As the aging population puts more pressure on scarce resources, the debates as to who gets selected for essential health care services will become increasingly contentious.  The typical response is to look for ways to reform health care in order to ration services more efficiently.  Another answer is to shore up the supply of nurses.  This paper argues for additional supports for the estimated three million informal caregivers in Canada.  Options include greater provision of home supports and workplace policies that allow flexibility for elder care.  Another possibility involves the development of secondary suites, an affordable housing option that enables the provision of care at home.  The paper argues that urban design makes an important policy contribution to our social challenges.