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Because of wide-ranging changes in demographics, family structure and the financing and delivery of health service, long-term care has emerged as an important concern for health and public policy. But long-term care has lacked a conceptual foundation that public policy analysts and families can draw upon to shape its development. This text examines how community-based long-term care can develop constructively in an environment in which expanded public financing is an unlikely option. The authors begin by discussing the history, financing and delivery of long-term care. Chapters propose strategies for strengthening home- and community-based services: expanding cash payments and more extensive self-financing, expanding the use of assistive technology and supported housing, and increasing the use of volunteers. Examining all aspects of current medical and home care services, the authors propose a model for home care which maximizes cost-effective delivery of reliable services tailored to individual needs. Unlike current health care programmes, their proposal builds on new insurance options to show how reallocating personal resources can make home care costs comparable to those of a nursing home but allow the individual greater personal freedom.