De-institutionalisation of care for older people in Mediterranean countries has not been sufficiently analysed, in terms of policy discourse and implementation. The aim of this chapter is to study and compare both aspects within a cluster of three different Mediterranean countries: Israel, Malta and Spain. Although these countries differ in their historical, geographic and demographic features, they share a number of features. The traditional provision of care by the family has decreased as women’s employment rates have risen and family sizes have shrunk. Despite attempts to counter this through various ‘ageing in place’ policies, in none of the three countries have such attempts managed to fully offset undue institutionalisation due to the lack of family or financial resources, let alone enable the return of older persons from institutions to the community. Despite differences, enough similarities exist to propose a Mediterranean variant of LTC for older persons. This is characterised by ongoing reliance on family care even in the face of rising female employment; by underdeveloped or under-resourced community services; and by growth in private care services including recourse to migrant care labour. These features have implications for older adults who lack family support or financial means, and for the sustainability of care policies in the face of rapid demographic ageing.