Aim: to investigate whether the carers’ approach could be explained as referring to the clinical picture or the fact that the patient had a diagnosis of schizophrenia. Background: In institutional care, a symptom-oriented approach is a frequently used but seldom-discussed method for treating people with severe mental illness. Design/method: An exploratory study of the staff’s view of a caring approach for a fictitious elderly long-term schizophrenic resident was conducted. All the carers working in the field of psychiatry at seven different units in one municipality in northern Sweden were an integral part of the study. The units were divided into two groups and classified as ‘dwelling’ and ‘support’. The ‘dwelling group’ was characterised by carers working at traditional group dwellings, the ‘support group’ by carers working in small teams and visiting people with long-term mental illness in their homes. Answers were received from 62 women and 23 men, of whom 14 were RNs and 69 were ENs. Measurements: A questionnaire was used; it was developed from a case description of a 68-year-old woman with typical symptoms of severe cognitive decline with problematic behaviour and a diagnosis of long-term schizophrenia. Findings: The main finding in this study is that carers with long experience become less sensitive in their relationship with the resident than less experienced carers. There appears to be a tendency for long work experience to have a negative effect on the carers’ attitude towards the resident. Conclusions: The carers could be interpreted as being caught in a moral dilemma between ends and means. On the one hand, the ‘conformist mode’, with the acceptance of ends and means, and, on the other hand, the ‘innovation mode’, with acceptance of ends but with few legitimate means to achieve them.