As hospitals increasingly operate nursing homes, retirement centers, and home health agencies, pastoral personnel will be challenged to demonstrate to hospital planners the importance of providing pastoral care for the elderly clients of these services. Older persons have significant needs that cannot be met by psychotherapy, social work, or other disciplines. The "young old," for example, are typically in early retirement and often feel useless and without dignity. The "middle old" are in transition between independence and dependence, health and chronic illness, and it is the thought of dying that most haunts them. The major concerns of the "frail old" are suffering and the provident care of God, particularly in the face of crippling or catastrophic illness. Through the process of life review and active listening, pastoral care specialists can help elderly persons find the inner power that produces hope and character. Departmental restructuring may be necessary, however, to meet the increased demand as the hospital moves into geriatric life care. Local church personnel could be used as well to provide hands-on service. Pastoral care departments should be alert to plans for hospital expansion and develop creative, long-range strategies for providing care.