We analyze the optimal provision and insurance of long-term care in a context where preferences and risks vary across individuals. We combine a survey experiment conducted with 3,002 people aged 55 to 69 in Quebec with Quebec administrative data on care needs profiles, service provision, and health transitions. Our results suggest that an optimal scheme would reduce co-insurance for institutional care, increase it for home care, and lead to a constrained expansion of home care services. Compared with the current system in Quebec, such a reform would increase the use of home care, triple public spending, and generate a substantial gain in welfare, while highlighting the central role of capacity and labour constraints in the organization of long-term care.