To ensure the equitable distribution of services for the elderly within a government-driven market development framework, it’s essential for countries to conduct a thorough evaluation of the current allocation of institutional elderly care resources. Leveraging data from China’s provincial yearbooks covering the years 2012 to 2021, this research utilizes the CRITIC-TOPSIS method for resource assessment and a coupled coordination model to gauge adaptation levels. Moreover, a spatial Durbin model is applied to examine the factors influencing these patterns. The study’s outcomes reveal that, despite an expanding elderly population and increased care resources, significant spatial disparities in resource distribution and adaptation remain evident. This underscores the urgent need for precise policy interventions and the redistribution of resources to diminish these inequalities and foster equitable, effective elderly care services across various regions.