Background Demographic trends show that the number and proportion of older people in the United Kingdom is increasing - some 2.3 million people were aged 80 and over in 1997 and this is expected to rise to 3 million by 2021. Alongside this the Royal Commission for Long Term Care for the Elderly (1999) suggests that long term care costs are set to rise significantly. In 1995 the cost of long term care of elderly people was £11 billion, by 2021 with no changes in demographic patterns, health costs and dependency patterns this would rise to an estimated £19.9 billion with worst and best scenarios this suggests costs are likely to be between £25.9 and £15.9 billion. The patterns of care for older people are changing. A number of care and housing agencies suggest that residential and nursing care is likely to be replaced by more 'very sheltered' housing schemes. In addition, care-planning strategies will attempt to keep people in their own homes for longer. (Association of Directors of Social Services (ADSS) submission to the Royal Commission on long term care, 1998). Given these factors, the time seems ripe to consider the potential for reducing dependency and the resulting costs.

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