This report explores reform scenarios for the support of the autonomy of the elderly in Quebec and presents an assessment of their impacts. They all involve a shift towards home care and services for people with moderate to severe needs, and they also all involve an adjustment in the resident’s contribution to accommodation. The analyses show that substantial savings could be made by implementing the proposed reforms. The authors suggest creating an autonomy account, which involves giving an amount to the elderly who are losing their autonomy. This amount would be in an account, and it could be used to purchase the services of a home support provider. With this account, the number of hours of service financed by the public sector is modulated according to the needs of the person, which helps to ensure the horizontal equity of the system. Finally, the authors discuss the possibility of modulating public funding according to the financial resources of the person in order to improve vertical equity.