OBJECTIVES:  Based on the survey data of Shaanxi Province in 2012, this paper analyzed the situation of health services need and utilization of the rural elderly left at home (RELAH), and discussed their influencing factors. METHODS:  1) Four-steps modeling method. Based on this method, we built four regression models which were the logistic regression models of two-week out-patient rate and hospitalization rate last year, and the linear regression models of the logarithmic out-patient expenses and the logarithmic in-patient expenses. 2) Logistic regression analysis. It was used to analyze the influencing factors of health services need and utilization of the RELAH. 3) Chi-square test. We used it to make comparison analysis on health services need and utilization between the RELAH and the normal rural elderly. RESULTS:  1) The health status of the RELAH are poorer, many of their health services demands haven’t been got released compared with the normal rural elderly, and the features of health services of the rural oldest old left at home are high need but low utilization. 2) The influencing factors of health services need of the RELAH mainly include education, occupation, income level, age and whether living together with their grandchildren. 3) The influencing factors of health services utilization of the RELAH mainly include marriage, income level, age, accessibility to health services, living together with their grandchildren, being required hospitalization last year, suffering from chronic diseases and the types of medical institutions for treatments. CONCLUSIONS:  Combined with research results, we give some suggestions. Firstly, perfect the compensation mechanism of medical institutions to reduce patients’ medical expenses. Secondly, make the land expropriation reasonably, and avoid farmers suffering from the jobless situation. Thirdly, develop the family doctor system actively. Fourthly, develop the county economy, reduce the families’ numbers of the RELAH and ensure them have families’ accompanying when ill.