Abstract
One of the most far-reaching and least remarked upon changes in the Welfare State in recent years has been the shift from public to private provision of long-term residential and nursing care of elderly people. In 1975 an estimated 16 per cent of elderly people in long-term care in England lived in private nursing and residential homes. By the end of 1985 this proportion had risen to 37 per cent (Table 16.1; Figure 16.1). If, as seems likely, local authority and voluntary provision remain at a standstill and National Health Service geriatric departments continue their withdrawal from long-term care (mitigated to some extent by an increase in psychogeriatric provision), the private sector will have to provide all the volume growth necessary to keep pace with demographic change. Its share of the ‘mixed economy’ may thus reach 50 per cent by the turn of the century. What does this change mean for those elderly people who spend the last months or years of their lives in some form of communal establishment? And what are the prospects for the future?
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