Institutional Long-Term Care in Lithuania: Residential Services, Reform and Changing Expectations

Moving into a social-care home in Lithuania is usually not the first response when an older person begins to need support. National policy places emphasis on helping people remain at home for as long as this is appropriate, using general social services, home support, day social care, integrated assistance and other community options. Residential social care becomes relevant when those approaches are insufficient to meet the person’s needs safely and sustainably.

That does not make institutional provision a residual or disappearing part of Lithuania’s long-term care system. Residential social care remains essential for people whose needs are intensive, whose home circumstances cannot support safe care, or whose social situation makes continuing at home unrealistic. The more important policy question is therefore changing: not whether residential care should exist, but when it is appropriate, how it should be organised and whether it protects dignity, autonomy, relationships and quality of life.

This seventh article in the Lithuania Ageing, Long-Term Care & Community Support Knowledge Hub examines institutional long-term care within that changing context. It focuses on residential social care for older people and adults with disabilities while distinguishing it from healthcare-based institutional nursing. It also considers Lithuania’s longer transition away from large institutional models and towards smaller, community-oriented forms of support.

Residential care sits at the intensive end of the social-service continuum

Lithuania’s social-services framework is designed around increasing levels of support. People may first receive general services or social attendance, then more intensive day social care or assistance at home. Where these responses are no longer sufficient, short-term or long-term residential social care can be considered.

This sequencing matters because institutionalisation can otherwise become the default response to unmet community need rather than a decision based on the person’s actual circumstances.

For an older person, residential social care may become appropriate when they require sustained assistance with daily living that cannot reliably be provided at home, particularly where frailty, dementia, mobility problems or the absence of informal support combine. Adults with disabilities may also receive residential social care, although Lithuania’s disability reform direction increasingly emphasises smaller-scale community living and independent support rather than traditional institutional provision.

Residential social care should also be distinguished from institutional healthcare and nursing. Lithuania’s health and social systems have different funding, professional and organisational arrangements. A person living in a social-care home may still require healthcare services, but the institution’s social-care role is not identical to hospital or nursing treatment financed through the healthcare system.

The distinction matters because long-term residence involves much more than meeting physical needs. A person is living there, often permanently. Quality therefore extends to privacy, relationships, meaningful activity, choice, control and connection with the wider community.

Municipal assessment remains the gateway to publicly organised residential care

Where long-term social care is financed through public resources, the person or their representative normally approaches the municipality responsible for their place of residence. Municipal social workers assess the need for social services and, where appropriate, the need for long-term social care.

Current Lithuanian arrangements distinguish the assessment of ordinary social-service need from assessment for long-term social care, with defined administrative timescales for both assessment and decision-making.

The key principle is that residential placement should follow assessment rather than replace it.

Assessment needs to understand:

• the person’s ability to manage daily living and self-care;
• health conditions and functional limitations relevant to support;
• cognitive, behavioural or communication needs;
• the home environment and availability of realistic community alternatives;
• family involvement without assuming unlimited unpaid care; and
• the person’s preferences, relationships and desired living arrangements.

The municipality then needs to determine whether less intensive services could reasonably meet the need or whether residential care is justified.

This reflects a wider person-centred planning and strengths-based approach. The question should not simply be whether the person qualifies for a residential place. It should be whether residential care is the most appropriate way of supporting the life they are now able and want to live.

Scenario: residential care is considered after home support reaches its limit

An 89-year-old woman with advanced frailty and moderate dementia lives alone. Municipal home support has gradually increased, her daughter visits most days and outpatient healthcare professionals are involved. For several months, the arrangement remains viable.

Her needs then change. She begins waking disoriented at night, leaves the apartment building on two occasions and increasingly requires assistance with transfers. Her daughter starts sleeping at the property several nights each week while continuing to work.

The decision is no longer simply whether another daytime visit can be added.

A municipal reassessment needs to examine the combined sustainability of the arrangement: the woman’s safety, her cognitive deterioration, night-time need, physical assistance requirements and the daughter’s capacity. Additional home support may still be possible, but its practical availability matters as much as theoretical entitlement.

If residential social care is considered, the discussion should include the woman and her daughter as far as possible, consider proximity to familiar relationships and identify what information needs to accompany the transition.

