Of all the health challenges that older adults face, fecal incontinence is one of the most dreaded. Fecal incontinence can lead to feelings of shame and embarrassment, and a downward spiral of psychological distress, dependency, and poor health. Fecal incontinence is often a reason for needing nursing home care. Nursing home residents are among the most fragile older adults. Among this group, there are often problems of defecation, such as constipation, diarrhea, and fecal incontinence. Fecal incontinence is a complex problem. The most important risk factors are functional incapacity, reduced cognitive function and mobility, diarrhea, constipation/impaction, stroke, some neurological diseases, diabetes, and comorbidity in general. Loose stool as well as hard stool can be related to fecal incontinence. Urgency associated with bowel movements and weak pelvic floor muscles are also factors. It is therefore necessary to have a comprehensive person-centered approach for fecal incontinence management, addressing the potential role of co-morbid disease and current medications, functional and cognitive impairment, and the degree of bother to the person. An environment with physical or social obstacles may impair a person’s ability to maintain continence, and adjustments may be needed. This is particularly relevant to individuals who have physical or mental disorders. Nurses must have high knowledge and advanced skills when it comes to meeting nursing home residents’ needs for assessment and management. The level of knowledge and engagement among health personnel on the value of good bowel care is often low. There is, at present, relatively limited evidence from high-quality experimental trials for many fecal incontinence interventions in this population. Good care quality enables nursing home care personnel to approach managing fecal incontinence compassionately while maintaining the dignity of the resident.