This paper aims at showing how strengthening and adapting the system of care to the needs and expectations of older people today requires a change in the way to conceive the ethical approach. If clinical ethics remains a fundamental tool of the ethical approach in order to identify and to understand the ethical issues of a geriatric practice both complex and uncertain, as well as to adequately articulate the patient's expectations, the technical quality of care and the organization of a complex support, this area of care manifests the need for an institutionalization of the ethical approach. To be relevant, legitimate and effective, the ethical approach must not only be opened to the organizational aspects of care but also be able to fit into the institutional dynamics.