The move should not be interpreted as evidence that home care “failed”. The woman’s needs have changed. The governance question is whether the system responded proportionately as that change occurred and whether residential care now offers a more sustainable balance of support, safety and quality of life.

Lithuania’s residential sector includes different forms of provision

Residential social care is delivered through a varied provider landscape rather than one national institutional system. Municipal, state-linked, non-governmental and private organisations can all be involved in providing residential care.

The system also contains different types of licensed residential settings. These include social-care homes for older people and adults with disabilities, specialised nursing and social-care homes, group living homes and other forms defined through Lithuania’s licensing arrangements.

The existence of smaller group living settings is particularly significant within deinstitutionalisation. It reflects a shift from large congregate institutions towards more ordinary domestic environments for some people who still require substantial support.

However, size alone does not determine whether support is genuinely community-based or person-centred.

A small home can reproduce institutional routines if residents have little choice over when they wake, eat, leave the building or participate in everyday life. A larger residential home can still improve autonomy by organising support around individual preferences, privacy and community participation.

The stronger distinction is therefore between institutional culture and person-centred living rather than simply between large and small buildings.

This connects with outcomes, independence and community inclusion. Residential provision should be assessed by what life within it enables, not solely by its bed numbers or physical configuration.

Personal contributions make residential care a household financial decision too

Long-term residential social care in Lithuania is publicly subsidised but is not ordinarily free of personal contribution.

Under current arrangements, the amount paid by an adult for long-term social care is calculated with reference to income and assets. The standard contribution cannot exceed 80% of the person’s income. Where the value of relevant assets exceeds the municipality’s applicable property-value norm, an additional monthly amount can be charged based on the value above that threshold.

Where a person receives the individual assistance cost compensation that replaced earlier targeted nursing or care compensations, that compensation is directed towards payment for long-term social care.

The remaining eligible cost is met through the applicable public funding arrangements, involving municipal and state resources depending on the person and service.

This structure provides substantial financial protection compared with requiring residents to pay the full institutional cost privately, but it also means residential care materially changes the use of personal income.

Financial communication is therefore part of good transition practice. People and families need to understand how the contribution is calculated, which income or compensation is included, how property affects the assessment and what happens if circumstances change.

A person can also enter a social-care home privately using their own resources and later apply for publicly financed social care. This illustrates an important distinction between accessing a place and receiving public financial support for that place.

Choosing a residential place is about relationships as well as capacity

Where residential care becomes necessary, location can substantially affect the person’s future quality of life.

A place located close to family, friends and the community the resident already knows may preserve social relationships that are otherwise difficult to maintain. A distant placement can create practical barriers to visiting, particularly where relatives are older themselves or public transport is limited.

Municipalities therefore need to understand residential capacity geographically, not only as a total number of available places.

A vacancy may satisfy an administrative need while producing a poor social outcome if it moves someone far from their existing network.

This becomes especially important in municipalities where provider capacity is limited or where specialist requirements narrow the available options.

The same principle applies to couples. Where one partner needs residential care and the other does not, placement decisions reshape everyday family life. Supporting relationships after admission should therefore be considered part of quality rather than an optional social activity.

Scenario: the available bed is 70 kilometres from the family

An 83-year-old man needs long-term residential social care following progressive neurological deterioration. His wife, aged 80, cannot safely provide the physical support required at home. Their municipality accepts that residential care is appropriate.

The nearest preferred home has no current place. Another suitable provider can accept him immediately but is approximately 70 kilometres away.

From a capacity perspective, the problem has been solved. From a family perspective, it has not.

His wife does not drive. Visiting would require relatives to transport her or a difficult public-transport journey. A permanent placement at distance could therefore reduce a daily marriage to occasional visits.

The municipality has to balance immediate care need against continuity of relationships. Waiting at home may no longer be safe, so the more distant placement may initially be necessary. However, that should not automatically end the decision process.

The person can remain visible for transfer closer to home if an appropriate place becomes available, and the provider can actively support contact while he is living at distance.

At system level, repeated cases of distant placement should become planning evidence. They may demonstrate insufficient local capacity or an unsuitable distribution of specialist provision rather than a series of unrelated individual preferences.

Quality regulation establishes the floor, not the whole experience

Residential social care is a licensed activity in Lithuania. The Social Services Supervisory Department under the Ministry of Social Security and Labour issues licences for social-care provision, can suspend or revoke licences and supervises compliance with licensed activity conditions.

