This study investigates the dynamics of policy reforms pertaining to care for older adults in post-socialist Lithuania. In the Soviet era social services in Lithuania were in a rudimentary stage of development. By the early 1990s a combination of long-term demographic trends such as ageing, a decline in fertility rates and an increase in divorce rates, and the impact of radical neo-liberal reforms significantly increased the number of older individuals living alone and in poverty. In response, a number of measures were undertaken to reform older-age care, resulting in decentralisation, institutional layering and institutional recalibration of social services. It is argued that the historical legacy has proved to be especially significant in the institutional development of social services by reproducing a State-centred system, although with a growing trend towards the privatisation and marketisation of social care. The role of various organised interests and civic groups, policy makers and international organisations, as well as ideologies and broader sets of cultural values in shaping social services pertaining to the care of older adults are discussed.