To measure the importance of religion among nursing home residents, describe their use of religious coping strategies, and examine the association between religiousness, religious coping, and psychological well-being.Cross-sectional study.Two nursing facilities in Boston, Massachusetts.One hundred forty cognitively intact to moderately impaired long-stay nursing home residents.Subjects rated religion as either "not important," "somewhat important," or "very important." Use of religious coping strategies was measured using the 14-item Brief RCOPE. The outcome measure, psychological well-being, was measured with the Bradburn Affect Balance Scale. Covariates included demographic variables and a measure of social engagement, comorbidity, functional status, and mental status. Linear regression was used to examine the association between religious importance and psychological well-being after adjusting for covariates.Subjects rated the importance of religion as follows: very important (54%), somewhat important (27%), and not important (19%). The mean score on the Affect Balance Scale was 5.9 +/- 2.1 (SD) (range 2-9). After multivariate adjustment, viewing religion as somewhat or very important (versus not important, P=.0019) and absence of negative religious coping strategies (P=.0083) were associated with better psychological well-being (with higher scores on the Affect Balance Scale) (P=.007).Religion was important to most older residents living in 2 religiously affiliated long-term care facilities. Residents for whom religion was somewhat or very important and who did not use negative religious coping strategies are more likely to have better psychological well-being.