The Department also monitors and evaluates social-care quality and supports application of social-care norms. Its supervision includes risk-based approaches to selecting licensed providers for inspection.

This provides an important national assurance layer. A residential provider should not operate merely because local demand exists; it needs to meet the conditions associated with the relevant social-care licence.

Regulatory compliance, however, establishes only part of the quality picture.

A home may comply with staffing, environmental and procedural requirements while residents experience limited choice or monotonous daily life. Another may record few incidents because residents rarely leave the building, not because risks are being managed particularly well.

Quality therefore requires both standards and outcome evidence.

Wider quality standards and assurance frameworks are strongest when they combine minimum protections with information about the actual lives people are experiencing.

Organisations considering equivalent oversight challenges can use the Governance Maturity Assessment to examine whether accountability, risk and operational assurance are sufficiently connected. It has no Lithuanian regulatory status; its relevance lies in testing whether provider governance goes beyond formal compliance towards meaningful oversight of quality and outcomes.

Residential quality is created through ordinary routines

Institutional quality is often discussed through inspection, staffing ratios and formal care plans. Residents experience it through much more ordinary details.

Can someone decide when they get up? Can they have food outside fixed mealtimes? Can they personalise their room? Can they maintain a relationship privately? Can they go outside without waiting for a group activity? Are staff sufficiently familiar with the person to notice subtle deterioration?

These are not peripheral hospitality questions. They determine whether a care setting behaves primarily as someone’s home or primarily as an organisation.

Older residents may spend years in long-term social care. People with disabilities may potentially spend much longer. Organisational convenience therefore has the capacity to shape an enormous proportion of a person’s life.

Person-centred residential care requires services to organise routines flexibly wherever possible while still meeting collective responsibilities for safety, staffing and efficient operation.

There will inevitably be limits. A shared service cannot provide unlimited individual staffing, and some activities depend on workforce availability. The governance requirement is to make those constraints visible rather than allowing institutional routine to be mistaken for personal preference.

Workforce determines whether residential care feels institutional

Residential long-term care is profoundly workforce-dependent. Technology and buildings matter, but staff shape most of the resident’s daily experience.

Lithuania’s demographic and labour-market pressures therefore have direct implications for residential quality. Homes need workers across the entire 24-hour period, including weekends and holidays. Recruitment difficulties cannot easily be absorbed by reducing opening hours or postponing activity.

Staff also need more than the ability to complete care tasks. Residential teams may support residents with dementia, frailty, communication difficulties, mobility limitations, complex health conditions and emotional responses to major life changes.

The required workforce therefore depends upon:

• sufficient staffing capacity throughout the day and night;
• appropriate skill mix and access to health professionals;
• training relevant to residents’ changing needs;
• effective supervision and leadership;
• continuity so residents are not constantly supported by unfamiliar workers; and
• working conditions capable of retaining experienced staff.

This places workforce skill mix and practice competence at the centre of residential reform.

A modernised building with unstable staffing can still deliver poor continuity. Conversely, a strong team can improve residents’ lives substantially even within an imperfect physical environment.

Scenario: vacancies change the character of a care home

A residential social-care home has historically organised small daily activities, community visits and flexible routines. Over several months it develops persistent staff vacancies.

There is no single major incident. Instead, the service gradually changes.

Community outings become less frequent because fewer staff can accompany residents. Mealtimes become more fixed because it is easier to organise support collectively. Agency or temporary workers increase, reducing familiarity. Staff spend more time ensuring essential personal-care tasks are completed and less time supporting residents to pursue individual activities.

Basic care continues, so the service can initially appear stable.

Governance that monitors only serious incidents or occupancy could miss the decline. Resident feedback, workforce turnover, activity patterns, complaints and care-plan outcomes would reveal a different picture.

The appropriate response needs to address the workforce cause rather than simply instructing staff to increase activities. Leaders need to understand why vacancies persist, whether workloads are sustainable, whether pay and career development are competitive and what level of staffing is necessary to maintain the intended service model.

Organisations facing equivalent pressures can use the Predictive Workforce Risk Module to connect staffing indicators with service-continuity risks. The central lesson is that workforce instability often changes quality gradually before it produces a reportable failure.

Families should remain part of life after admission

Moving into residential care changes family roles but should not erase them.

