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Rural conditions and circumstances contribute to different perspectives on institutional long-term care. A rural ethnographic study revealed issues of transition into and out of nursing homes as identified and illustrated by older adults, their families, and care providers. Findings included the use of rural nursing homes as an alternate housing option because of limited assisted-living options, appropriate and inappropriate referrals to nursing homes, and strained family caregivers. Helping olders adults and families evaluate and access appropriate community resources, including housing, is essential to providing continuity of care.