To empirically measure the quality of home visiting nursing (HVN) agencies in Japan, we longitudinally observed the duration of clients’ HVN use and identified the factors correlated with hospitalization/institutionalization. Medical and long-term care insurance data were analyzed from 1,722 persons with disabilities aged at least 75 years who began using an HVN. At the 12-month follow-up, 67.7% of clients were no longer using the HVN; among these, 48.9% were hospitalized/institutionalized and 23.6% had died. Cox regression analysis showed that risk of hospitalization/institutionalization in HVN agencies depends on client characteristics at service commencement. Measuring the quality of HVN agencies by weighting clients’ characteristics as risk factors for hospitalization and/or institutionalization may be appropriate.