The Neuropsychiatric AIDS Rating Scale, which classifies HIV-related cognitive impairment along a six-stage continuum, was used to explore the relationship between the severity of impairment and management and residential problems among 318 persons in San Francisco with suspected HIV-related cognitive impairment. Nearly half of the sample were in the moderate, severe, or end stage of impairment. One-third of the 318 persons, most of whom were in the moderate and severe stages, were reported to present residential placement problems. The management problems most associated with placement difficulties were home safety, wandering, confusion, and memory difficulties. More than a fourth of the moderately to severely impaired patients were living alone with no outside help or were homeless and living on the streets. Results of this study support the development of specialized residential programs for patients with HIV-related cognitive impairment.