Hospital care is highly disease-focused, tending towards further specialisation, and largely driven by technological innovations. Frail elderly, however, are an important and rapidly growing group of patients that is not best cared for in such a clinical environment. Case histories and the description of outcomes of an innovative programme called 'CareWell Primary Care' reveal that triage based on frailty and a global geriatric assessment of frail patients which is linked to goal-oriented hospital care and shared decision-making are the cornerstones of much needed improvement in delivering effective, safe, and sustainable hospital care to our ageing population.