The doctor … [and] the nurse [say] that this guy shouldn’t be at home … I don’t really know if I agree with that … There [are many] … reasons why, if we can stabilize things … he should be able to stay at home … He wants to stay at home…. A lot of people … [are] telling me what to do. Social workers’ interactions with community-dwelling elderly people and other health care professionals may be profoundly influenced by ethical issues that arise when elderly individuals capacity for self-care is impeded by limited cognitive resources (Proctor, Morrow-Howell, & Lott, 1993). The major purpose of the qualitative study discussed in this article was to expand our understanding of the ethical tension embedded in the decision-making processes of home health care social workers as they evaluate decisional capacity of elderly individuals experiencing cognitive impairment. This examination of social work processes is a beginning effort to illuminate the dynamics of the clinical–ethical tensions inherent in social work practice with community-dwelling elderly people.