The fire broke out around 9:00 pm (1300 GMT) Tuesday at the nursing home in Longhua County, roughly 180 kilometres (112 miles) northeast of the capital Beijing.
Twenty people were confirmed dead by 3:00 am Wednesday, Xinhua reported.
"Other elderly people in the nursing home have been transferred to nearby hospitals for further observation and treatment," the state news agency said.
The cause of the blaze is under investigation, it said.
An individual responsible for the nursing home has been detained by police, the county government said.
Deadly fires are relatively common in China due to lax building codes and an often slipshod approach to workplace safety.
In January, a fire at a vegetable market in Zhangjiakou city, northwest of Beijing, killed eight people and injured 15.
A month before that, nine people died in a fire at a construction site in eastern China's Rongcheng city.
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