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Barbara Wade, Lucianne Sawyer and Judith Bell, Dependency with Dignity: Different Care Provision for the Elderly . Occasional Papers on Social Administration, no. 68. Bedford Square Press, London, 1983, 252 pp., ISBN 0 7199 11044.

In the present climate of concern about the care of the dependent elderly, a great deal of attention is being paid both to the inadequacies of existing services and to the search for more appropriate forms of care. These vary from the officially sanctioned promotion of community (family) care and the more effective use of residential services to expansion of the private sector and the examination of various kinds of innovative schemes. It is one such scheme, the State Nursing Home (SNH) which provides the rationale for the authors' survey of current provision and a potential model for the future. Their book is a most timely and comprehensive contribution to the debate, if at times presented in a rather irritating way. The book falls into three main parts. In the first (chs. 1-4), Wade, Sawyer and Bell present a review of the monumental problems besetting the current system of care. The evidence on such matters as bed-blocking, lack of coordination between services, inappropriate placement, unmet need in the community and the burden on informal carers is all thoroughly documented and constitutes a useful contribution in its own right. Underlying this patchwork system, they argue, is a model of care dominated by medical definitions of the problem which views dependency as synonymous with disability and pays little regard to client involvement and choice. This is by no means a novel observation, but in placing the issue of the kind of caring ideology best suited to meeting the needs of the elderly firmly on the agenda they rightly assert that new schemes such as the SNH are no guarantee of success.