A widespread bias exists among legal, medical, and social service professionals that the appropriate placement for elderly individuals with cognitive impairment (dementia) is a nursing home. Two major reasons for institutionalization are to remove the patient from a potentially harmful situation and to relieve the family of the burden of care. However, research studies have shown little relation between burden and severity of symptoms. Critical factors which account for the differences in the experience of burden are how well the caregiver manages problem behavior, the level of support given to the caregiver, the relationship between the caregiver and the patient, and the quality of the prior relationship. Interventions to improve caregivers' skills in managing the patient and to reduce stress and diminish burden may make home care a viable alternative to the nursing home. Interventions to lower burden include providing information about dementia and its effects on behavior, teaching a problem solving process for managing behavioral impairments, and identifying potential sources of support to relieve the primary caregiver. These interventions can be made through three treatment modalities: (1) one-to-one counseling; (2) family meetings; and (3) support groups. (Each of the intervention techniques and treatment modalities is described in the remainder of the text.) (BL)