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The author documents a need for alternatives to institutional care for rural North Dakota elderly, provides data to assist those interested in pursuing alternatives, and recommends steps to initiate action to achieve the goal of providing long-term care outside of the traditional nursing home. The research included analyses of the literature, 22 interviews conducted with professionals in the field of gerontology, and the results of a focus group research project completed by the author in 1990 which was conducted with urban, rural, and institutionalized individuals, 65 years of age or older, in four North Dakota communities.