• Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. • The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. • Findings related to personal and instrumental activities of daily living are reported and include elders’ experiences and views relating to the help and assistance they receive. • The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.