Geographic utilization patterns of nursing homes were examined by comparing patient origin with facility location. The 1985 Patient Origin Study produced by the Virginia Department of Health was used to see if there are predictable geographic patterns of patient migration to nursing homes. A random sample of thirty nursing homes was taken from all facilities in Virginia in the 1985 study. The migration data were used to determine median migration distances, to investigate decreases in utilization with distance from a facility, and to distinguish spatial markets of nursing homes. Comparisons were made between urban and rural facilities to see how factors of limited availability and children-as-decision makers affect the migration patterns. The findings show that there is a distinct pattern of decreasing utilization of nursing homes with distance from the facility. Both urban and rural nursing homes primarily serve the immediate environment in which they are located. Maps of patient origins show that there are service areas for nursing homes which are modified by population distribution and physical geography. General findings show that location is crucial for nursing home utilization. The existence of a facility generates need awareness and utilization throughout the immediate population. On the average, twenty-six percent of the patients at a nursing home come from the same zip code in which the nursing home is located. More than half the patients come from within eight miles of a facility. Eighty-three percent of the patients come from within 26 miles. The ratio of out-of-region migration to urban nursing homes is significantly higher than that for rural nursing homes. The results of this thesis can be used to predict utilization patterns of nursing homes. The findings also have implications for Medicaid budgeting because they show geographic, demographic, and economic factors which affect nursing home utilization rates. / Master of Science