The aim of this study is to structuralize a model of the factors determining the quality of nursing care perceived by the director or manager of a long-term care facilities (hospitalization of patients) using FSM(Fuzzy Structural Modeling), employed in structuralizing social systems. The results were as follows: first, quality in the top tier was shown to be connected with job commitment, commitment to the organization, work experience, care skills, knowledge about the elderly, training and education, which are factors in the middle tier; and second, the structure of the middle tier (job commitment, commitment to the organization, work experience, care skills, knowledge about the elderly, training and education) either showed a connection with the lower tier, which includes employment type, job satisfaction, leadership, relationship with users and workplace relationships, or showed a connection among the factors within. These results confirmed the following: first, care skills and knowledge about the elderly, which demonstrate the job expertise of caregivers, showed a connection with service quality based on work experience; second, job commitment in the middle tier was observed to affect various factors in the same tier such as care skills, knowledge about the elderly, training and education amongst others, and it was determined that it is an important determining factor in service quality. Lastly, a meaningful result was shown in relation to leadership. The leadership skills of the director of the facilities had a connection with the care caregivers' commitment to the organization, which had a connection with service quality. This structure showed the kind of role the director must play in order to improve service quality.