Objective: To describe the nursing home (NH) environment and its impact on the experiences of young adults living in NHs after spinal cord injury (SCI). Design: Qualitative, longitudinal design; qualitative analysis of transcripts of multiple in-depth interviews over a 30-month period. Settings: Inner city and suburban NHs. Participants: 6 young adults admitted to a large urban rehabilitation hospital who met the study criteria and were discharged to an NH after inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measure: The impact of the NH environment on medical complications and rehospitalizations; and personal experiences of residential living and self-rated quality of life (QOL) after SCI. Results: Participants were aware of and dreaded the prospect of going to an NH. Multiple moves to different NHs were interspersed by a series of hospitalizations for treatment of medical complications. These disruptions in physical location were driven by medical necessity and were then used as leverage for a more personally compatible NH environment. Eventually, all subjects found a better refuge. Conclusions: The NH milieu plays a significant role in life adjustment after SCI: it impacts quality of care, SCI complications, hospitalizations, long-term rehabilitation outcomes, and ultimately QOL.