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Background: Care facilities are particularly challenged by the COVID-19 pandemic. Besides others this includes human and structural resources., Objective: This cross-sectional study evaluated the occurrence of infections, psychosocial stress and the different strategies to handle the COVID-19 pandemic in care facilities., Material and Methods: Data collection took place in 7 care facilities in Baden-Württemberg, Germany between 17 July and 25 August 2020. This included a SARS-CoV‑2 PCR and antibody testing and a questionnaire for residents and staff. Care facilities were questioned on interventions and preventive measures taken., Results: Out of 829 SARS-CoV‑2 PCR tests all remained negative. Only 2 asymptomatic subjects had detectable SARS-CoV‑2 antibodies. All subjects (n = 6) with a history of positive PCR had no detectable antibodies. Healthcare workers were mainly worried about infecting family, friends and especially residents (54.4%) with less fear to infect themselves (27.2%). Individual stress caused by the COVID-19 pandemic: 17.1% exhaustion, 16% financial burden and 13.1% sleeping disorders. Coping strategies included a moderate increase of harmful behavior (+3.3% alcohol, +4.3% nicotine). This was relevantly more important in staff aged under 35 years (+13% alcohol, +12.7% nicotine). Women reported a 2.4% increased use of medication, 49.8% of respondents reduced their social contacts, 76.8% changed their individual hygiene behavior. Care facilities felt prepared to a limited extent for the challenges faced by the pandemic., Conclusion: Even with a low prevalence of infections at the time of the survey the COVID-19 pandemic challenged care facilities at multiple levels. This should result in better preventive management and coping strategies., (© 2021. The Author(s).)