It is clear where most of us would like to live when we are old. We would naturally wish to stay in our own homes and would only consider going into residential, nursing home or long-stay hospital accommodation as a last resort. It is difficult to provide a truly satisfying quality of care in continuing-care facilities and many old people who are in these places would prefer not to be there.

Long-term institutional care should be considered only after all other options have been thoroughly explored (Greengross 1987). It should be a carefully planned positive choice. Continuing care in institutions for the elderly should be available for those who actively want it and really need it. If this form of placement is appropriate, it should be provided in a supportive, homely environment where the individual's autonomy and privacy can be respected and where people can enjoy a good quality of life and high standards of care.

Ensuring that long-stay care is indicated and that the care provided is of the highest order requires careful strategic planning. Strategy originally meant the skill of a general: it was the art of conducting a military campaign by preparing and utilising forces so that the initiative would be secured and the war won.