A comprehensive psychiatric treatment program called Outlook was designed to treat isolated residents of inner-city housing projects for the elderly. A large proportion of the elderly referred to the program had no family members or were estranged from them; approximately 80 per cent lived alone. All had multiple problems, and almost all were shown to be at high risk of institutionalization. During the first two years of the program, 108 clients were treated through a problem-oriented approach using a counselor-case manager and multiple therapies; only nine clients had to be referred to nursing homes or other institutions. The data suggest that well-designed programs can help elderly patients who have multiple problems but no family support to remain independent.