Image processing technology is to use computer, camera, and other technologies to calculate and process images and make the image clearer and convenient for quick extraction of information. Image processing technology has entered an all-round development stage. It also plays a great role in the components of the intelligent service model for the aged. Now many countries in the world have entered the aging stage, but old-age equipment is relatively backward and personnel management is not standardized. Based on these problems, this paper studies the intelligent model of old-age care in small- and medium-sized cities by using the image recognition method. Based on the analysis of the present situation of intelligent old-age care, an intelligent system is proposed, which solves the problems of defects in old-age care facilities and insufficient comprehensive management of medical staff in some small- and medium-sized cities. This system has RTID positioning system and APP client, which can ensure the privacy of the elderly. Through real-time identification of images in the elderly service, the rationality and layout optimization of existing old-age facilities are analyzed. The mathematical model is used to detect the regularity of participants’ daily activities. The image experiment results show that the prediction accuracy is over 90%, and the optimal prediction effect is obtained. In addition, a questionnaire survey was conducted among many elderly people over 50 years old to investigate their willingness to use smart old-age products.