The local authority's cabinet unanimously has agreed on plans for the future of its seven homes.
One will cater specifically for dementia patients, three will be developed into residential complexes, while there are plans for an integrated health hub.
A report said specialised care demand and costs created "serious challenges".
A 12-week consultation received 440 responses.
The control and development of Bodlondeb, Aberystwyth, will now be offered to a third party, with the aim of creating a home capable of caring for dementia patients.
Min-y-Mor in Aberaeron and Hafan Deg in Lampeter will become elderly residential complexes, while the council will look into redeveloping Yr Hafod in Cardigan.
Jointly with Hywel Dda health board, it will also attempt to re-open the closed Awel Deg in Llandysul as a centre to address the need for extra dementia care.
There are plans to create an integrated health hub at Bryntirion in Tregaron.
Cartref Tregerddan in Aberystwyth will remain as it is.
An overhaul of residential care homes will take place in Ceredigion to reduce costs and cut the number of empty beds.