The chapter focuses on the implementation of de-institutionalisation in care for older people in
the Czech Republic and Slovakia. The principles of de-institutionalisation were incorporated in the
national strategic documents of both countries after the 2004 accession to the European Union.
First, the question of how this concept influenced the Czech and Slovak national strategies,
legislation and organisation of social services for older people is tackled. Subsequently, the
chapter looks at the ‘responses’ of regional and local authorities and providers of care services
for older people. Two case studies are then presented, which illustrate the ambivalent nature of the
de-institutionalisation process. Particular attention is paid to the new role played by domiciliary
care since this service form takes a central role as a ‘substitute’ for outdated or expensive
institutionalised care. The chapter highlights how, even though a de-institutionalisation strategy
was introduced at the national level in both countries, it was implemented without guaranteeing a
constant and steady flow of financial resources, and the transition of national policy priorities to
a ‘new’ conception of care for older people at the regional and local levels has been rather slow.
As the case studies suggest, the implementation of the national strategy can actually lead to the
exact opposite outcome than originally intended, with significant policy implications.