I think my general perception of the appearance of nursing homes has remained. My grandmother was just recently in one and the appearance was exactly as I imagined and that's not a compliment. They really don't look anymore home-y than a hospital does.
In terms of the caregivers working at nursing homes, I think my opinion has changed for the better. I know several people who work in nursing homes and they really enjoy working with the elderly and brighten their days, as well as taking good care of them.