This research is an ethnographic case study examining factors that affected the availability and quality of care received by women at a rehabilitative residential program for dual-diagnosed persons in Topsfield, Massachusetts (MA). Data was collected for the study through ethnographic field notes of the work site, a community survey of public attitudes toward the homeless in the area, interviews with the clients at the shelter, interviews with the staff of the shelter, and a focus group discussion (FGD) with the shelter's management. A survey of current literature about services for mentally ill or dually-diagnosed homeless and poor and the recent history of welfare reform in the U.S. provided background information and context for the study. This literature provided information on common obstacles to creating recovery programs for the dual-diagnosed client, and revealed that mental illness and the resultant poverty often contribute to substance abuse. The study found that there are a variety of factors that negatively affected the availability and quality of care given to the women at the shelter. These factors included: inadequate state funding for the program, poor salaries and benefits for the staff members, lack of safety in the shelter for staff and clients, inadequate facilities, the isolation of the site, inadequate monitoring of clients, inability of the clients to break the cycle of addiction, and community attitudes towards the shelter and its clients.