A test of a civilised society is how well it cares for its most vulnerable members. It is the care and compassion for the elderly, especially those with degenerative conditions, that must count as the sternest test. The Care Commission has produced its first comprehensive national picture of the state of care in Scotland. While facilities for children are generally good and those for the disabled receive a qualified thumbs up, it is care homes for older people that give "significant cause for concern". Help the Aged was quick to note the contrast. "Some of the treatment elderly people receive in care would be unacceptable in childcare," it said.

A test of a civilised society is how well it cares for its most vulnerable members. It is the care and compassion for the elderly, especially those with degenerative conditions, that must count as the sternest test. The Care Commission has produced its first comprehensive national picture of the state of care in Scotland. While facilities for children are generally good and those for the disabled receive a qualified thumbs up, it is care homes for older people that give "significant cause for concern". Help the Aged was quick to note the contrast. "Some of the treatment elderly people receive in care would be unacceptable in childcare," it said.

Old people are loath to make a fuss and too few are fighting on their behalf. As a result, too many care homes fall short. The main problem appears to be staffing, with inadequate numbers of often inadequately trained staff. There is also the issue of privacy and dignity, with 6000 residents still sharing bedrooms, despite a target to phase this out by year's end except for those wanting to be together. There are concerns about poorly supervised meal times and failure to consult residents about their food preferences. The overall impression is of some Scottish care homes treating clients more like inmates. There are exceptions but, generally, the larger the home, the less satisfactory and the less personalised is the care experience on offer.

If we fail to tackle these issues, they will only worsen. A second report yesterday predicts that more than 1.7 million people in the UK will be suffering from dementia by 2051. At present, one in eight of the population has caring responsibilities. Within 30 years, that is likely to be one in five. Unless we are to contemplate impersonal "granny farms", we need to find new models of care and better ways of supporting those willing to look after elderly relatives at home. The strains and contradictions implicit in these relationships were exposed in the recent Holyrood debate about elder abuse during passage of the Adult Support and Protection Bill.

More helping hands in the home and better respite care must underpin these arrangements. This will place unprecedented pressure on social care budgets. While there is consensus about NHS care remaining free at the point of delivery, who should pay for social care is more complicated, especially as many are still keen to look after frail parents. A national debate about this issue is already overdue.