OBJECTIVES: The long-term care needs in patients under maintenance hemodialysis (HD) have not been explored before. To estimate the changes of proportion for different functional disabilities along time after beginning HD and the lifelong care needs. METHODS: We used a population-based cohort consisting of 84,657 incident patients under maintenance HD in Taiwan between 1998 and 2009 to calculate the survival functions. The Barthel Index (BI) was used to measure functional disability levels cross-sectionally in 1272 HD patients recruited from multiple HD centers. A BI score less than 50 was considered a severe disability. The kernel-smoothing method was used to estimate the dynamic changes of different functional disability. The survival function was extrapolated to lifetime by a semi-parametric method and then multiplied with proportions of different kinds of functional disabilities over time to obtain the lifetime care needs after age stratification. RESULTS: On average, patients under maintenance HD had 6.5 (± 0.1) years without disability, 1.9 (± 0.1) years with moderate disability, and 1.3 (± 0.1) years with severe disability. The most common needs for assistance throughout their lifetimes were stair-climbing and bathing which were 2.8 years and 1.6 years, respectively. HD patients were expected to have about 3 years living with disabilities for all age groups above 35; however, old patients showed higher proportions of functional disabilities. CONCLUSIONS:  HD patients are in need of long term care. The older the age, the higher the proportions that need different care services.