Instead, the provision of such care is falling more heavily on the individuals and their families, a report published today claims, as health authorities reduce the number of continuing care beds.
In some areas there is now no NHS provision for non-acute nursing needs while community care - the Government's much- heralded alternative to residential care - is largely 'an act of faith' which has been little tested in practice.
The report says: 'The belief that properly targeted and more efficiently organised services will enable people to be maintained in the community may be ill- founded.'
The policy could result in 'blocked beds' in the acute sector as they are taken up by old people who have no one else to care for them.
It warns that care in the community 'largely equals care by families, which in turn largely equals care by women'. However, the future availability of such care is doubtful due to major changes in population structures, patterns of marriage and divorce, and women returning to work.
Melanie Henwood, author of the report which is published by the King's Fund Institute, an independent policy analysis centre, said yesterday that policy for the care of the elderly was developing by 'default'.
The NHS withdrawal from long-term care was 'especially clear' in the failure to develop NHS nursing homes, she said. Three homes that opened between 1983 and 1984 provided an 'exemplary and cost-effective' model of care for the elderly but they have not progressed beyond the pilot stage.
'The disengagement of the NHS from continuing care has profound implications since it represents a redrawing of the boundaries of the NHS and a transfer of financial responsibility both to the social security system and to individuals and their families . . . The NHS nursing home should be developed as a priority,' Ms Henwood said.
Between 1991 and 2001, it has been predicted that the number of people in Britain aged at least 85 will have increased by a third to more than one million. Although life expectancy is increasing, there is no evidence that elderly people are becoming fitter and healthier and less likely to need care, the report says, '. . . the proportion of life spent free of dependency is declining'.
The report concludes that providing care for the elderly will be more difficult than the Government has assumed, and that the role of residential care needs to be reassessed.
The responsibilities of the NHS in caring for this group should be clarified and health authorities made more aware of their contribution.
Through a Glass Darkly: Community Care and Elderly People; King's Fund Institute; also Bournemouth English Book Centre, 9 Albion Close, Parkstone, Poole, Dorset, BH12 3LL; pounds 8.95.Reuse content