Objective: To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone. Design: A retrospective cohort study using routinely collected data. Setting and Participants: Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015. Methods: Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode. Results: A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode. Conclusions and Implications: Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.