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The purpose of this ethnographic study was to explore the perception, care, and preferred treatment of Hmong American elders with chronic confusion (i.e., dementia). We conducted this study over 30-months in Minnesota and Wisconsin, using participant observation and in-depth interviews with 25 Hmong Americans (family caregivers, traditional healers, community leaders). Traditionally, the eldest son has the primary responsibility for his aging parents, with his wife providing the actual care. Conflicts with this norm are emerging due to changing circumstances of Hmong living in America. Caregiving was viewed as reciprocal for the love and care given by the elder generation and a model of traditional values for the younger generation. The role and spiritual orientation of the informant influenced the perceived cause of chronic confusion. However, the traditional spiritual needs of the elder became the primary factor in determining health-seeking behaviors. Overall, informants were opposed to nursing homes and viewed the care of elders as a family responsibility. We encourage the use of these findings for the development of family-based education programs within the Hmong-American community. [ABSTRACT FROM AUTHOR]