Geriatric medicine started in long-term care, when the pioneers in the emerging specialty examined the inhabitants of the Victorian workhouses to discover elderly, largely ignored, yet eminently treatable patients. They focused attention on the then taboo subjects of incontinence, dementia and immobility. They developed a paradigm which entailed a proper assessment and, where appropriate, rehabilitation. This empirical process was central to their evident success, and achieved a reduction in unnecessary institutionalization by restricting long-stay care to those who could not, after full assessment and treatment, be discharged. The concept of progressive patient care developed, to make best use of somewhat meagre facilities. Day hospitals spread nationally, and outreach teams developed. Respite care schemes provided support to the huge numbers of informal carers, by sharing the load with the hospital service.