Since 1990, Albania has witnessed rural out-migration on a massive scale, both to other countries, chiefly Italy and Greece, and internally to Tirana and other major towns. The scale of this migration has disrupted the multi-generational rural social and kinship systems that, before 1990, displayed strong and coherent family bonds, and simultaneously accommodated paternalistic state directives and were supported by welfare provision for all members of the population. The sudden political, social and rural dislocations that followed the end of the communist regime have made older people particularly vulnerable: many have been left behind by their emigrant children, creating the phenomenon of socially-isolated ‘elderly orphans’. While the migrants' remittances cushion this social isolation, the loss of children and grandchildren through emigration has undermined older people's self-respect and raison d'être in Albanian family life. This paper, based on fieldwork and interviews in regions of heavy out-migration in northern and southern Albania, examines the human impact of emigration on the older people who have been left behind as well as their coping mechanisms, one being to follow their children abroad to care for the grandchildren, enabling the ‘middle generation’, working-age parents both to engage in paid work.