Older adults living in nursing homes are highly vulnerable to patient safety problems. Based on 47 articles, this integrated literature review identified three categories of systemic factors impacting the safety and health outcomes of older adults living in nursing homes. The categories include personal factors (e.g., medical needs, specialized care needs), institutional factors and characteristics (e.g., staffing and skill mix, safety culture, staff training and education), and policy/external support factors (e.g., finances, primary payor source).