How might a crisis in long-term care of people with dementia be averted.

The number of people with dementia in the United Kingdom is set to increase steadily over the next 50 years with an ageing population [1]. Although the rise in demand is long anticipated, the planning and provision of services for people with dementia across a spectrum of care appear to be failing to meet increasing need. People with dementia are already disadvantaged. For example, early recognition of dementia and the provision of support by carers in the community is patchy [2], while people with acute health needs because of coexistent physical illness have poor outcomes and often experience unnecessary disability [3, 4]. Furthermore, such people with dementia may have limited rehabilitation because of unjustifiable pessimism and be excluded from appropriate end of life care [5]. To these disadvantages can be added an impending crisis in provision of long-term care. In this issue, MacDonald and Cooper report that, while approximately half of all people with significant dementia in the United Kingdom are now in care homes, the number of available long stay places has fallen by a sixth in the last decade [6]. They project current utilisation and demographic changes to predict future demand. They forecast that, by 2043, over double the present provision will be required to maintain the present level. The authors fear an impending crisis of care unless there is both a greater shift to community rather than residential provision, and also a new acceptance, by purchasers and providers, that the main function of long stay care for older people is to support people with dementia. There are consequent requirements for improved staffing and training. They acknowledge that their study is potentially limited by reliance on extrapolation of data on dementia frequency in care homes in the southeast of England to the United Kingdom as a whole, where some regions, particularly Scotland, have differences in infrastructure and funding arrangements. Although future projections must always be treated with caution, a massive increase in demand for long-term care seems inevitable. Potential solutions