Dependency levels were assessed in 441 elderly people in long term geriatric hospital care, 488 living in private nursing homes and 637 in the local authority residential homes in Fife. Results indicated that the most dependent were in hospital care, the most able in residential homes with private nursing homes accommodating elderly people with intermediate dependency levels. While each care setting cares for severely dependent elderly people, up to 29% of those in residential homes, 24% of those in nursing homes and 6% of hospital residents were considered by care staff to be fully independent. The implications of this in relation to the future provision and pattern of long term care for the frail elderly in Fife are considerable.