This paper offers a case study of the development, implementation, evaluation and national scale-up of a novel intervention for dependent older people living in vulnerable families. It also identifies key lessons for other countries facing similar health service challenges. Since 2011 Programa Maior Cuidado (PMC) has been supporting care-dependent older peolpe living in poor neighbourhoods of Belo Horizonte. Local health posts and social assistance centres work together to identify elegible families and provide integrated support. Trained paid family-support caregivers, recruited from similar communities, provide families 10 to 40 hours of help a week. This offers family caregivers respite from round-the-clock care-work, and PMC carers also promote family care-giving skills. PMC carers monitor older peoples condition and report back to monthly case reviews jointly conducted by staff at health and social assistance posts. Over the past five years, there have been an ongoing process and impact evaluation of PMC, includind both before and during the COVID-19 pandemic. These have generated broadly positive Findings, including evidence that PMC is cost effective, promotes more effective use of health services and benefits both older people and their families. This had led the Ministry of Health to support PMCs national roll-out, and PMCs identification as a model of best practice by WHO, World Bank and other agencies.