Using data from an urban Professional Standards Review Organization, the authors examined the pattern of discharges for persons aged 65 years and older from acute hospitals for 1979 and 1980. Of the 9% of elderly persons who were discharged to nursing homes, those older than 85 years were 10 times as likely to enter a nursing home as those aged 65; females were twice as likely as males; and those with a diagnosis of mental illness were more likely than those with a diagnosis of physical disease, but the effects were additive. Even after adjustments for patient source, patient characteristics, and therapeutic service, the university teaching hospital was less likely to discharge elderly patients to nursing homes than were the 10 community hospitals in the area.