The objective of this retrospective chart review study was to determine the prevalence and predictors of nursing home admission of older hospitalized heart failure patients. Subjects were Medicare beneficiaries discharged with a principal diagnosis of heart failure in 1994 in the state of Alabama, United States. The outcome variable was admission to a nursing home after hospital discharge. Using multivariable logistic regression analyses we determined patient and care variables independently associated with admission to a nursing home. Patients (n = 985) had a mean (+/- S.D.) age of 79 (+/- 7.5) years, 61% were female and 18% African-American. Eighty-three (8%) patients were admitted to a nursing home. Over 80% of those admitted to a nursing home had prior nursing home residence. After adjustment for various demographic, clinical and care variables, age (adjusted odds ratio [OR] = 1.14; 95% confidence interval [95%CI] = 1.06-1.23), pre-admission residence in a nursing home (adjusted OR = 1422; 95%CI = 341-5923), and length of hospital stay (adjusted OR = 1.11; 95%CI = 1.02-1.20) were independently associated with admission to a nursing home. Among patients with no prior nursing home residency (n = 908), 15 (2%) patients were newly admitted to a nursing home upon discharge. In addition to age and length of stay, diabetes (adjusted OR = 6.46; 95%CI = 1.58-26.41) was independently associated with new admission to a nursing home. In conclusion, nursing home admission rate for this cohort of older hospitalized heart failure patients was low. Age, length of hospital stay, and diabetes were associated with new nursing home admissions. Further studies are needed to identify modifiable risk factors for nursing home admissions and to develop appropriate interventions.