Over the past two decades nursing homes have become the major supplier of l
ong-stay care for frail older people in the UK. Demographic projections ind
icate that die volume of nursing home places will continue to increase to k
eep pace with demand and that the population of homes will become steadily
more dependent. Little systematic research exists to indicate how nursing h
ome care compares with hospital care; the evidence that does exists tends t
o be restricted to local studies and thus is not generalizable. Local studi
es indicate that in both care settings there are,shortfalls in terms of mee
ting basic quality of care standards. Despite this, there is obvious potent
ial for nursing homes to act as an alternative to hospitalization, provided
that there is suitable access for residents to specialist care and, for ex
ample, appropriate administration of medicines. Proposed changes in governm
ent policy will introduce more uniform standards in nursing homes and assoc
iated inspection structures and procedures. However, further research is ne
eded to ascertain the clinical and consumer value of different intervention
s in nursing homes, and the cost-benefit of enhancing provision available i
n terms of preventing or forestalling demand on hospitals or reducing hospi
tal length of stay. In the light of the commitment to develop evidence base
d practice, it is important that such research is urgently advanced to elim
inate poor practice. In our rights conscious society, future generations of
older people are unlikely to be as tolerant of substandard care.