Objective This study investigates the effects of emotion-oriented care on the behavior of elderly people with cognitive impairment and behavioral problems. This approach is mainly based on the validation approach, but also uses insights from other approaches like reminiscence and sensory stimulation. Methods 16 Homes for the aged with structured clay care units were randomly allocated to an intervention or control group. 151 Residents with cognitive impairment and behavioral problems were included in the study. The eight intervention homes received a training program with regard to emotion-oriented care. In the eight control homes usual care was continued. Measurements were performed at baseline and after 3, 6 and 12 months of follow-up (assessment by caregivers and relatives). The primary outcome measure was the change in behavior of the residents. Results The results of multilevel analyses (overall, subgroup and per protocol) showed no statistically significant, nor clinically relevant effects in favor of the intervention group on the behavioral outcome measures. Conclusions There is insufficient evidence yet to justify the implementation of emotion-oriented care on a large scale. Additional studies are needed in which special attention is given to the implementation process.