Background Many ethical challenges and problems in nursing homes have been described. Decision-making can be complicated and the residents’ will is often uncertain. A previous study from our group showed that relatives often participate in ethics discussions whereas residents do not participate.

Aim The aim of the present study was to investigate how participation of residents in ethical decision-making in nursing homes can be improved.

Methods The Caritas Socialis in Vienna, Austria is a model of good practice for systematic ethics works in nursing homes. Four different arenas for discussion of ethical challenges are implemented in the organisation.Cases with residents participation in ethics meetings were documented in order to describe strategies to encourage residents participation.

Results Ethics meetings with participation of the residents where documented. In most cases the head nurse encouraged residents to participate in the ethics meting. Obstacles for the participation of the residents according to the staff were e.g. bad health status and cognitive impairment.

Discussion It seems to be important to encourage residents to participate in ethical-decision-making and ethics meetings. Probably the staff is too reluctant to include the residents because they fear that this may cause distress for the residents

Conclusion Residents should be encouraged to participate in ethics discussions whenever possible. The presented cases show that this is possible and worth doing.