Relatives may previously have provided substantial practical care. Once formal staff take responsibility for daily support, families can return more fully to being spouses, children, siblings or friends rather than functioning primarily as unpaid carers.

That transition can be positive, but it can also involve guilt, grief and uncertainty. Families may worry about whether the resident is receiving enough attention or feel excluded from decisions they previously managed themselves.

Good residential services recognise both the resident’s autonomy and the value of supportive family relationships.

This means involving relatives where the person wants that involvement, communicating significant changes, listening to information about routines and preferences, and supporting visiting and continued relationships.

It also means maintaining appropriate boundaries. Families do not automatically retain control over every aspect of the adult resident’s life simply because they provided care previously.

The wider principles of family partnership and carer support therefore remain relevant after residential admission. Partnership is strongest when family knowledge contributes to care without displacing the person at the centre.

Deinstitutionalisation is broader than closing large buildings

Lithuania’s deinstitutionalisation agenda has been particularly important for children and adults with disabilities. National reform has sought to enable people with disabilities and their families to receive individualised community services rather than relying on long-term institutional placement.

This involves transferring not simply residents but resources, skills and responsibility into community settings.

Closing an institution without sufficient housing, personal assistance, community support, healthcare and workforce capacity can relocate risk rather than eliminate institutionalisation.

Likewise, replacing one large institution with several small homes achieves limited reform if everyday routines, decision-making and social separation remain unchanged.

The deeper reform concerns power.

Institutional systems tend to organise life around collective provision. Rights-based community models aim to organise support around the individual’s choices, relationships and participation in ordinary society.

The transition therefore requires changes in workforce practice, housing, municipal planning, financing and public attitudes as well as physical infrastructure.

For older people, the same underlying principle is increasingly relevant even though the policy history differs. Expanding home and community support can reduce unnecessary admission to residential care, but good residential provision remains necessary for those whose needs genuinely require it.

Group living can bridge residential support and community life

Smaller group living homes have become one of the practical mechanisms within Lithuania’s transition towards community-based support for people with disabilities.

The model can offer a more domestic environment, smaller resident groups and greater connection with ordinary neighbourhood life than traditional large institutions.

Its success, however, depends on how support is delivered.

If staff make all decisions, residents spend most of their time together and community participation occurs only through organised group outings, the building may be smaller without the experience becoming substantially more individualised.

Effective group living requires support for ordinary routines: shopping, relationships, employment or day activity, local transport, personal interests and time spent independently where appropriate.

This is why co-production, choice and control matter. Residents should influence how support works, not simply receive a smaller version of institutional care.

Positive risk is one test of whether reform is genuine

Institutional environments can reduce visible risk by restricting opportunity. If residents rarely leave without staff, they may be less likely to encounter certain hazards. They are also less likely to exercise autonomy.

Community-oriented residential care requires a more proportionate approach.

A resident may want to walk independently to a nearby shop, prepare some of their own food or spend time with friends away from staff supervision. These choices can involve foreseeable risks, but eliminating every risk can itself diminish quality of life.

Organisations considering such decisions can use the Positive Risk-Taking Planner to structure thinking around benefits, risks, safeguards and contingencies. The tool does not determine Lithuanian legal rights or substitute for professional assessment; its usefulness lies in preventing risk management from becoming automatic restriction.

The ability to support ordinary risk is one practical indicator of whether a residential service has genuinely moved towards person-centred practice.

Residential services need stronger outcome evidence

Traditional institutional performance measures tend to focus on inputs and safety: occupancy, staffing, expenditure, incidents and compliance with requirements. These measures remain necessary, but they do not explain whether residents are living well.

Outcome evidence can examine whether people maintain function, participate in decisions, remain connected with families and communities, experience meaningful activity and feel safe without unnecessary restriction.

For older residents, deterioration will sometimes occur despite excellent care. Outcome measurement therefore needs to be sophisticated enough not to treat every decline in independence as provider failure.

The relevant question may be whether function was maintained for as long as reasonably possible, whether deterioration was recognised early and whether the person’s preferences continued to shape support as needs changed.

Resident and family feedback provides another essential perspective. Complaints are particularly valuable when treated as intelligence rather than simply cases to close.

Wider service-user feedback and co-production can reveal patterns about routines, privacy, communication and relationships that formal inspections may see only briefly.

