title: The changing face of community and institutional care for the elderly.
abstract: BACKGROUND
  The NHS and Community Care Act 1990, implemented from 1 April 1993, was expected to alter profoundly the provision of domiciliary services to old people. This change needs to be compared with what would have happened if no action had taken place. We sought to identify trends in community and residential care before and after 1993 to facilitate this comparison.
  
  
  METHODS
  Statistics were collated from diverse government publications and other authoritative sources.
  
  
  RESULTS
  Between 1985 and 1993 there was a progressive contraction of public community and residential services, as well as hospital beds available to the elderly. The concomitant huge increase in places publicly funded in private old people's and nursing homes appears to have been little affected by the implementation of the NHS and Community Care Act.
  
  
  CONCLUSIONS
  The NHS and Community Care Act has had little effect in curbing the institutionalization of old people, which has reached now the highest percentage this century at 7 per cent. A considerable expansion of community services would be required to return to the per capita provision of the early 1980s.
authors.affiliation: Division of Geriatric Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
authors.forename: M
authors.initials: M
authors.lastname: Impallomeni
authors.forename: J
authors.initials: J
authors.lastname: Starr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000331:legislation & jurisprudence / Q000639:trends*; D005260:Female; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000191:economics / Q000266:history / Q000331:legislation & jurisprudence / Q000639:trends*; D049673:History, 20th Century; D006707:Homes for the Aged / Q000331:legislation & jurisprudence / Q000639:trends*; D006801:Humans; D008297:Male; D011157:Population Dynamics; D015397:Program Evaluation; D011640:Public Policy; D006113:United Kingdom