Using empirical evidence, this paper provides conceptual approaches to prevention and health promotion in long-term care - an area that has gained only limited attention in German discussions on prevention. First, a short analysis of long-term care in Germany is provided; existing problems but also resources with regard to prevention and health promotion in order to identify starting points for the development of interventions are presented. The existing pressure and problem accumulation in long-term care that calls for action on maintaining and promoting the health of long-term care professionals as well as long-term care users are illustrated. Considerations on programs for health promotion in long-term care focus on the users, in particular the oldest old, of long-term care. Finally, considerations on a conceptual framework for a user-oriented approach to prevention and health promotion in long-term care is presented.