Using secondary data, an analysis was done of the prevalence of inappropriate clinical care among 3,149 Virginia Medicaid nursing home residents. Six types of inappropriate care were examined: the underprovision of skilled nursing care, physical rehabilitation and routine medical care; and the overuse of psychotropic drugs, physical restraints and urinary catheterization. Thirty-two (32) percent of the residents received inappropriate care in at least one care area and 7% received inappropriate care in two or more areas. Residents who received the most inappropriate care were more dependent in their activities of daily living, uncommunicative, incontinent, likely to have had a stroke, and less disruptive. Residents who received the most inappropriate care are among the most vulnerable residents, and stronger regulation and outside advocacy may be needed to protect them from inappropriate care.