Despite nearly half-a-century of government legislation promoting community healthcare for older people, the Clinical Standards Advisory Group lately described community care in the UK as 'fragmented with unacceptable variations in standards and quality'l. Because healthcare is free at the point of delivery whereas social care is means-tested, costs are continually shunted between health authorities and social services, and decisions are led by funding allocation rather than need. About half a million people, predominantly frail elderly, at present live in care homes; and with expansion of the population aged over 80, the next 20 years will see a sizeable increase in the number requiring extensive social and medical care. While all but 5% of people aged 65 and over live in their own homes, 25% of those aged over 85 are in institutional care2. The emphasis on maintaining people in their own homes by improvements in community care may limit the number requiring admission to care homes, but those admitted are likely to be more dependent because of rising thresholds for admittance and the prevalence of survivors of, for example, cytotoxic chemotherapy or life-extending chronic disease management. In 1993, £7 billion was spent on community care and long-term care; of this, £6.3 billion, or 1% of gross domestic product, was spent on old people. At present, there is no certainty that this money is being spent appropriately or that taxpayers are getting value for money.

Background Injuries resulting from falls are the major cause of death, hospitalisation and emergency department presentation in persons aged 65 years and over in our community. More than half of all injury deaths in this age group is due to falls. During 1997, 214 deaths 1 and approximately 7,000 hospitalisations of persons aged 65 years and over in Queensland were attributed to falls.