In the United States of America (USA), as elsewhere, ‘assisted living’ is difficult to define, partly no doubt a reflection of the history of housing and care for older people. The term ‘assisted living’ is applied in the USA to a range of settings, including residential care, adult care homes, personal care at home, homes for the aged, and adult care homes. Golant, in setting the scene, defines ‘assisted-living residences’ as ‘important long-term living arrangements that offer shelter and care to physically and cognitively frail older persons, typically in their eighties or older’, and then adds, ‘these purposively designed group residential settings offer a protected residential living arrangement with 24-hour awake staff, meals, congenial social situation, scheduled and unscheduled help with everyday activities (e.g. bathing, dressing, grooming, mobility and eating), medication management, and sometimes health- or nursing-related services. These predominantly private-pay options are mostly marketed to higher-income or asset-rich older persons, who are unable to live safely or comfortably on their own in their ordinary dwellings even with the assistance of family members but seek to avoid entering a nursing home’ (p. 3). Although serving a relatively small percentage of older people, this type of housing and care has become a research topic for several gerontologists, and many have contributed to this collection alongside care providers and policy makers from both the public and private sectors – this diversity of perspectives is a positive feature.

There are three sections: the first (Chapters 1–5) provides a detailed overview of the issues; the second presents perspectives on private-sector provision from providers' and consumers' points of view (Chapters 6–10); and the third situates this provision in local, state and federal contexts (Chapters 11–15). Golant (Chapter 1) begins by discussing the issues that will influence the future development of assisted living. The principle of promoting individual autonomy and decision-making underpins assisted living, but there can be tensions between promoting ‘active ageing’ and meeting the needs of people with cognitive and physical impairments or chronic health problems. How assisted-living residences meet this range of needs is addressed in Chapter 2, where Hyde, Perez and Reed discuss a social model of care for people with increasing health needs, and in Chapter 8, where Kutzik and colleagues consider how future technological developments may enable people with complex health-care needs to live with greater levels of autonomy. There is a need for flexibility in meeting parallel lifestyles that may vary over time and blur the boundaries between different types of assisted provision. Calkins and Keane discuss these converging worlds in Chapter 3, and Wylde draws on residents' perspectives to consider whether people wish to live in assisted-living residences alongside others who are more frail (Chapter 6). Debates about the resident mix are seen as central to discussions about the growth of assisted-living residences.

At a broader level, the question of whether age-segregated living is the way forward for housing in later life is also taken up in this book. Some argue that future generations will become more demanding in terms of their wishes for housing and care, while others, such as Woolf and Jenkins (Chapter 7), recognise the uncertainty concerning the role of the family in providing care for older members and see age-segregated, assisted-living facilities as a definite alternative. But who and which older people will be able to afford assisted living? The majority of such residences in the USA are purchased, and presently only a small percentage of low-income older people are able to live in such settings through benefits such as Medicaid. The future financing of schemes is debated by Mullen and Singer (Chapter 10), with attention to the importance of economies of scale, levels of service, types of environment, construction costs and land values. At the same time, Carder, Morgan and Eckert (Chapter 5) consider the fragile future of small board-and-care homes, settings that have been able to integrate with local communities and which operate with moderate fees.

An on-going issue not exclusive to the USA is the status and regulation of assisted-living facilities. In the USA, assisted-living residences are currently licensed and regulated through the States alongside their regulation of other types of long-term care such as nursing homes. There is an expectation that whilst the States will recognise the diversity of types of assisted-living residences, regulation will increasingly focus on issues such as staffing, training and the built environment. In taking this debate forward, Zimmerman, Sloane and Fletcher (Chapter 4) offer an important discussion of different inputs for measuring quality, and Newcommer and colleagues (Chapter 13) consider the consequences of regulation, commenting on advantages and disadvantages as accountability becomes more diverse.

The later chapters address the complexities of local, state and federal government involvement, each in their different ways influencing how assisted living develops. The enormity of paying for care in later life is also debated: the link between public and private finance (Doty, Chapter 11); the funding of ageing-in-place and community care (Stone, Harahan and Sanders, Chapter 12), and how assisted-living residences sit within the wider overall funding of long-term care (Brown Wilson, Chapter 14). Polivka and Salmon close the book by arguing that, for assisted living to meet the needs of a greater and more diverse population of older people, the importance of nurturing privacy, dignity and autonomy in home-like environments must be emphasised – a form of ‘ageing in place’ (Chapter 15). The scope of the book is immense, from considering the diverse needs of older people, through discussion of recent developments in housing with care and of various approaches to paying for long-term care, to the tensions between age-segregated and age-integrated living. This book should be on the shelf of everyone who has an interest in comparing the experience of the USA with parallel developments in housing-with-care throughout the world. There are lessons to learn here, suggestions on offer from a variety of perspectives, and debates that are set to continue.