But what about meaning? What about purpose and hope? These are the intangibles that are harder to provide and impossible to monitor and regulate. That's why any state ranking of nursing homes based on "deficiencies" gives you only limited information.

Nursing homes that receive Medicaid funding are required by government oversight to have an activities program. "But what ends up happening is the activity sinks to the lowest common denominator," Morrison says.

Providing meaningful activities for the old-old, says Scott Wright, director of the University of Utah's Gerontology Interdisciplinary Program, "is a sleeping giant." That includes the old-old who live in their own homes or the homes of their grown children, although the lack is most conspicuous for those who live in facilities.

Beth Baker gets to the crux of the problem in her book "Old Age in a New Age." Activities, she argues, "are not about filling up the hours between meals and before bedtime. They represent whether the day — and by extension the lives of the residents — has meaning."

Of course, it's possible to bring meaning to one's life even if your main activity is bingo. The core of what's meaningful to you, says Morrison, might be nature or your religion or simply the "continuity of existence." Still it's not hard to see that there's an aimlessness that inhabits many nursing homes, even amid the outings and the crafts.

A typical nursing home calendar might list bingo, sing-alongs and something called "dice bowling." One local nursing home lists "Lawrence Welk" as a weekly activity.

If you walk the halls there on a Saturday evening, glancing into residents' rooms as you pass by, you will in fact see the benevolent face of the long-dead band leader on many of the TVs. There's something comforting in Welk's sing-song, sunny delivery, something timeless about seeing Myron Floren on the accordion playing another polka. It would be easy to write off "Lawrence Welk" as a meaningless activity — but to do so might reflect the easy arrogance of a person who has the luxury of doing whatever she pleases on a Saturday night.

"How effectively can we as healthy people judge the quality of life of people in facilities?" asks Utah Commission on Aging director Maureen Henry. "I think the data show that people in facilities consistently rank their quality of life higher than others would rate it."

What are the elements of a good life for a 90-year-old with impaired cognitive capacity, and how can we practically provide that? Henry asks. "I don't think we know."