As the population ages, the proportion of older people requiring functional support will increase significantly, as will the ‘dependency ratio’ (the number of dependent people divided by the working-age population). These demographic changes will place significant strain on society and systems of long-term care (LTC). Growing expectations of standards of care will, in the future, amplify tensions between quality and affordability. Although there is significant international variation, the LTC system in many countries has become increasingly sophisticated, with services provided in both the home and residential LTC provision. The roles of informal carers and family are also being acknowledged as part of a complex system of care .