The UK has not yet found a clear, fair and adequate system for financing the growing demand for long-term care as the population ages. In the 1990s it shied away from major reform which would have secured a sustainable and rational financing structure, as implemented in some other countries and recommended by many in the UK. The Joseph Rowntree Foundation has been leading a debate on how to start moving towards better funding arrangements. While the need for big change over the long term has not gone away, important steps could be taken now to reduce the difficulties in the present system. This Foundations reviews the evidence and arguments brought forward and concludes this JRF programme of work by presenting some costed options for reform.