The institutional atmosphere and programming of a nursing home can often engender a downward spiral of increasing dependence and learned helplessness in its elderly residents. Elderly patients with chronic medical complaints combined with psychiatric and management problems are especially susceptible. An intermediate-and skilled-care nursing home began a special program in 1974 to deal with these patients. The program features problem-oriented rather than diagnosis-oriented recordkeeping and the use of a multidisciplinary therapeutic team to treat problem residents. Over the first four years of the program, behavior problems of many residents were resolved, and many of the original residents admitted to the program were released, some into independent community living. Case studies highlight the type of patients successfully handled in the program.