Objective To explore the association of adjustment of nursing home life among elderly residents with discrepancy between expected and de facto care, and to analyze the influencing factors of nursing adjustment. Methods The demographic data questionnaire, the Nursing Home Adjustment Scale (NHAS), the Elderly Residents-Perceived Caring Behaviors Inventory and the Actual Feeling of Caring Behavior Inventory were used to survey 195 elderly residents by convenient sampling method. Results The median total score of NHAS was 94.00（80.00,104.00） points; the median discrepancy score between expected and de facto care stood at 11.00（3.00,22.00）. The adjustment to nursing home life among elderly residents was positively correlated with the de facto care they received, while negatively correlated with discrepancy between expected and de facto care （P<0.01 for all）. Multiple stepwise regression analysis showed that discrepancy between expected and de facto care，satisfaction with service, education level, character trait and subjective economic status were the influencing factors of adjustment to nursing home life among elderly residents（P<0.05，P<0.01）. Conclusion The elderly show a medium to high level of nursing home adjustment. They are facing emotional distress, and relationship development problems, and experiencing apparent disappointment regarding discrepancy between expected and de facto care. Nursing home staff are supposed to assess and identify those with poor adjustment, remediate the inadequacy in humanistic care, and assist the elderly to better adapt themselves to nursing home life.