Against the dual strategic backdrop of healthy aging and high-quality development in the Yellow River Basin, the Shandong section of the basin exhibits pronounced trends of population aging and high prevalence of chronic diseases among the elderly. Traditional medical, elderly care, and nursing services operate in a fragmented manner, with significant issues such as disconnection between medical care and elderly support, separation of nursing and care services, and imbalanced resource allocation, making it difficult to meet the long-term continuous care needs of elderly patients with chronic conditions. Grounded in the theories of holistic governance and collaborative governance, this study employs literature review, field research, case analysis, and expert consultation to examine the current state, practical challenges, and underlying causes of integrated medical-nursing-care services for elderly patients with chronic diseases in the Shandong section of the Yellow River Basin. It proposes establishing a comprehensive service framework encompassing four dimensions, service providers, service content, service processes, and service support; develops differentiated implementation pathways for urban and rural areas, and establishes a sustainable mechanism integrating policy, talent, funding, and regulatory oversight. This research provides theoretical insights and practical models for enhancing health service delivery for elderly patients with chronic diseases in the Yellow River region, promoting deep integration of medical, nursing, and care services, and advancing the realization of healthy aging.