It is believed that the incidence of dementia is underreported in African Americans, partly because of delays in seeking medical care. There is a critical need to explore factors that impede the diagnosis and treatment of dementia in this population. As part of a larger ethnographic study, in-depth interviews were conducted with 15 African American family caregivers living in 2 counties of the Arkansas Delta. This article focuses on (1) primary concerns related to the elder's condition and (2) access and use of health services. Findings are discussed within context of historical and sociopolitical factors of the geographic region.