The purpose of this article is to describe and analyse the principle of help to self-help in care work and the representations of and norms on old age and care needs supporting the principle in relation to moral and ethical aspects. The article is based on the results of a study conducted in a small rural Swedish municipality in 2006–2008 and a study conducted in a big city in 2014 and 2015. The material consists of interviews with first line managers, care workers and care receivers. The results of this article show that the principle of help to self-help in the care of older people exists in both public sector home care in a small municipality and a home care system in a major city with customer choice system. The results also show that representations of and norms on old age and care needs highlight the normative value of help to self-help, which has both ethical and moral dimensions. In the care of older people this is translated into care receivers maintaining their mental and physical strength which challenges the value of care receivers’ self-determination.