Home care in old age: A lost cause

States. The differing natures of the health and social services systems of each country and the welfare ideologies that underlie them have affected the expansion of home care for this group of people. Hence, Denmark-and to a lesser extent Britain-has relatively well developed networks of home care services, in contrast to Germany and the United States. However, any significant shift away from predominantly medical and institutional care to more home-based, social care is highly unlikely. In this article, I consider the policies and provision of home care for frail elderly people in four countries, the United States, Germany, the United Kingdom, and Denmark. I analyze the key factors affecting home care provision for this group and use this analysis to explain the successes and failures of the different countries. I explain why in the U.S. and Germany espoused home care policies have largely failed in practice; why in the U.K. policies have been slightly more successful; and why, among the four countries, Denmark has achieved the highest level of success when it comes to providing services for older people in their own homes. It is well known by now that populations are aging-the proportion of those over sixty-five has increased, and a growing number of people reach very old age, surviving into their eighties and nineties. Some of these suf-fer from varying degrees of frailty and need help on a long-term basis t