This chapter systematically reviews the research progress on the allocation of institutional elderly care resources and spatial optimization, analyzed from four dimensions: theoretical framework, research paradigm, policy evolution, and micro-level empirical studies. First, based on the three core theoretical logics of resource equity, spatial justice, and governance capacity, it constructs the value foundation and institutional support for elderly care resource allocation. Second, it summarizes the paradigm shift from quantity expansion to structural optimization, from static layout to dynamic adaptation, and from supply-oriented to demand-responsive approaches. At the macro level, it analyzes the guiding role of national policies, fiscal mechanisms, and regional pilot programs in spatial configuration, pointing out ongoing challenges such as significant regional disparities, severe resource mismatches, and insufficient governance coordination. At the micro level, it introduces methods and tools such as accessibility measurement, site optimization models, and age-friendliness assessment of the built environment, emphasizing multidimensional data integration and a human-centered analytical perspective. Overall, the allocation and spatial optimization of institutional elderly care resources has become a complex issue concerning equity, efficiency, and sustainability, requiring systematic responses across multiple scales and interdisciplinary domains.