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This analytic study surveys the transformations of elderly care policies and practices since the early 1990s, by comparing the trajectories of two extremely different care systems: Italy, a familialistic model with no relevant changes in social policies; and the Netherlands, a formal care model under restructuring. The author demonstrates that, in spite of strong policy pressures, the Dutch system remains a formal care model and represents a case of institutional and social resistance to welfare restructuring By contrast, the Italian system has shifted from family-based to a mix of family- and market-based model, despite the absence of substantial policy intervention. She argues that the ongoing changes need to be seen from a micro-to-macro perspective, considering the choices and strategies of the actors that are limited and conditioned by the institutional framework, but also represent possible forces of social change.