The relationships between professionals and community-dwelling frail older persons may be profoundly influenced by ethical tensions that arise when elders' capacities for self care are impeded by decreased physical, cognitive and psychological resources. A central feature of the ethical tensions faced by home health care social workers often involves the evaluation of decisional capacity for the elders they serve. Decisional capacity is deemed a necessary factor in the support of autonomy. Enhanced autonomy has been found to influence health status, mortality rates, and feelings of well being. The manner in which social workers make decisions concerning autonomy has profound impact on the frail elders they serve. Situations complicated by ambiguity concerning the decisional capacity of elders are challenging for social workers. Because participation of elders in health care planning decisions has been shown to have many positive effects, social workers' decisions concerning involvement of cognitively impaired elders have clinical as well as ethical implications. The qualitative study which will be presented examines the ethical tensions experienced by social workers in the process of making clinical decisions concerning the decisional capacity of the community-dwelling elders they serve. A convenience sample of 17 social workers participated in interviews. Constant comparative methodology was used for analysis. Major themes that emerged will be reported. Issues of medical compliance and safety prompted the evaluation of decisional capacity by social workers. Elders' awareness of safety risk and their reasoning served as the bases of social workers' evaluations of decisional capacity. Ethical tensions emerged in response to many complex issues. Key among these were pressure from other professionals and uncertainty associated with cognitive and psychological processes. The tension between support of autonomy and beneficence was strong. The pull of autonomy was found in participants' clear support for elders' participation in care planning even in the face of high safety risk and cognitive impairment. Ethical tension related to beneficence was found in their intense worry about clients' safety. It is recommended that educators of professionals who will work with elders in the future focus on the differential assessment of psychological and organic processes related to impaired judgement and introduce greater complexity in training future social workers to analyze the ethical dimensions of their work.