This paper aims to estimate the future long-term care needs and expenditures in Quebec while proposing and evaluating a reform package that could deliver increased coverage as well as be more financially sustainable than current policy. This reform package consists of a shift towards more intensive use of home care while increasing public coverage of care needs. A key feature of the proposed reform is to improve the ability of users to choose their provider with the creation of a senior’s care account, an account that grants individuals in need to purchase services from several providers, including both home and institutional care. To improve the neutrality of public support across care arrangements, we also propose to increase residents’ contribution in nursing homes while favoring the continued use of existing tax credits to help seniors with lower needs in terms of care. Using detailed dynamic modelling of care needs, living arrangements, and expenditures, we estimate that long-term care needs will grow rapidly in the next two decades and the costs will quickly become prohibitive under current policy. We show that substantial cost savings may exist.