By conducting field observations of the practice of integrating rural medical and elderly care， this study adopts the Smith policy implementation model as the theoretical framework to analyze the implementation challenges of rural integrated medical and elderly care from four dimensions: idealized policy， policy implementation agents，policy target group，and policy implementation environment. Corresponding optimization pathways are proposed. Research shows that rural integrated medical and elderly care faces practical challenges，such as ineffective rural home-based care service centers，a lack of collaborative innovation among integrated medical and elderly care departments，a severe imbalance in the supply and demand structure，and insufficient and under-qualified caregivers. Accordingly，the article proposes optimization approaches from four aspects，including strengthening policy system construction，promoting coordination among multiple implementation agents，meeting the needs of target groups，and reinforcing human resource support.