This paper examines the dynamics of the process of negotiation in a nursing home by focusing on the process of gaining advantage. The concepts of primary and secondary advantage are introduced in order to allow comparison and organization of the data. In the course of examining what rewards are possible and how they are achieved, we are able to see that the impetus to treat and the control of treatment action often lies with the staff of the home rather than the physician, that officially imposed definitions may be unfavourable to the persons they are imposed upon and that the process of deciding on everyday activities is often complex.