The Quality Dashboard Builder offers organisations examining comparable issues a way to connect safety, workforce, experience and outcome indicators. It is not a Lithuanian reporting framework; its relevance is the governance principle that residential quality becomes clearer when different evidence streams are viewed together.

Technology can support safety without turning the institution into a surveillance environment

Residential care can benefit substantially from digital records, assistive technologies, medication systems, sensors and remote access to healthcare expertise.

For an ageing Lithuanian population and a constrained workforce, technology may reduce administrative duplication and help staff identify emerging risk earlier.

It also creates ethical questions.

A sensor used to identify falls may be proportionate and helpful. Constant surveillance installed primarily because it reduces staffing anxiety can interfere with privacy and dignity. Digital records improve coordination only if staff can use them effectively and if information flows to the people who need it.

Technology therefore needs governance around purpose, access, consent, security and response.

It should also support human relationships rather than replace them. Remote healthcare consultation may avoid unnecessary journeys, but residents still need meaningful interpersonal contact within daily life.

The more institutional the setting, the greater the risk that technology is implemented for organisational convenience rather than resident choice. Strong digital practice therefore starts with what problem is being solved for the person.

Scenario: a sensor identifies risk, but the pattern matters more than the alarm

A residential home introduces night-time movement sensors for residents who are at significant risk of falling. One resident begins triggering alerts much more frequently than usual.

Staff initially respond to each alert individually, assisting her back to bed. No fall occurs, so the technology appears to be working.

After several nights, however, a senior worker reviews the pattern rather than the individual alarms. The increase represents a change from the resident’s normal routine.

Clinical review identifies discomfort caused by a health problem. Treatment resolves the immediate issue and night-time wandering reduces.

The scenario illustrates the difference between monitoring and intelligence. The sensor did not prevent the underlying problem; it produced information from which staff could recognise change.

Governance should therefore consider not only whether equipment is operational but whether repeated alerts, incidents or changes are reviewed thematically. Technology becomes valuable when it improves professional judgement rather than merely generating more notifications.

Safeguarding risk changes when people depend on one institution for everyday life

Residential services concentrate power. Staff influence access to food, medication, personal care, communication, money, transport and the outside world. Residents with cognitive impairment or communication difficulties may be particularly dependent on those relationships.

This makes safeguarding culture critical.

Abuse in institutional settings does not always appear as a dramatic individual event. It can take the form of rough practice, humiliation, inappropriate restriction, neglect, financial exploitation or routines that systematically disregard residents’ rights.

Workforce pressure can increase risk where rushed staff become task-focused or poor practice is normalised.

Effective safeguarding therefore requires routes for residents, families and workers to raise concerns; clear investigation and escalation; leadership visibility; and learning when patterns emerge.

The wider principles of safeguarding culture and leadership are especially important in residential environments because people cannot simply leave the service at the end of a visit.

Quality assurance should also consider restrictive practice and the use of institutional routines as forms of control, not only overt abuse.

Residential care needs to remain connected to healthcare

Residents of long-term social-care homes frequently have substantial healthcare needs, particularly in older-age services. Social-care providers therefore cannot operate in isolation from primary healthcare, nursing, specialist services, rehabilitation and end-of-life care.

The interface becomes more important as residents become frailer and live with multiple chronic conditions.

Poor coordination can produce avoidable hospital attendance, delays in treatment or repeated transfers that are distressing to the person.

Conversely, residential services should not become informal hospitals simply because access to community healthcare is difficult. Staff roles and competencies need to remain clear.

The best operating model brings healthcare into the residential pathway while protecting the distinct purpose of the social-care home as a place where people live.

Advance planning can also reduce unnecessary crisis decisions. For residents approaching the end of life, discussion about preferences, appropriate clinical intervention and family involvement can support care that is both clinically appropriate and personally meaningful.

Residential capacity still needs planning even during deinstitutionalisation

Policy emphasis on community support can create a planning risk if residential care is treated as a model that will simply disappear.

Lithuania’s ageing population means the absolute number of people with high-intensity long-term care needs may increase even if a greater proportion are supported at home.

Residential capacity therefore still needs strategic planning.

The appropriate question is what type of residential provision will be required.

Future demand may include more residents with advanced dementia, frailty and complex combinations of health and social needs. Traditional large-scale capacity may therefore need to evolve towards more specialised, smaller or more flexible forms of support rather than merely expand in its existing form.

