcomes in the long-term care environment. Based on this study, implications, and strategies for stakeholders to address quality of care, access to care, and cost-containment in long-term care are recommended.