This study finds that the percent of elderly decedents who ever had used a nursing home rose modestly between 1986 and 1993, with increased use before the last year of life. There was no change in the length of use among users. Projections indicate that a 65-year-olds risk of ever entering a nursing home will rise to 47 percent over the next 20 years. With increases in the number surviving to age 65, the number ultimately entering nursing homes will double. The findings suggest that changing disability rates and Medicare policy had little net impact on patterns of nursing home use. Barring more dramatic health or policy changes, nursing home costs will be a growing share of national health spending as the population continues to age. (Medical Care 2002 October; 40(10):965-975).