Summary Background Demands for long-term care facilities for the elderly increased rapidly due to longevity of the current population and a trend toward nuclear families with fewer offspring . A study showed that the prevalence of depression is 8–15% and 30% among the community-dwelling and the institutionalized elderly , respectively, in the USA compared with 29.5% and 39.2% in Taiwan . The major goal of this study was to investigate the prevalence of depression in the elderly residing at long-term care facilities in Taiwan, to explore the relationship between demographic characteristics, health status, social support, and the participation in leisure activities with the development of depression in the elderly, and finally to propose possible interventional items for clinical use and further interventional study design. Methods A cross-sectional survey of the elderly was conducted through interview using questionnaire. A total of 309 subjects, aged 65 and above, in six long-term care facilities were enrolled in this study. The questionnaire collected information on their characteristics, health condition, the level of social support and daily activity, and depression status. Results Thee prevalence of depression among the elderly residing at long-term care facilities was 37% in Taiwan, and self-funded elderly had a higher depression rate than those in government-sponsored facilities. Participants with advanced ages, religious practices, literacy, longer facility stay, better instrumental activities of daily living (IADLs), more leisure activities, and strong social support had lower association with depression. Factors strongly associated with depression included better self-assessed health status, ability to perform IADLs, level of social support (especially social companionship), and leisure-activity involvement. Conclusion We summarized the perceptions for preventing the elderly residing at facilities from developing depression, including increased interactions provided by caregivers, more family visits and social companionship, and more frequent leisure activities. Further interventional studies with a larger group of participants and longitudinal design should be conducted to confirm our recommendations.