This paper aims to estimate the future long-term care needs and expenditures in Quebec, and to propose and evaluate a reform package that increases the use of home care while increasing public coverage of care needs. The proposed reform improves users’ ability to choose their provider with the creation of a senior’s care account; it also improves the neutrality of public support across care arrangements, by increasing residents’ contribution in nursing homes and maintaining existing tax credits to help seniors with lower care needs. 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 that costs will quickly become prohibitive under current policy. We show that substantial cost savings may exist.