The traditional facilities focus on a particular level of care and a clearly defined (referred) target group. Changes in the level of care required may force people to move as often as four times: first, to a house more suitable to their physical abilities (no high thresholds, no steep stairs); then, to an intermediate facility such as a service flat; next, to a home for the elderly; the final stage is a nursing home. In practice, people will often arrive at a nursing home from their own private house, either directly (prompted by dementia) or after hospitalisation (prompted by physical disability). But a number of older people do indeed pass through the four different environmental settings mentioned above. One rung higher on the care ladder will mean higher costs, less independence and a more restricted housing.