For older adults, it's not the public mental hospital for which we seek alternatives but the nursing home, where the overwhelming majority of residents have a diagnosable mental illness. The sad truth, our shared secret, is that the main function of nursing homes is caring not for physical illness, but for psychiatric and behavioral problems. Cournos and Le Melle, in their commentary (page 996), rightly advocate for a more humane approach. We desperately need to expand home-based care, adult day centers, partial hospitalization, and outreach teams, and we need training programs for the professionals who will run them. Nursing homes are poorly equipped to treat complex psychiatric and behavioral problems, but community-based care is fragmented and geographically uneven. The patient usually prefers to stay in the community. After all, if you get Alzheimer's disease, what would you choose: a nursing home or an adult day center?