The British healthcare system is an egalitarian one; it is paid for by the taxes of citizens so that one day, when they need it, health care will be provided without leading to poverty. The National Health Service still fulfills this role for the majority of people; however it is not always simple. Since the NHS exists on a limited budget, it is not able to provide all people with all the services that they may desire. Many people as they age require extra help, especially in the last few months of their lives. It is here where the NHS does its bit. Once a person requires assistance from a doctor or admission to hospital, you begin to receive the benefit of having paid your taxes. The public health system means that no-one is denied health care and assistance when they require it most.

As in the United States, most people in England want to be able to live and age in their own homes. The NHS provides for this to a limited extent. Doctors, physical therapists, podiatrists and home caregivers are all able to come to visit you in your own home with the expense falling onto the NHS. Being at home is regarded as a much better environment than being in hospital or in residential care, and it is more fiscally manageable as well.

However, the NHS is not able to pay for everything. The financial allowance from the government is not large enough to cover the cost of care most people will need. If people require more care than the NHS can provide, then they often have to pay for this privately. For example, staying in a nursing home can be expensive; although some care is financed by the government, nursing homes can cost around 500 pounds a week ($1,000). Nursing homes commonly charge fees that require family members to help pay for the service. Unless someone has a large retirement or savings account, the cost of care can be a tough issue. People are therefore inclined to stay in their own homes as much as possible.

This led the government to subsidize home services and try to increase healthcare facilities that do not necessitate hospitalization. This seems to have had a good effect on the elderly in England. While the problems of mobility and affordability of care still present most families a major hurdle to overcome, community spirit and activity has increased vastly due to the number of elderly people that are now able to remain in their own homes for longer than was previously possible.

A good example is the senior bus-pass. All people over the age of 65 are given a bus pass that enables them to travel free-of-charge within the county they live in. This has enabled many people to remain at home for longer and not spend on residential care what they may hope to leave to their family.

An example of where this state assistance has made a huge difference is the village of St. Neot, which lies in a secluded valley in the heart of Cornwall in Southwest England. The village has several clubs for the elderly that meet at least weekly. The Welcome Club was set up to enable new people to integrate with the community. This meets for lunch once a week and brings together people of all ages from within the village.

A similar weekly club, run by the charity, Age Concern, aims at preventing the elderly from becoming isolated. There are also activity clubs open to all villagers; these include clubs for bridge, bowling, art, gardening, singing and walking. The facilities exist within the village itself and people often find that there is no need to travel.

There is a local produce market that meets in the village every Saturday and the village post office, which serves as a general store, stocks the essentials, while it also provides the facility for the elderly to pick up their pension every week. A free bus runs to the local supermarket. All of these activities and facilities allow the elderly to remain at home as long as possible.

It can be a challenge to find this level of local services in the U.S. While Americans would like to stay at home as they age, there is often not enough financial support for doing so. Currently, almost half of Americans who live past 65 spend some portion of their time in a nursing facility and 25 to 35 percent die in a nursing facility, whereas only 20 percent of elderly English die in a nursing home. Part of this difference may be explained by the extensive local services available in England -- a model that Americans may look to adopt in the future.

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