With the deepening of the population aging and the growth of the economy in China, the demand for improving the lives of the elderly groups is increasing, and the prospects of the old-age industry, especially the real estate market for the old-age, are bright. Small and medium-sized enterprises (SMEs) play an important role in promoting the development of the old-age real estate. The development of the old-age real estate for SMEs is not only conducive to the healthy development of the old-age real estate market, but also conducive to the middle and low-income elderly to enjoy high-quality and convenient old-age services. The method adopted in this paper is mainly to compare the modes that SMEs can adopt in the three links of development, financing and operation of the old-age real estate, to calculate the costs and benefits of various modes, and to analyze their advantages and disadvantages. The types of enterprises suitable for various modes are also discussed. The conclusion of this paper is that for different links, SMEs should adopt different modes in the process of developing old-age real estate. In terms of development mode, SMEs should choose to cooperate with service agencies because SMEs have weak capital strength and risk tolerance, narrow financing channels and less market resources. In terms of financing mode, SMEs should choose government-enterprise cooperation because it can reduce the development cost, especially the cost of land, also can obtain policy support and administrative approval convenience. In addition, this mode can well reflect the profitability and welfare characteristics of the old-age real estate and can achieve social spillover benefits. In terms of operation mode, SMEs should choose only construction but not operation so as to avoid the risks brought by the latter operation.