In spite of considerable interest and anecdote, the degree to which plants, animals, and children are present in long-term care, and the impact of these interventions on resident outcomes, has received relatively little empirical attention. As part of a longitudinal study of 193 residential care/assisted living (RC/AL) facilities and 40 nursing homes (NHs) in four states, the presence of plants, animals, and children in study facilities was assessed, and nearly 3000 subjects were followed longitudinally for a year. Data were analyzed to identify the relationship of plants, animals, and children to mortality, hospitalization, and the rate of resident decline in activities of daily living (ADLs). The majority of both RC/AL and NH facilities provided their residents with little or no contact with plants, animals, or children. In longitudinal analyses, the presence of plants was associated with 4 unfavorable and 1 favorable outcome (out of 24 comparisons made), the presence of animals was associated with 3 favorable and no unfavorable outcomes (out of 24), and the presence of children was associated with no significant outcomes. While the study had limitations, the trend for animals and not plants to be associated with favorable outcomes may represent a true effect based on interactions between animals and residents. The lack of results regarding children may be due to the overall low prevalence of child-resident interactions.