It is not our intent to slant any blame towards physicians or nurses in the acute hospital settings, as we are well aware that most health care staff try their best to solve the equation of strict time constraints and increased work loads. However, available evidence indicates that we can do better for older people in acute care. Acute hospitals are ‘fit for purpose’, which is to respond to acute emergencies, road trauma and the like, undertake highly specialised and expensive tests, and conduct acute and planned surgery. However, most acute hospitals are not ‘fit for purpose’ in responding to the needs of the major users of their services, old, frail people with multiple co‑morbidities and sometimes cognitive impairment as well. There is an inevitable culture clash between acute care where speed may be the essence in saving life and consultation with the patient is not an option, versus the slower paced, person‑centred consultation and optimised stimulation that is quality elder care. The typical older patient with co‑morbidities and general frailty does not present clear cut symptoms for straightforward diagnosis, efficient treatment and rapid discharge. Moreover, the acute hospital organisation into ‘specialities’ such as neurology and orthopaedics means that staff knowledge often lies within these specialities, something that can work against a holistic approach and quality outcome for older people. Although acute hospitals are excellent for single diagnoses, rapid treatments, and short stays, when older people end up in this setting they suffer from the consequences such visits are known to induce.