This thesis draws together a series of publications that were based on research studies conducted between 1981 and 2011, covering care homes and alternative forms of housing with care. The majority of the studies were funded by the Department of Health or its predecessors, and were aimed at responding to policy issues, particularly for local authority grant funding. However, the funding provided the opportunity to collect information for broader purposes, and a central feature linking the studies was the collection, as far as possible, of consistent information about the characteristics of residents over time. The thesis includes 12 pieces of work, based on information collected in ten studies, and illustrates the changes in care home provision from 1981 onwards, and the potential role of alternative forms of housing with care. The aim of the thesis is to explore the following themes: the changing role of care homes and the development of the independent sector, particularly the private sector; factors associated with care home costs; changes in the relative role of residential and nursing homes, including changes in the characteristics of residents over time; changes in the quality of provision; the impact of care home closures; provision for self-funders and the expectations of residents; and the development of alternative forms of housing with care, and the degree to which specialised housing can provide an alternative to residential care. Care homes in the UK provide around 470,000 places and account for over half the expenditure on social care for older people in England. However, information about care facilities and residents is very limited. The papers presented here aimed to fill some of the gaps in understanding residential care and possible alternatives by making use of data collected in a unique series of related research studies conducted over a period of 30 years.

In this thesis I present a narrative that describes and analyses the contested and moving boundaries in adult social care through the lens of three enduring themes: the health and social care interface; hospital discharge and NHS continuing health care; and eligibility for adult social care. The thesis draws upon a range of my published work undertaken from 2002-2011, and this in turn reflects a wider body of work undertaken from the 1980s onwards. The thesis is developed from my work which comes from a distinctive model of independent research and analysis, combining original empirical fieldwork and evaluation with detailed policy analysis and commentary. The publications are principally derived from research studies and evaluations commissioned from me by the Department of Health; by the Commission for Social Care Inspection (CSCI), and by the Putting People First Consortium and the Social Care Institute for Excellence (SCIE). This thesis examines the problematic boundaries between adult social care (particularly in the care of older people), and the NHS which have been in evidence since the creation of the two systems, and the extent to which these boundaries are contested and fluid over time. I argue that the location of the boundary is of great significance because of the consequences not merely for respective organisational responsibilities and budgets, but also - importantly - for individual service users and their families. The thesis was written on the cusp of the introduction of major legislation in social care, with the Care Act 2014 due for phased implementation from April 2015. It is an opportune moment to consider how and to what extent the Act offers the prospect of stabilising the shifting sands of the landscape of adult social care.