Most current sociological approaches to work recognise that the same activity may be undertaken within a variety of socio-economic forms - formal or informal, linked with the private market, public state or not-for-profit sectors. This article takes care of the elderly as an exemplary case for probing some of the linkages between paid and unpaid work. We attempt to unravel the interconnections between forms of care work undertaken in different socio-economic conditions in two settings, the Netherlands and Italy. The research is part of a broader programme concerned with differing interconnections and overlaps between work activities. In this article, we are concerned with: 1) how paid and unpaid care work map on to four ‘institutional’ modes of provision - by the state, family, market, and voluntary sector; and 2) with the configurations that emerge from the combination of different forms of paid and unpaid work undertaken through the different institutions. Despite the centrality of family-based informal care by women in both countries, we argue that the overall configurations of care are in fact quite distinct. In the Netherlands, state-funded care services operate to shape and anchor the centrality of family as the main provider. In this configuration, unpaid familial labour is sustained by voluntary sector state-funded provision. In Italy, by contrast, there is significant recourse to informal market-based services in the form of individual migrant carers, in a context of limited public provision. In this configuration, the state indirectly supports market solutions, sustaining the continuity of family care as an ideal and as a practice.