OBJECTIVES: We examined how state regulations for long-term care facilities address environmental sanitation. METHODS: State regulations for nursing homes and assisted living facilities across all 50 U.S. states and the District of Columbia were sourced from government websites. We searched using key terms about environmental sanitation and then quantified our findings to answer four questions. RESULTS: More states required infection preventionists in nursing homes (29 states) than in assisted living facilities (14 states). References for environmental service workers appeared more frequently in nursing home regulations (22 states) than in assisted living regulations (6 states). Infection control training was required more often in nursing homes (32 states) than in assisted living facilities (27 states). Gloves were the most common personal protective equipment cited, addressed in 14 state nursing home regulations and 13 state-level assisted living regulations. Only 7 state nursing home regulations and 2 assisted living regulations addressed carpet, with only 6 addressing high-touch items. CONCLUSION: State regulations inadequately address environmental service workers, staff training, carpets, and high-touch items. These regulatory gaps could pose significant risks to long-term care residents if infection control policies and procedures rely solely on regulatory requirements.