Shelter with care and the community care reforms

<p>Bruce Vladeck wrote that the American nursing home was like the story of the mule in the settlement of the West. Without it, the history would have been different. But it was simply not the main focus for anyone, certainly not for those living through it. An exaggeration perhaps. But during the years of reform, shelter-with-care (SWC) has received perhaps less attention in the British community care reforms than did nursing homes in Lyndon Johnson's introduction of Medicare and Medicaid. The reforms could provide a context which could evolve an even nobler family of beasts: not one or two species but several, all drawing genes from the same British SWC stock. This essay speculates about how that will happen, and about some of the pressures on the evolution which will influence the kind of beasts they will be.