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The chapter focuses on the implementation of de-institutionalisation in care for older people in the Czech Republic and in 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 question of what were the ‘responses’ of regional and local authorities and providers of care services for older people are addressed. 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is paid to the new role played by domiciliary care since this service form takes a central role as a ‘substitute’ for outdated or expensive institutionalised care.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 policy can actually lead to the exact opposite outcome than originally intended, with significant policy implications.

The de-institutionalisation of care for older people in the Czech Republic and Slovakia: national strategies and local outcomes