“They take Medicaid, they’re near my house and they have an opening.”

Criteria for choosing a nursing home for a father suffering the symptoms of dementia? Apparently so, for John and Wendy (Philip Seymour Hoffman and Laura Linney), two estranged and deeply competitive siblings, brought together by a problem that is, or should be, front of mind for anyone with an elder in the family or who hopes to be one some day. Heartbreaking, gritty and beautifully acted (Linney is an Academy Award nominee for her role) Savages, is right on target in depicting the bleak landscape of a typical nursing home, complete with screwball and futile attempts at gaiety, i.e. the changing, nursery-school seasonal motifs, as well as the explosive pressure and the wacky behavior it generates.

Item: in her own when-the-going-gets-tough-the-tough-go-shopping moment, Wendy attempts to make the barracks-like accommodation more homey for Dad (Philip Bosco). We see her hanging sheer curtains to hide the institutional blinds, plumping up the pillows, and plugging in a lava lamp as a final touch. Not long after, when she finds a cushion she had bought for her father in the firm grip of another resident, she snatches it away while the elderly woman wails. Gut-wrenching.

The film is also a reminder that housing our elders — and one day, ourselves — should the ability to perform many tasks of daily life become too difficult, is a challenge for an entire family, and for the larger community. Except in the most extreme circumstances that demand 24/7 care, there are better, less expensive alternatives to a nursing home (recent figure for South Florida: $5,000/month). It comes as no surprise that most older people want to live as independently as possible in surroundings that are familiar — who wouldn’t? So it is encouraging to find models like the concierge program in Boston’s Beacon Hill Village beginning to proliferate in other cities. The program gives subscribers age 50 and older who live in the neighborhood, access to an array of services for a fee, everything from cleaning and shopping assistance, to car service for a doctor’s appointment or night on the town.

For lower income elders living in subsidized housing, needed services at reasonable cost are available through a program created in South Florida by 2006 Purpose Prize winner, Conchy Bretos. It is in demand nationwide. After she appeared on the Today Show, Ms. Bretos, an experienced lobbyist, activist and executive administrator of special population programs, returned to her desk to find her in-box jammed with over 3,000 email messages.

The Eden Alternative, founded in 1991 by Dr. William Thomas, a Harvard-educated physician and geriatrician, focuses on de-institutionalizing the culture and environment of today’s nursing homes and other long term care institutions. To date, it has trained over 15,000 Eden Associates and now claims over 300 registered homes, in the U.S., Canada, and Australia.

Savages has been called a black comedy. We see it as a wake up call. The long term care insurance that is being marketed relentlessly to older Americans is only as good as the facilities and staff available. We need fresh, innovative thinking sooner rather than later. We need activism.