The physical environment of residential health, care, and support facilities (RHCSF) is a critical component in providing supportive and resident-centered care for the elderly. Although past reviews of the literature have focused on specific settings for the elderly or specific residential populations of the elderly, a systematic literature review that covers the range of settings and populations has been lacking. This article provides an overview and synthesis of the most recent empirical evidence addressing the impact of the physical environment on residents and staff of RHCSFs. The review also identifies gaps where future research is needed. This review found 66 studies examining the relationship between the built environment and outcomes in three broad domains of resident quality of life, resident safety, and staff and organizational outcomes. The studies address a range of topics including the impact on elderly residents of the facility scale and size, outdoor environments, and environmental quality.