The growing number of old and very old people in the United Kingdom is attracting increasing attention, particularly with respect to the cost of providing institutional, residential and nursing home care. It is estimated that about 6% of people will require this type of care and the current annual cost is over 3.5 billion pounds. In the United Kingdom, provision of institutional care for elderly people has undergone significant change in the past two decades, with a shift from National Health Service provision of long-term hospital care to the current dominant role of private home care by independent commercial sector providers.