The search for the most appropriate, effective and efficient ways to care for vulnerable older people is an enduring one. Hence, the importance of research which seeks to explore how best to meet the needs of frail older people at the margins of care, whose care needs can therefore be appropriately met in more than one setting. The theme of balance of care has been a recurrent theme in the literature of long-term care and relates to ideas of optimality and efficiency in resource use and has been primarily, but not exclusively, applied to the care of older people. Interestingly, it is not a new concept but rather one which is implicit in policy relating to the care of vulnerable older people since the 1970s, although periodically it has risen to become more explicit. In this context it almost always relates to the relative priority accorded to services provided in the community compared to those provided in long-term care settings, such as care homes or hospital.