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This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by 'bottom-up' local processes as well as 'top-down' policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation. KEY WORDS--older people, specialist services, National Service Frameworks.

Studies in environmental gerontology have progressed our understanding of the ways in which older people respond to and manage the environments in which they live, including their decisions about relocation and the influencing factors. Much of this work, however, has been done with relatively healthy and mobile older people living in domestic environments. It is often the case that when care-home residents move, the decisions are taken by others while the residents are passive and maybe hardly consulted. Far from the residents' preferences and initiatives being instrumental, they are moved by imposition. In the United Kingdom, the setting of this study, such imposed moves are common, partly because registration regulations restrict the range of care that a home can provide, and make some moves unavoidable. A questionnaire was distributed to care homes in two English local authorities to determine the incidence of relocation, and 10 homes were approached to take part in further studies, which included case-note audits, and interviews with staff and 12 older people who had relocated. The study found that the pattern of moves was complex, and that some residents were active in deciding to relocate and in the selection of the relocation home. The study concludes, however, that for residents to have an active role, they must be given support both to access the information required for decision-making and to implement their decisions. KEY WORDS--older people, relocation, care homes, environmental gerontology, autonomy.

In an increasingly mobile society, the importance of place can be forgotten in the process of making decisions about where older people should receive care. There is some evidence, however, that issues of location and place are important to older people, both in the way that their sense of self is developed and maintained through identification with places and through their ability to participate in activities. This paper describes a research study which followed a group of older people through the process of moving into care homes, and discusses some of the data produced, which indicated how a sense of place shaped the process of moving.