Purpose: Nursing home (NH) residents are at risk for skin damage due to high rates of incontinence but there is a lack of knowledge about their skin health. The purpose of this analysis was to describe incontinence associated skin damage in NH residents. Methods: Sixteen NHs were randomly selected to examine the cost effectiveness of four skin care regimens for preventing incontinence dermatitis (ID). NH staff prospectively assessed the skin of enrolled residents for damage during a six-week period. Participating residents were required to be incontinent and have skin without damage (perineum, buttocks and surrounding areas). Results: 1,918 residents were screened and the prevalence of incontinence among them was 63.2%. Of the screened residents, 10% (191/1,918) had existing skin breakdown for multiple reasons and 3.5% (68/1,918) had ID specific skin breakdown. Of the screened residents, 51.1% (981) qualified for prospective assessment of skin damage and were enrolled. The occurrence of any skin damage and ID specifically in enrolled residents did not differ among the four skin care regimens (p=.07 and .55, respectively); therefore, data of all enrolled residents were combined for analysis. Skin damage occurred in 4.6% (45/981) of enrolled residents and was related to incontinence (73%), pressure (16%), trauma (7%), and other reasons (4%). Incidence of ID was 3.4% (33/981). Of those with ID, 76% were female, 88% were <89 yrs., 85% were Caucasian. (48%) of residents with ID had double incontinence. ID occurred most often in the buttocks (73%) or perianal (70%) areas and usually spread to more than one body location. Severity was mild in 49%, moderate in 39%, and severe in 12% of cases. ID persisted in 39% of cases for >2wks. Conclusion: Most skin damage in NH residents is attributable to incontinence, and ID frequently persists for more than 2 weeks.