Workforce availability will strongly influence what is viable. A municipality may want additional places, but beds without sufficient skilled workers do not create safe capacity.

Planning should consequently connect demographics, community-service growth, hospital pathways, workforce and current occupancy rather than forecasting residential demand from historical utilisation alone.

Changing expectations will reshape what residents and families consider acceptable

Residential care is also being changed by public expectations.

Future generations of older Lithuanians may expect greater privacy, digital connectivity, individual choice and control than was historically associated with institutional care. Adults with disabilities increasingly expect rights-based support and ordinary community participation rather than lifelong segregation.

This changes the standard against which providers are judged.

A service may be safe and well maintained but still feel outdated if residents have little control over routines, limited privacy or few opportunities to maintain ordinary life.

Providers therefore need to think beyond physical modernisation. Buildings matter, particularly accessibility and private space, but culture and workforce practice determine whether those environments feel like homes.

Changing expectations also increase the importance of transparency. Families can compare providers, seek information about quality and expect meaningful involvement. Digital communication can strengthen connection but may also increase scrutiny of poor practice.

The direction is towards residential services that need to demonstrate not simply that they provide care, but that residents retain identity, rights and ordinary human relationships while receiving that care.

The future role of residential care is becoming more precise

Lithuania’s long-term care system is moving towards a more differentiated model.

Home support and integrated assistance should enable more people with low or moderate needs to remain in their communities. Personal assistance and smaller community settings should reduce inappropriate institutionalisation of people with disabilities. Prevention and rehabilitation can delay some transitions into long-term residential support.

Residential care can then become more clearly focused on people for whom it genuinely offers the best available setting.

This is a more sustainable role than treating institutions as the default solution whenever family care becomes difficult.

It also raises the quality threshold. If people enter residential care later and with greater complexity, providers will need stronger workforce capability, healthcare coordination and dementia competence.

Community expansion and residential reform are therefore not competing strategies. Each depends on the other.

Insufficient community services create premature residential demand. Insufficient high-quality residential capacity leaves families and home-care systems carrying levels of need they cannot safely sustain.

The strongest long-term care system requires both, with clear pathways between them.

What other countries can learn from Lithuania’s residential-care transition

Lithuania’s institutional-care history reflects its own political, social and administrative development, and its current reforms are shaped by municipal responsibility, European investment and national disability policy. Those institutions cannot simply be transplanted elsewhere.

Several underlying principles have wider relevance.

First, deinstitutionalisation should be measured through people’s lives rather than building closures. Smaller settings and community addresses matter only when they produce greater autonomy and participation.

Second, residential care remains necessary even in systems committed to ageing at home. A balanced system needs sufficient high-quality capacity for people whose needs cannot reasonably be met elsewhere.

Third, regulation provides essential protection but cannot measure the whole resident experience. Workforce continuity, choice, relationships and meaningful activity need visibility alongside compliance.

Fourth, family relationships should remain part of care after admission. Institutional provision should replace unsustainable caregiving tasks without unnecessarily replacing the family itself.

Finally, community and residential care need to be planned as one continuum. Expansion of one changes the demand, workforce and complexity profile of the other.

Conclusion

Institutional long-term care remains an essential part of Lithuania’s social-care system, but its purpose and expectations are changing. Residential provision is increasingly positioned at the intensive end of a broader continuum, after home, day and community services have been considered and where sustained support cannot reasonably be provided elsewhere. At the same time, Lithuania’s deinstitutionalisation agenda is challenging older assumptions about how people with disabilities in particular should live and receive support.

The next stage of reform therefore cannot be judged simply by reducing institutional places. Lithuania needs enough residential capacity for an ageing population while ensuring that admission reflects genuine need rather than missing community alternatives. It needs stable and skilled workforces, effective healthcare interfaces, transparent personal contributions, strong national supervision and municipal planning capable of preserving relationships and geographic access.

Most importantly, the quality standard is changing. A residential setting is not successful merely because people are safe, fed and cared for. Residents should retain privacy, identity, meaningful relationships, reasonable choice and connection with the wider world.

That is the strongest direction for Lithuania’s institutional-care transition: not abolishing residential support, nor defending older institutional models, but defining a clearer role for high-quality residential care within a system increasingly organised around autonomy, community participation and support matched to the individual rather than the institution.