In spite of the moves over the last 20 years towards community care, there remain substantial numbers of elderly people with both physical and mental illness who require residential, nursing home and hospital care. There is evidence to suggest that health service provision of long term care for the mentally ill has been, and continues to be, reduced. In addition there has been reduction in beds for long term care by geriatric physicians and while the nursing home and residential care sectors have expanded, this expansion has been entirely within the ‘independent’ private and voluntary sector, with considerable contraction of local authority provision. Representations have been made about this to the Old Age Section of the Royal College of Psychiatrists and they have reported on this (Benbow & Jolley, 1992). Concern has not been confined to the profession. Over the last year, there has been considerable media publicity about the long term care of elderly people in institutions. Some of this has been very critical [Panorama, 20.1.92] and has provoked debate on the pages of the national papers.