Population ageing presents big challenge for cities, which will have to support increasing number of elderly citizens with special social and health needs. New services based on integrated care, community approach and modern technologies can help to face this challenge. Use of ICT-based solutions can enable new ways of indicating, delivering and managing care and help increasing senior citizens' quality of life. Therefore, innovation in elderly care should be part of Smart city agenda. But out of all topics linked to Smart cities, elderly care is maybe the most resistant when it comes to implementing new technology. The article discusses the obstacles in innovation in integrated elderly care and presents participative design methods as possible catalysator of change. The case study from the City of Prague demonstrates the use of participatory design in designing complex ICT based solution for integrated elderly home care in major European city. The article summarizes what stakeholders were involved in the project, what methods were used and how participatory design contributed to the final solutions and their acceptance.