Along with the fast growth of the aging population, commercial senior apartments offering comprehensive services have emerged as an important component of the social elder care system. Nevertheless, little academic attention has been paid to (a) the motivations or reasons behind Chinese elders’ interest in living in midrange or high-end elder care apartments and (b) how they might negotiate this decision with their families, especially their adult children. A qualitative study involving 55 in-depth semi-structured interviews along with participant observations was conducted with elders living in four full-service commercial senior apartments in the city of Hangzhou, Zhejiang province, China. A grounded theory technique including open and axial coding was adopted to develop and group key themes. Based on the theory of family power relations, data analysis revealed four important resource types: economic conditions, physical conditions, social capital, and ideological value system. These resources have crucial impacts on the decision-making power tendencies of elders and their adult children. Results also indicated that distributed cognition occurs when elders and their adult children possess distinct decision-making preferences (i.e., autonomy vs. interdependence); for example, some elders had a higher level of desired autonomy whereas others may seek more decisional support from their adult children. Based on elders’ and adult children’s distributed cognition, four approaches to family consumption decision making were identified: independent, collaborative, constrained, and isolated. Specifically, elders who engaged in independent decision making possessed a greater desire for autonomy and believed that their adult children supported their autonomy in the decision-making process. Among elders demonstrating collaborative decision making, they showed a stronger desire for decisional support from their adult children and perceived their children as willing to provide such support. Regarding elders subscribing to the constrained decision-making style, they displayed a lower desire for decision-making support and strong perceptions of interference from their adult children in the decision-making process. Conversely, elders with the isolated decision-making style had a strong desire to obtain decisional support from their adult children, but their needs for support were not met. Our findings further indicated that as resource availability (i.e., economic conditions, physical conditions, social capital, and ideological value system) changes, the four decision-making styles may evolve and thus exhibit dynamic characteristics. For example, if elders abandoned the traditional Confucian concepts of filial piety (i.e., raising children in order to be taken care of in old age), then their decision making tended to shift from a constrained style to a collaborative one. Similarly, if adult children’s attitudes towards commercial senior apartments changed, then elders with a constrained decision-making style generally moved toward the independent style. Theoretically, this research advances understanding of communication and negotiation behavior between middle-class elders and their adult children when making decisions about elder care services through the lens of family power relations. Relevant literature has mainly assumed the perspectives of social work and gerontology to explore elders’ decision-making processes when deciding to move into a nursing home; scarce work has investigated how middle-class elders come to decisions to live in commercial senior apartments and how they negotiate the decision-making process with family members. Therefore, our findings have important practical implications for supply-side reform of China’s elder care system. Essentially, these results may help commercial senior institution operators or practitioners understand the demands of elders with different decision-making preferences, thus enabling elder care professionals to tailor their marketing strategies and provide customized services. For example, for elders with a high desire for decision-making support from their adult children, institution operators can promote communication between these parties, provide detailed information about elder care, and encourage adult children’s participation in the decision-making process.