The article deals with the development of institutionalized care and its overall discourse concerning the elderly sick people in Germany from 1924 to 1961. This period of time embraces an ambivalent process of modernization that falls short of any unilinear success story. Neither politics nor the medical sciences had the impact to make the nursing homes catch up with the advanced hospitals. They became low-grade institutions within the national welfare system. These homes evolved from poor-law houses with no specialized care whatsoever. The chronically ill and infirm old people emerged during the 19th century not as the result of straight forward professionalization. The Social Hygiene in the Weimar period and the racist paradigm of the Nazi-period turned a blind eye to the chronically ill elderly people well into the era of the murderous "euthanasia". At least in the second half of World War II chronically sick old people were increasingly regarded as so called "useless eaters" and, thus, doomed to be killed or starved to death. The mortality rate remained very high after the end of the war due to wide-spread hunger. The situation did not improve until 1948 and in the 50s this part of state welfare took advantage of the general expansion in the social and health care system.