System of choice and privatization are two significant changes in Swedish elderly care in recent decades. Sweden’s three largest cities have different strategies to handle these changes. This article explores and compares older migrants’ use of home help services and nursing homes to understand whether there are differences between these cities and why this might be the case. A mixed method was used. Privatization and system of choice were found to promote ethnically-profiled care and the use of care by migrants from the Middle East and Africa, although extant research often portrays these groups as vulnerable and lacking accessibility to elderly care.