This chapter addresses the issues of imbalanced layout, resource mismatch, and insufficient accessibility of elderly care institutions in Chongqing. It proposes and validates a spatial optimization scheme that combines suitability evaluation with the Maximal Coverage Model. The results indicate that the optimized distribution of elderly care institutions shifts gradually from “core agglomeration” to “multi-point balance,” achieving a rational extension of resources from the central urban area to the new urban districts and the underdeveloped regions of northeastern and southeastern Chongqing, while maintaining service stability in the central area. The degree of spatial agglomeration is alleviated, and the distribution of institutions shows a more balanced diffusion trend. In terms of accessibility, weakly covered areas are significantly improved, and both the number and area of low-accessibility sub-districts (townships) are greatly reduced, enhancing the overall accessibility and convenience of elderly care services. Regarding equity, the allocation of bed resources between urban and rural areas and among different regions tends to become more reasonable, alleviating spatial imbalance and significantly improving fairness indicators. The layout of newly added institutions is concentrated in districts and counties with prominent bed shortages and evident service gaps, effectively responding to the comprehensive needs of elderly population distribution, supporting public service facilities, and transportation conditions. Overall, the optimized layout achieves the coordinated goals of quantity expansion, spatial balance, and functional enhancement. It not only provides empirical support for improving Chongqing’s elderly care service system, but also offers valuable experience for spatial governance of elderly care institutions in other cities with complex terrain and significant regional disparities.