OBJECTIVE: To describe medication use by residents of residential care facilities for the elderly (RCFEs). DESIGN: A cross-sectional survey of medication use. SETTING: Licensed, private RCFEs recruited from a roster of all licensed RCFEs in the Los Angeles area. SUBJECTS: Residents who were ≥60 years of age and whose medications were centrally stored in the facility. MEASURES: Age, gender, race, health insurance coverage, dietary restrictions, ambulation status, medical diagnoses, and medication profile. RESULTS: A total of 818 residents were surveyed. Residents were primarily white women who were >80 years. The average number of medications per resident was five; 94% of the sample took at least one medication. Cardiovascular drugs, central nervous system drugs, analgesics, diuretics, and potassium supplements were most commonly used. Use of multiple drugs within a therapeutic class was also common, with means ranging from 1.46 to 1.81 per resident for the most commonly prescribed classes. Diagnoses supporting the use of many medications were not documented in the residents' health records. CONCLUSIONS: This RCFE sample was medically frail and took many medications. The frequent use of cardiovascular medication reflected the prevalence of cardiac disease in the elderly. The frequency of psychotropic drug use without a corresponding indication suggested prescribing for symptoms rather than documented medical conditions. Lack of recorded diagnoses limited the ability to evaluate drug therapy. Improved record keeping; periodic medication review; and resident, staff, and prescriber education are necessary to ensure appropriate medication use in this setting.