Researches shows that a common perception among elderly care staff about elderly with foreign backgrounds is that they have special need and that it requires special measures, and that those needs are not similar to the needs of elderly with Swedish background. This study is based on a research with six case managers who work within the context of Swedish elderly care. In this research we interviewed six managers from three different cities in southern Sweden to find out if case managers perceive that the needs of elderly with foreign background differs from the needs of elderly Swedish background. However we also found out what challenges case managers experience in meeting with respectively group. From our interviewers we found of that all six case managers agreed that there are no differences between elderly with foreign backgrounds and elderly with Swedish background when it comes to their needs, and that they claimed that every individual have the same nursing needs regardless of background. Case managers therefore perceive that elderly with foreign backgrounds needs do not differ from the needs of elderly Swedish background. This study also shows that the case managers nevertheless choose to address topics such as eating habits, language disorder, style of clothing, relatives, home care staffs practical work, and described those topics as different and challenging in meeting with elderly with foreign backgrounds than older elderly with Swedish background. The case managers in the study all agreed that the profession needs to develop like giving out information in different languages and further educations on other cultures. This due to reduce misunderstandings between them and the elders and to provide a fair and equal care for all elderly people. Our conclusions are therefore that there are no differences between the needs of elderly with foreign backgrounds and elderly with Swedish background, but there are some challenges case managers describe and also tendency among case managers to unknowingly make a difference between these groups.