People who know the social care system well say that it is almost impossible to exaggerate the chaos that has been created by well-meaning initiative after well-meaning initiative. The system is now so complex that, one expert told me, only four professionals in the country really understand it.

And while Whitehall dithers, elderly people and their families are left confused, helpless and sometimes shockingly neglected by what can feel like bureaucracy gone mad.

Where does health care end and social care begin? No one seems to be sure: which is why so many families feel as if they have fallen between two stools as they shuttle between hospitals and care homes. How ill do you have to be to get state support? That seems to vary enormously from local authority to local authority.

But the overall trend is clear: the Local Government Association has admitted that by 2009, if you are judged to have “moderate” needs (can’t wash your own hair or walk up the stairs, for example), you will get no help at all, whatever your income and whether or not you have relatives.

Cutbacks in relatively cheap services mean that we are propelling people more quickly than need be into the enormous expense of care homes or hospitals.

The Department of Health has a Minister for Care Services, who is supposed to bring NHS and social care together. But at the sharp end, buck-passing seems to be the order of the day. Local authorities are cutting back on day care and other services for the elderly, and so is the NHS, despite the unprecedented spending of the past five years.

Basic services such as nail-clipping may sound like luxuries, but they can prevent falls and thus the need for hospital care. More worrying are the NHS cuts in what is called “continuing care”: nursing care for people who are confused or immobile.

Age Concern believes that about 100,000 people are eligible for continuing care, but that only around 38,000 are getting it. That leaves more than 60,000 people paying for care that legally they should not have to. “Don’t believe what your local authority and NHS tell you – make sure you get independent advice,” an Age Concern spokesman tells me. “You will not get reliable, honest, complete information on how the social care system works from its practitioners, because many of them simply cannot fathom their own way around all the benefits and eligibility criteria.”

These are problems that are set to get dramatically worse. The number of people aged 85 and over is expected to increase by two thirds in England in the next 20 years. A recent review by Sir Derek Wanless for the King’s Fund found that simply keeping pace with that demographic change would require spending to double. It called for radical changes in the system and a model of free care for everyone in need up to an agreed level, after which individuals’ contributions would be matched by the State up to a defined limit.

Sadly, it does not look as if any such reforms will come in time for Liz Penny’s family. And none of those reforms will end the wilful neglect of old people that seems to be commonplace in some hospitals.

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