As the number of chronically ill elderly increases and the costs of hospital and nursing home care rises, consideration is being given to alternatives for long-term care. One alternative being explored in California is the Alameda County Homemaker Program which provides home health care to the frail elderly. Interviews were conducted with all 30 impaired elderly clients who received from 2 to 6 hours of personal and household assistance per week. An Activities of Daily Living and Instrumental Activities of Daily Living scale was used to determine the extent of the respondents' impairment and how their needs were met. The results revealed that those elderly who lived alone, had the fewest informal supports, and were being maintained by formal supports were the least impaired of the group. This finding negated the hypothesis that a positive relationship exists between level of impairment and reliance on formal supports. It appears that, beyond a certain level of impairment, formal supports alone are not sufficient to keep the frail elderly at home; formal supports supplement and sustain rather than supplant informal supports. This study suggests that severely impaired elderly may be maintained in the community with minimum home and health care services. Government policies supporting institutional rather than home care must be addressed. (Sixteen data tables are included, and instruction sheets for home care services and forms for determining types of social services needed are appended. (NB)