Elderly service delivery within the medical-surgical division of a large midwestern tertiary care center was assessed to explore how to meet better the special needs and address the complex situations that older adults present. Twenty-seven nursing staff members working in the four medical-surgical units and the medical intensive care unit were interviewed using participant observation and unstructured interviewing methods as they delivered care to older adults. The following categories emerged from the qualitative data analysis: problems related to the care of older adults, causes of confusion, effective and potentially effective interventions for older patients, and staff educational needs. A major suggestion was to develop an interdisciplinary seniors team to provide consultation on issues related to older adults to nursing staff, medical staff, and other interdisciplinary staff involved in patient care. The team would evaluate the appropriateness of interventions, equipment, and personnel use related to older adults as well as identify and develop quality assurance activities to monitor and evaluate the care delivered to older adults.