Think now or pay later

A charity providing residential care for older people has just published the proceedings of a symposium held to celebrate its first 10 years.1 Brendoncare espouses the unification of “residential” and “nursing home” care; making best use of professional skills; and the view, delicately put by one of its trustees, that not everyone wants to play bingo and watch EastEnders.2 The title of its wide ranging symposium, The 4th age in the 3rd Millennium, smacks of a countdown—as well it might. If things go on as they are, population aging will lead to 10.8% of the gross national product being consumed by domiciliary and institutional long term care by 2030.3

Three things need to be done. Firstly, care must be as efficient as possible. We know too little about the cost effectiveness of the components of long term care, and there are intriguing variations in policy. Shreeve quotes people receiving domiciliary care costing £700 …