Rapid socio-cultural transformations, including urbanization, migration, and the restructuring of joint family systems, have significantly altered traditional models of elderly care in India. Old age homes, once perceived as culturally stigmatized institutions, are increasingly emerging as alternative residential arrangements for senior citizens. This qualitative study explores the lived experiences, emotional well-being, social integration, health concerns, and identity perceptions of elderly residents residing in institutional settings. The research was conducted under the framework of the National Service Scheme (NSS) community engagement initiative and involved in-depth interviews and open-ended survey responses from 40 elderly residents across two old age homes. Thematic analysis generated eight interconnected themes: (1) Family Disintegration and Changing Social Values, (2) Loneliness and Emotional Isolation, (3) Health Vulnerability and Medical Dependency, (4) Adjustment and Adaptive Coping, (5) Social Relationships within Institutional Settings, (6) Perceptions of Institutional Care and Services, (7) Expectations from Youth and Broader Society, and (8) Spirituality as a Meaning-Making Resource. Findings indicate that while institutional environments largely ensure physical security, routine medical care, and basic material support, emotional fulfillment and identity affirmation remain only partially addressed. Residents frequently negotiate feelings of abandonment, diminished authority, and perceived burden alongside gradual adaptation and spiritual resilience. The coexistence of structural care and emotional vulnerability reveals a critical gap between functional adjustment and psychosocial well-being. The study underscores the urgent need for holistic elderly care models that integrate emotional recognition, intergenerational engagement, community participation, and dignity-centered policy reforms. Strengthening relational belonging and identity preservation within institutional contexts is essential to ensuring not merely extended life, but aging with dignity.