For decades, intramural care of infirm elderly persons in the Netherlands has been classified into caring for them in residential care homes and nursing homes. Over the past five to ten years, the composition of the population of elderly persons has been subject to change, particularly of those in residential care homes. Organisations and institutions providing care for the elderly are going through turbulent times. All kinds of partnerships between residential care and nursing homes are being entered into. Intramural organisations providing care and nursing will have to respond to the integration of caring and nursing functions. Based on a pilot study into the need for care and support among the elderly in residential care and nursing homes, the author proposes a structure in which the first echelon consists of home care, the second of care centres and the third of geriatric centres where mainly cure oriented care is provided.