Your statement "domiciliaries where we house our unwanted or otherwise unmanageable elders" used to describe modern nursing homes is an example of the kind of shaming society as a whole heaps upon these institutions.
With 13,000 beds, we admitted 11,000+ patients since January, 1997, the majority of them for convalescent care after a brief diagnostic stay at the hospital. Our centers are now the medical equivalent of the "medical wards" of acute care hospitals only a few years ago.
Nowadays, any one who needs nursing care beyond diagnosis is urged to the Skilled Nursing Facility....at a considerable $$ savings and for equal if not better supportive care.
The problem is the shaming that goes with the option....