Although we have suggested strategies that can improve acute hospital environments, a cynic would argue that economic reality and the slow pace of change make it unlikely that these strategies will be introduced to the extent required to meet the needs of many older people. More feasible is perhaps a balanced approach that provides some environmental adjustments for older people, core knowledge and skills for all staff, and access to gerontic expertise in care of older people. If such adaptations are accompanied by continuous development of ‘older people centres’, we can start to better meet the multidimensional needs of older people. Our parents and grandparents deserve better than what they currently receive.