Background: Elderly receiving public services and care are often frail, suffer from chronic diseases, and sustain a high risk for malnutrition. Objective: To evaluate nutritional status and long-term outcome in elderly living at home. Methods: Of 507 eligible subjects receiving home care in five Swedish municipalities, we examined 353 (age 82 ± 7 years, 64% females). The subjects were interviewed, and the nutritional status was assessed by means of the Mini Nutritional Assessment (0–30 points; the lower the score, the greater the risk). The Mini Nutritional Assessment consists of 18 questions concerning, e.g., anthropometry (body mass index or BMI; kg/m²) and global and dietary issues. The mortality was evaluated in 224 study participants after a 3-year period. In one municipality, 31 of 64 elderly were reexamined after 3 years. Results: 8 and 41% of the elderly were assessed as malnourished or at risk of malnutrition, respectively. BMIs <20 and <23 were found in 12 and 31% of the subjects, respectively. Chewing and swallowing problems and reduced appetite were more often reported by those at risk of being malnourished compared with the well-nourished study participants (p < 0.001). Meals-on-wheels services were given to one third, of whom 66% used one portion for several meals. The 3-year mortality was 50% for those who were malnourished, 40% for those at risk of malnutrition, and 28% for the well-nourished group (p < 0.05). The corresponding mortality was 50% for subjects with a BMI <20, 35% for those with BMIs 20–28, and 27% for those with a BMI >28 (p = 0.05). After 3 years, a weight loss of 4.0 ± 5.8 kg was registered (p < 0.001). Conclusions: About half of the home-living elderly with public support were malnourished or were at risk of malnutrition. The malnourished subjects often had problems during mealtimes and seldom ate full meals. Elderly with a BMI >28 displayed the lowest risk of death within 3 years.