While there has been significant development in the care standards of nursing homes in recent years, they remain, in general, institutions that emphasise efficiency, safety and protection, rather than dignity, privacy, friendship and self-esteem.

There is still a lack of living options other than nursing homes for frail seniors who do not have anyone to care for them at home ("Nursing needs"; last Thursday).

Sickness and ageing are hard, and for some people, it means a long period of decline and disability. The value of life cannot be measured by physical and mental ability alone.

The professionals and institutions these people turn to should not make things worse through restriction and alienation, unintended though they may be.

We can take inspiration from history. In the past, the options open to people with terminal illness were either euthanasia or futile, painful and expensive "treatment" that may not prolong life and may even cause harm.

English doctor Cicely Saunders was one of those who found ways to help these people die well, by addressing total pain - physical, mental, social and spiritual distress.

She began the hospice movement in the 1960s, with strong emphasis on palliative medicine, which is very much practised today.

Assisted living has become common in Australia, Britain and the United States. It enables continued living within a community familiar to the older person with growing dependence.

Some regard it as an intermediary between independent living and nursing homes. But it could be created so as to eliminate nursing homes altogether.

The call is not just to policymakers. Clinical experts, care experts and private individuals must also proactively seek the ingredients of a meaningful and purposeful life for those with mental and physical deterioration due to frailty and old age.

With creativity, passion and determination, we can respond to the challenge and reinvent elder and dementia care, and make it affordable in our community.

Wee Shiou Liang (Dr)