The elderly represent the fastest growing segment of incident patients entering end-stage renal disease (ESRD). Increasingly, social scientists and caregivers are faced with changing models of care, which will challenge traditional patterns of patient acceptance into costly medical therapies. This paper analyzes the outcomes and cost of taking care of patients over the age of 65, and compares these costs and outcomes with other age groups. The results are somewhat unexpected, in that the incremental costs are not appreciably higher, although the outcomes are considerably worse compared with that in younger age groups. Proposals are made for addressing these issues.