Background <p>Stroke is the leading cause of death and a major cause of disability in China, posing significant challenges for post-stroke care and rehabilitation. Understanding how different living arrangements affect the health outcomes of stroke survivors is increasingly important. This study aims to compare different living arrangements-either living at home or in care institutions-and to evaluate their impact on stroke survivors’ health.</p> Methods <p>Based on the cross-sectional survey data from the Long-Term Care Insurance of Shanghai, China from January to June 2023, we identify the key characteristics of stroke survivors living in different locations. Kernel-based propensity score matching is employed to enhance comparability between groups. Health outcomes, including self-reported health status, and post-stroke infections, are compared between the two living locations.</p> Results <p>Among 54,575 stroke survivors, 47,347 (86.76%) reside at home, 7,228 (13.24%) live in care institutions. Stroke survivors residing in health institutions are generally older and exhibit worse disability status compared to those living at home. The median Barthel Index of the home group is 10 (6–13), and 5 (2–9) in the institution group (<i>P &lt;</i> 0.05). Individuals living at home (odds ratio [95% CI]) report poorer health status (1.349[1.238–1.470]) and higher risks of pulmonary infections (1.319[1.150–1.513]), urinary tract infections (1.745[1.458–2.090]) and pressure sores (2.410[2.027–2.866]). The Barthel Index correlates with improved self-reported health status, and a reduced risk of pulmonary infections and pressure sores.</p> Conclusions <p>This is the first large-scale study in China to systematically assess the living arrangements of stroke survivors, revealing significant disparities in health outcomes based on living location. The findings underscore potential limitations in both home care and institutionalized care for stroke survivors and highlight the need for enhanced support in both settings.</p>