LEARNING OUTCOME: Determine the role of indirect calorimetry in long-term care. Patients (pts) in a long-term nursing care center (NCC) are at risk for the complications of malnutrition due to altered mental status & reduced mobility. This prospective study evaluated the effect of energy balance (EB) on nutrition-related complications, & determined the role of indirect calorimetry (IC) in the NCC. Pts residing in one NCC were included in the study if there was evidence of low albumin, pressure sores (PS), weight (wt) loss, actual/ideal body wt <85% or >150%, tubefeeding (TF), TPN, or mechanical ventilation. After 4 weeks (wks) of monitoring, pts were evaluated wkly by IC for 8 wks. Caloric requirements were defined by resting energy expenditure + 10–15% for activity. Monitors included daily temp, & stool frequency; wkly calorie count, Norton Scale (NS), wt, PS number/stage, prealbumin; & monthly Quality of Life measure by Minimum Data Set; analysis by Chi square test. Of the 110 pts screened, 41 met study criteria; 17 excluded for death, discharge, agitation, or refusal to participate. The 24 pts completing the study were 20.8% male with mean age of 77 (range 29-104), & could be grouped by EB. Group I (n=14), had positive EB for ± half of wk, 28% lost weight, 59.1% had increased risk of PS (lower NS score), & 14.3% developed PS. Group II (n=10), had negative EB for ± half of wks, 70% lost weight (p=0.05), 20% had increased risk of PS (lower NS)(p=0.07), & 40% developed PS(p=0.216). In Group II there was 70% noncompliance to IC due to advanced directives prohibiting TF, disbelief in cal ct, & desired wt loss in obese pts. Extrapolating study results (cost of PS, TF, & IC) over entire NCC system, identification & nutrition Rx of pts in negative EB should reduce PS incidence by half, with annual cost savings of $23 million. While IC identifies pts at risk for nutrition-related complications, its efficacy is limited by bias, & ethical concerns. Education of pts, families, & MD's regarding nutritional issues is needed to ensure positive EB through inexpensive TF/oral feeding, and to reduce the morbidity/expense of these complications