Abstract Objectives The objectives of this paper are: (1) to estimate the transition probabilities among self-rated health status for the oldest Chinese aged 80 and above; (2) to project the future need of long-term care due to changes in demography and health status among the oldest Chinese. Methods Self-rated health data collected in Chinese Longitudinal Healthy Longevity Survey conducted in 1998, 2000 and 2002 were used to estimate the self-rated health status transition probabilities, and to project future long-term care need by calculating the number of unhealthy person-years. Results The majority of the oldest Chinese's health status remains unchanged or worsens within 2 years. The number of unhealthy person-years rises regardless of gender, and the absolute number and increase rate of females are higher than those of males. Under the assumption that average care expenditure is 15 US dollars per hour in 2010, the long-term care expenditure will increase from 8352 million dollars in 2010 to 42,530 million dollars in 2050, a growth of more than 400% over the next 40 years. Conclusions Long-term care need for the oldest Chinese will rise rapidly in the next decades, which should stimulate increased governmental and public awareness of their need.