In England, older people and others who need social care must self-fund unless their assets fall below £23,250, in which case they receive state support. In this British Medical Journal article, Anders Bach-Mortensen and colleagues examine how this system has created a quality divide in residential care (care homes), with state-funded residents experiencing worse quality care, and many others having unmet needs or relying heavily on unpaid family carers. They describe how these inequalities have severe consequences for health and wellbeing, for the finances of local authorities (which fund social care), and for the NHS. They conclude that "reform will inevitably require substantial investment, but continuing the status quo means paying more for worse outcomes."