Discharge planners throughout the country have expressed frustration with the lack of placement options for persons with human immunodeficiency virus (HIV) infection (PWHIVs) who need continuing care. A New York hospital study found that for 48 percent of patients seen by social workers, the predominant discharge planning problem was lack of community residential or home care options (Mantell, Schulman, Belmont, & Spivak, 1989). Placement difficulties often lead to unnecessarily long hospital stays for PWHIVs. Studies suggest 10 percent to 36 percent of PWHIVs in hospitals could have been cared for in a less specialized setting if one had been available (Holland & Conley, 1988; Luehrs, Orlebeke, & Merlis, 1986; Peterman & McCormick, 1988). Hospital stays not only are costly but also subject patients to risks of further infection and neglect their psychosocial needs (Engstrom, 1987). Like other residents, PWHIVs may require institutional care because of functional disability, social circumstances, and lack of available alternative resources (Afzal & Wyatt, 1989; Bressler, 1992; Koch, 1992). Estimated percentages of PWHIVs who will have long-term-care needs at some time during their remaining lives are between 10 percent and 25 percent (Afzal & Wyatt, 1989). One study (Gordon & Epple, 1993) estimated a total of 1,414 HIV-positive nursing home residents in 1992 and predicted that by 1997 these numbers will double to between 2,154 and 2,750. Studies have documented a range of negative responses from nursing homes regarding admission of HIV-infected people. Reported deterrents to admitting AIDS patients include the need for infection control procedures; potential fears of contagion among staff, elderly residents, and their families; reluctance of administrators and staff to admit homosexual and substance-abusing patients; problems with managing intergenerational relationships; potential exacerbated difficulties in staff recruitment and turnover; fear of losing future admissions; inability of facilities to provide state-of-the-art medical treatment; and lack of reimbursement for specialized care (Adams, 1989; Afzal & Wyatt, 1989; Benjamin, 1989). In the Chicago area in 1985, no apparent care resources were available. The street wisdom in the social services community was that no nursing home would care for an HIV-infected person. This article describes a successful intervention based on a series of needs assessments, educational programs, and advocacy efforts; this program may be replicated effectively elsewhere. PROJECT OVERVIEW The AIDS Long-Term Care Access Project (ALCAP) was established in 1990 to address the documented need for long-term-care access for PWHIVs in the Chicago metropolitan area. Set within the medical social work department of a public university teaching hospital, the project began with a strong clinical base of experience in HIV care, as well as linkage to a wide array of community-based service organizations. The project used a collaborative, incremental approach to planning (Kahn, 1969), adapting Hasenfeld's (1987) program development framework to include the following eight components for a successful program: identifying a need, mobilizing support, assigning responsibility for a board, defining a mission, obtaining seed money, doing a feasibility study, implementing the program; and monitoring and evaluating. Identifying a Need for Service In 1984 the first requests for referral of AIDS patients to long-term-care facilities surfaced at the University of Illinois Department of Medical Social Work. Workers reported that absolutely no resources existed. Hospital social workers and discharge planners throughout the city expressed frustration about long-term-care placements. By 1987 this concern had been identified in a community needs assessment undertaken by the AIDS Foundation of Chicago, which included a council of service providers. …