The complex health profile of an older adult entering a hospital presents staff and administrators with a new challenge. This paper documents the Vancouver Island Health Authority's (VIHA) move towards an Elder-Friendly Hospital (EFH). A new approach to hospital care is described, one that takes account not only of an acute healthcare crisis, but also the developmental phenomena associated with aging, with the likelihood of chronic illnesses compounding both diagnosis and treatment. Customized strategies and suggestions for implementation that may be useful to other healthcare agencies are explained.