Qianxinan Prefecture is the only state in Guizhou Province selected as the second batch of pilot cities of long-term care insurance. As an ethnic minority region, underdeveloped area and longevity township, Qianxinan prefecture has actively explored and constructed a long-term care insurance system and operation mechanism in line with local reality, and achieved remarkable phased results. Based on the comprehensive introduction of the long-term care insurance system in Qianxinan prefecture, this paper analyzes the problems, and puts forward some suggestions such as appropriately expand the scope of treatment enjoyment, optimize the treatment payment structure, carry out disability prevention and delay, expand the scope of auxiliary equipment rental and purchase catalogue, and carry out institutionalized risk prevention and control management. This study can provide reference for other underdeveloped areas to establish and optimize the long-term care insurance system.