Many older people living in care homes have an "unacceptable quality of life" and quickly become institutionalised, says a watchdog.
A review of homes in Wales said they were seen as places of "irreversible decline" where residents were unable to do things that matter to them.
The report was published by the Older People's Commissioner for Wales.
The Welsh government said it was already taking action on issues raised in the report, A Place to Call Home?
Care Forum Wales, which represents 500 care providers, said the findings support what it has long been saying.
Experts in health and social care undertook unannounced visits to 100 care homes across Wales.
And more than 2,000 questionnaires were completed by care home residents and their families.
The report's key conclusion was: "Too many older people living in care homes quickly become institutionalised. Their personal identity and individuality rapidly diminishes and they have a lack of choice and control over their lives."
It looked at residents' social participation, their home environment, diet, staffing and training as well as commissioning, regulation and inspection of services.
Commissioner Sarah Rochira called "for action to deliver the change required within our care homes and ensure that quality of life sits at the heart of the delivery of residential and nursing care across Wales".
Nurse gives elderly woman a drink The Welsh government said it was "already taking action on many of the areas highlighted"
She said: "While my review found excellent examples of truly person-centred care, enabling and empowering care that delivers the very best outcomes for older people, there are significant variations across Wales that result in too many older people living in care homes having an unacceptable quality of life."
The review was undertaken using the commissioner's statutory powers which means care providers and public bodies have to act on the findings.
Care and Social Services Inspectorate Wales (CSSIW) chief inspector Imelda Richardson said it had moved away from a tick box culture to focusing on quality of life of people during its inspections of older people's care homes in Wales.
She said while the majority of care homes provide good or excellent care, there is "still an unacceptable level of care in some homes".
Care Forum Wales chair Mario Kreft said the report did not "fully recognise what is being achieved despite the system".
He supported a call for services being commissioned for quality rather than reinforcing a "culture of compliance to the bare minimum".
He added: "The commissioning process should be about quality and securing value for money and not about paying the lowest possible price."
A Welsh government spokesperson said: "The Welsh government, for its part, is already taking action on many of the areas highlighted in this report through a draft Bill to strengthen the regulation and inspection of social services.
"We expect the care sector to consider this report carefully - as the Welsh government will - and reply to the Older People's Commissioner's specific points."