A medical, psychiatric and social assessment was conducted on 272 residents admitted consecutively to local authority residential care for the elderly in Nottingham in the year ending 31st January 1978. A high level of medical and psychiatric pathology was discovered, in spite of frequent general practitioner contact in the community and recent hospital admissions. Few of the staff in the old people's homes were sufficiently qualified to deal with the medical and psychiatric conditions of the residents only a third of whom had been examined by a general practitioner during the month after admission. The social service provision in the community showed an uneven pattern and did not appear to have a direct relationship with the residents' requirements, 12 per cent of whom could have remained in the community had there been adequate social assessment and support. Only just over half were appropriately placed, and a further third should have been in the care of the hospital services.

Recommendations for change are directed towards the provision of routine medical, psychiatric and social assessment of all potential residents by geriatricians and psychogeriatricians in close collaboration with social services in special local authority assessment homes.