Research on social support typically focuses only on support that the elderly receive from their social networks. The aim of this chapter is to analyze the exchange of services between the very old and their family. We hypothesize that elders with declining health will try to maintain the provision of services, even when they require and receive help. We address the issue of support exchanges in a random sample of two cohorts of community-dwelling octogenarians participating in the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (Swilsoo). We use a multilevel model to assess the effect of health (operationalized in three statuses: ADL-dependent, ADL-independent frail, and robust) on the frequency of services that the old persons provide and receive from their family. Our results show that the recourse by very old persons to insctrumental support from their family is linked to their health status. Being ADL-dependent drastically alters the capacity to provide services. Elders affected by frailty maintain the support they provide to their family at the same level as robust elders do. This highlights the importance in old age of preserving a positive and active role within the family.