America's long-term care system has been widely criticized for many shortcomings. It relies too heavily upon institutional services, it is too costly, it forces inappropriate levels of care upon patients by offering too few options, in too many instances it offers inferior quality care, and it places too much emphasis on caring for physical ills without concern for enhancing patients' quality of life. Alternative modes and settings now under consideration could solve one or more of these problems, but the choices would be constrained by financial and technical barriers. Different choices have profoundly different consequences for costs and numbers and types of patients served. This paper considers different roles and their consequences for one alternative: geriatric day care. The issues raised apply to other alternatives.