Based on policy instrument theory, this article systematically analyzes the structural challenges faced by Macao’s long-term care system for the elderly, such as fragmentation, lack of standardization, and shortages of professional manpower. Through a comparison of Hong Kong’s integrated governance framework and the United States’ InterRAI-based precise closed-loop management technology, this study proposes an innovative pathway tailored to the characteristics of Macao’s micro-economy. This pathway builds on the InterRAI standardized assessment tool to construct a data-driven closed-loop management mechanism that covers the entire process from “needs screening—care planning—resource payment—quality benchmarking—system optimization.” The aim is to explore a new sustainable elderly service governance model characterized by “government leadership, data-driven processes, and market collaboration”, providing a practical blueprint for restructuring the Macao system and offering both a theoretical reference and practical paradigm for other regions facing challenges of super-aged societies.