Referrals for home care services initiated prior to hospital discharge may prevent or delay readmission or nursing home placement, especially for elderly individuals with multiple, chronic health problems. While multiple factors could justify the need for home follow-up after hospital discharge, little is known about those patient factors associated with clinicians' decisions to refer older adults with cardiac or pulmonary disorders. Increased understanding of factors that contribute to initiating a home care referral could enhance clinicians' decision-making and thus improve post-discharge outcomes for these patient groups. This study examined patient factors associated with and predictive of the decision to refer for home follow-up, using a sample of older adults hospitalized with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Study findings suggest a model that includes patients diagnosed with both COPD and CHF, who are not married, need home health aides, and have a longer than average length of hospital stay may be helpful in predicting the need for home care referrals.