What are the factors that contribute to nursing home placement for individuals seeking formal long- term care services? This study sets out to identify predictors of nursing home placement for individuals receiving home care services through a locally funded levy program. Applying the Andersen's Behavioral Model of Health Services Use which focuses on the predisposing, enabling, and need factors that contribute to health care utilization, the author prospectively follows a cohort of newly enrolled participants for 2.5 years. Increased age, poor self-reported health, limitations in bathing and meal preparation, and higher medical expenses at baseline significantly increased the chances for nursing home placement. Recommendations for future research and policy implications are discussed.