Public attitudes to the old must change. We must stop devaluing them and forgetting their past and present contribution to society. Only then will there be the readiness to fund the long-term care they may need. Many elderly people are able to support themselves. They may have benefited from the increased value of their homes, or been able to contribute to an occupational pension; they may be in good health and have family or friends nearby. However, others, through no fault of their own, may be in a quite different situation. They may have cared for relatives instead of going out to work, or alternatively may have worked in low-paid jobs and been unable to save. They may suffer from increasing physical or mental disability beyond the capacity of their carers. They may live far from any relatives or may have outlived their families. They are a vulnerable group and could easily be exploited when they need long-term care if there are not adequate safeguards.

Both within the health service and in the growing private and voluntary sector there is great variation between the best and worst types of long-term care. As the number of hospital long-stay beds has diminished, research in our unit has shown that the physical dependency of our remaining long-stay patients has increased, and their mental capability diminished.