Purpose of the study: This qualitative study explores how older adults enroll in a Program of All-Inclusive Care for the Elderly (PACE). Primary practice setting: PACE is a community-based long-term care program for nursing home eligible older adults. Methodology and sample: The study includes interviews with older adults (n = 5), families (n = 4), and staff (n = 10). This study identified common circumstances that led to the recognition of a need for help. Results: These circumstances included the following: an acute event or crisis, older adult’s or caregiver’s drive to avoid entry into the nursing home, and the caregivers’ recognition that they need relief from their care demands. Once this need was identified, families typically found out about PACE because of happenstance; they happened to talk to someone who knew about the program. Implications for case management practice: If PACE is going to be a sustainable alternative to nursing home care efforts, it needs to focus on moving the enrollment process beyond happenstance. Professional case managers are positioned to help older adults and families plan for long-term care by understanding the availability of local community services, developing contacts with local community and long-term care services, and considering what information older adults and their families need, especially during acute care discharges, primary care encounters, and queries for nursing home services.