The policy decisions of the 1990's were designed to maximise the potential for older people to remain in their homes for as long as possible and to prevent unnecessary admission to hospital. The NHS and Care in the Community Act (1990) created the role of care management within Social Work (in Scotland) which made it necessary for district nurses to artificially separate the health and social care needs of older people. Whilst health care remained free at the point of delivery, social care was chargeable so the decisions taken by district nurses had implications for the care older people subsequently received. This study was set in an NHS Trust in Scotland and considered how district nurses constructed health and social need when assessing the care needs of older people. Following a pilot study, the main study was undertaken in two phases. The first phase profiled caseload data from 23 district nurses which was used to inform the researcher of current trends in decision making and to purposefully select nurses to interview. A Grounded theory approach was used to undertake 16 in depth interviews until a saturation point was reached and no new data emerged. Following detailed analysis based upon the method described by Strauss and Corbin (1990), core categories of context, gerontological knowledge and personal values emerged to inform the theory of how district nurses construct need. The contribution to new knowledge in this area includes an addition to the theoretical understanding of care delivery. The study has identified the key role played by the assessment of risk and the appraisal of family support. Gerontological knowledge and personal values have been shown to be central to both the assessment of risk, and the appraisal of family support. The study has also identified strategies used by district nurses to manage their workload, some based upon a rational response to the management of work and others. including the avoidance of less popular patients and carers, which are open to question The only area of district nursing care where the delivery of both health and social care is uncontested, is where patients are terminally ill