Home-based vs. Nursing Home Care: A Comparative Study on the Quality of Life of the Elderly in Nantong

Background: China’s aging population underscores urgent challenges in elderly care. In this study, quality of life (QoL) and nutritional status were compared between elderly populations in home-based and nursing home care to inform care strategies. Methods: A stratified random sample of elderly residents in the Chongchuan, Nantong, was assessed using online and offline questionnaires. The data were analyzed using SPSS 27.0. Results: Nursing home residents exhibited significantly lower QoL across all dimensions than home-based elderly. Female elderly exhibited significantly higher mean scores across all QoL dimensions than males. Individuals aged 60–69 years scored higher across all dimensions than the other age groups. Academic qualifications significantly influenced two dimensions, with higher academic qualifications associated with better outcomes. Pre-retirement occupation showed significant effects on four dimensions, although no inter-occupational differences were observed. Income significantly impacted one dimension, with higher income correlating with a better QoL. Significant effects of marital status were observed. Frequency of contact with children only influenced one dimension, with no differences across contact levels. Chronic diseases significantly affected all dimensions. Home-based elderly individuals had higher Mini Nutritional Assessment Short-Form (MNA-SF) scores than nursing home residents. MNA-SF scores showed significant positive correlations with all QoL dimensions. Conclusions: The higher QoL and nutritional status of home-based elderly individuals compared to nursing home residents was attributed to stronger family support, greater autonomy, and familiar environments. Care setting selection should consider health status and family support. Interventions targeting mental health, social interactions, and nutrition are essential for improving QoL in nursing homes.