The elderly care service subsidy system is a bottom-up system to ensure that the disabled elderly in economic difficulties obtain basic elderly care services. It is an important part of the social elderly care service system. Shanghai’s elderly care service subsidy system, as the earliest established one in China, is unique. However, with the adjustment of policy and the transformation of management mode, it has encountered many problems such as the weakening of system integrity, lack of standard adjustment mechanism, long application period, and limited scope of subsidies. High-quality development is the core theme of the new era and an important opportunity for the upgrading and transformation of the elderly care service subsidy system. It is also an inevitable requirement for the development of the times. According to the systematic analysis of the Shanghai case, the elderly care service subsidy system should follow the concept of high-quality development, clarify the system positioning, carry out top-level design under the overall framework of the elderly care service payment guarantee system, gradually expand the scope of pension service subsidies, straighten out the elderly care service subsidy application mechanism, and establish connection between the subsidy system and the long-term care insurance. In this way, the elderly care service subsidy system will be transformed into and upgraded to the combination mode of social assistance and social welfare, the vitality of the system and the role of redistribution will be enhanced, and the goal of high-quality development and equalizing basic people’s livelihood security will be achieved. The research results will also be intriguing for other provinces and cities in China.