The policy of the New South Wales government is that children with disabilities will have the best outcomes in a family environment. This contrasts with the past practice of placing children with profound disabilities in large institutions soon after birth. In this paper Paula Eyler reviews the current policy direction in light of the views and experiences of families who care for their children with a profound disability. Their views, along with the current literature, suggest that we need to rethink what is the best way to realistically care for children with such disabilities.