Stress for care providers and distress for clients with varying degrees of dementia-these are the dynamics Karen A. Lyman discovered in her study of eight Alzheimer's day care centers in California. Speaking as an advocate for both day care providers and people with Alzheimer's disease, the author presents a model of "what works" in Alzheimer's care.Many strategies developed by caregivers are self-defeating, Lyman found. Drawing on personal reflections, interviews, and anecdotes, she demonstrates how caregivers' struggle to maintain order through often unnecessary control contributed to patients' increased sense of self-doubt, anxiety, and incompetence. Negative expectations by caregivers brought on depression and rapid intellectual decline in patients, a "sense of hopelessness" that has been called "therapeutic nihilism."Lyman identifies unsupportive institutional policies, restrictive environments, and poorly organized programs as chronic sources of stress. The alternatives she offers meet caregivers' needs and permit clients a degree of self-determination and identity. Her model for care will be of great interest to gerontological professionals, policy makers, and family members dealing with victims of Alzheimer's disease. Author note: Karen A. Lyman is Professor of Sociology and Coordinator of the Gerontology Program at Chaffey College in California. She publishes widely and in 1991 received the American Sociological Association Outstanding Medical Sociology Dissertation Award.