In Bavarian psychiatric hospitals approximately 15,000 people with mental handicaps and mental illnesses were killed after the end of the so-called “Action T4”. Targeted death of mentally ill patients in numerous psychiatric institutions continued. Death from starvation was one of the strategies of so-called “decentralized” or “regionalized euthanasia”. The aim of the present study was to analyse psychiatric care of elderly patients in the time of “regionalized euthanasia” using the examples of the Bavarian-Swabian psychiatric hospitals in Günzburg and Kaufbeuren. Based on files of elderly patients from the archives of the district hospitals in Günzburg and Kaufbeuren as well as annual reports of both institutions spanning the years 1933 to 1952 we analysed whether criteria of “regionalized euthanasia” were fulfilled among elderly patients. Sources indicate that the focus was on patients’ needs for care and efficiency after the end of T4. There was a practice of “decentralized euthanasia” in some psychiatric institutions. With the Bavarian decree of starvation diet (Hungerkosterlass) food for all patients who were unable or unwilling to work was greatly reduced. There was an “opaque” transition zone from undersupply to active decentralized killing of patients.