The “national strategy for actively responding to population aging” has been elevated to a new height. Against this background, an in-depth exploration of residents’ elderly care consumption behavior is crucial for improving the elderly care security system. Based on a questionnaire survey of 727 residents and using cross-analysis methods, this study systematically examines the structural characteristics and influencing factors of residents’ elderly care consumption. The research finds that residents’ cognition of elderly care consumption presents a “reality-expectation” dual structure: current consumption is dominated by “subsistence-oriented” expenditures such as medical care and daily living, while future expectations are significantly inclined to “development-oriented” consumption such as culture and entertainment. The quality of elderly care services is a core pain point, and residents have a strong willingness to improve, which is also significantly related to their living status. There is a strong correlation between policy awareness and payment willingness—groups with high awareness have a high willingness to pay, a phenomenon that reveals the market activation effect of policy communication. At the same time, residents’ access to elderly care-related information is highly dependent on informal networks, with a high proportion of recommendations from acquaintances, reflecting the lack of professional information niches. Accordingly, this paper proposes that efforts should be made synergistically from four aspects: supply-side reform, precise policy communication, full-cycle elderly care planning education, and information platform construction, to promote the high-quality development of the elderly care consumption market through systematic paths.