Nursing homes with 30 to 50 percent of residents suffering from organic brain disorders are no longer uncommon today. Aging individuals with mental illnesses are also placed in care facilities for cost reasons. The caregivers, who are not qualified to handle these specific needs, feel significantly burdened by dealing with aggressive, confused, and depressed residents. Nevertheless, care services are increasingly provided by fewer and less well-trained staff. As a result, the living conditions, especially for people with dementia, often resemble a custodial environment. There is a lack of adequate psychosocial support and its funding. This paper addresses the question of what specific competencies and content social work can contribute to institutional elderly care, given the current framework conditions.