At this point in the analysis we have assembled all the components of residential care. We have noted how the design of homes has been undertaken against a background of competing ideologies, the historical weight of the institution versus the rhetoric of domesticity and family care. In the midst of this conflict we find the residential staff caught between the professional role of paramedic or social worker and the kinship role of extended family. At the same time elderly residents, predominantly old women, are relocated from familiar surroundings to a ‘home’ from home. Given these fundamental contradictions we ask what are the effects of institutional living and whether or not variation exists between homes. Are some homes less institutional than others? And if so, does this affect the well-being of residents? Particular attention is paid to a recent innovation in residential care, small group living, where the ideals of interdependency, resident autonomy, and self-help are highlighted. It is amongst these homes that we might expect to find the most progressive practice. We also consider how the realities of residential life compare to an ‘ideal’ setting as perceived by residents, thus enabling us to look forward to the care settings of the future. First, however, we must consider what is already known about institutionalization, how this has been studied, and which findings relate particularly to the care of old people.