Background: The long-term care (LTC) system development in China is still in its infancy and facing many challenges. This study compares the LTC system development across three provinces with different economic development levels - Shanghai, Fujian, and Henan in China. Methods: LTC relevant information were searched on government websites, peer-reviewed journals and social media, and summarized to reveal the local LTC development and challenges faced by different provinces. Results: Shanghai established strong policy support for care workforce training and ageing service facility development. However, the rapidly increasing needs of LTC threat the service quality and accessibility. Additionally, inequity in service development and delivery across different districts were observed. Fujian focused on integrating home- and community-based care services, and encouraged outsourcing care burden to unofficial care workers. The big challenge faced by the local system is the non-standardized and unprofessional care services provided by the unofficial care workers. Henan has gradually improved its LTC system, and made significant progress toward full coverage of ageing service facilities. However, the outflow of the care workforce led to the shortage of local care workforce. The mixing quality of aging care facilities and lack of care services in rural areas remained as significant issues. Conclusion: this study reveals the different strategies that different provinces used to cope with ageing population, and unique challenges that local systems face in long-term care. Future China's long-term care policy should tailor to local systems, diversifying service models, improving service quality, and cultivating human resources.