- Mr. Alsop is getting old. He needs to be looked after, don't you think?
This is passive and is the usual version for people who need care.
- Mr. Alsop is getting old. He needs looking after, don't you think?
This is active (for the reasons given in the comments by others). It has sinister overtones to me. It is reminiscent of 1940s gangster euphemisms for murdering someone, e.g.
"That guy needs taking care of. See to it Ratty."
"Don't worry Boss, I'll look after him." (checks gun)
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