The treatment of acute illness of the chronically disabled nursing home patient is a problem of great magnitude that concerns health care providers, the elderly and their families. Currently there is no knowledge available on the process of decision-making in nursing homes when an acute illness occurs, and there is little information available on the attitudes and beliefs of health care providers, patients and their families on this important issue. This is an anthropological field study. The purpose of the research is to investigate the social-cultural factors and other circumstances most likely to influence the evaluation and treatment of acute illness in nursing home. The goals of the research are to identify, describe and analyze: 1) the social-cultural factors (e.g. marital status and ethnicity) and other circumstances that influence decisions regarding treatment of acute illness in nursing homes; 2) the relationship between the attitudes, beliefs, values, and expectations of health care providers, patients, and their families and the decisions made when an acute illness occurs; 3) the process of evaluation and treatment of acute illness in nursing homes; and 4) the cultural rules that influence decisions regarding treatment of acute illness. The investigation uses three research strategies: participant observation in-depth interviews, and event analysis. Participant observation and event analysis will document the process of decision-making when an acute illness occurs, and identify those factors most likely to influence decision making. In-depth interviews with 105 physicians, nurses, patients, and their families (N=420) will investigate the social-cultural factors and other circumstances that influence the attitudes, beliefs, and expectations of health care providers, patients, and their families. The research will be conducted in three long-term care institutions selected because of their unique characteristics which facilitate investigation of the problem. This study has significance for important theoretical question in Medical Anthropology, Medical Sociology, and Gerontology as well as applied significance for health care providers (the elderly), and their families.