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An effective program of rehabilitation psychology in long-term care depends on an understanding of the conceptual bases for such care: the dynamic relationship between support and autonomy, and the strategy of incremental gains. Ideally, rehabilitation psychology ought to involve two forms of assessment: one, to establish generalized function; the other, a more traditional clinical assessment to establish the basis for clinical intervention. The role of psychologists in management should range from standard interventional techniques with patients to a significant role in helping the institution and the residents themselves as a group in dealing with institutional care. There are many barriers to the delivery of mental health services, particularly in reimbursement, but these barriers may be overcome through creative enterprise. There is an unusually important role for rehabilitation psychology in long-term care, but one that has not yet been realized.