I cannot have pot plants in the house. The overwhelming smell of pot plants and stale urine is my lasting memory of visiting residential and nursing homes many years ago as a GP trainee in Devon. Rows of pot plants arranged in the hallway and rows of elderly people in front of the television. This memory is, perhaps unfairly, coloured by my lack of experience and feelings of powerlessness at the time—as an inexperienced trainee I hadn’t seen many older people in the community and I wasn’t sure what to do. These homes were often in adapted older buildings which, despite modification, were probably unsuited for purpose and staffed by nurses displaced from mainstream nursing or washed up in a career cul de sac. I didn’t enjoy it.

Times have changed and elderly care and nursing homes are now much brighter, often purpose built, with the skilled professional staff specially trained for the job. You can tell the best places the moment you walk in the door—a happy, slightly chaotic atmosphere with lots of young enthusiastic care workers and the nurse in charge out on the floor. I love to see lots of activity, older people walking about, staff coming and going, directing the people traffic and plenty of unstructured noise. Photographs and daily events, music and entertainment. Gone are the parking lots of geriatric chairs.

There is still a touch of sadness however. While I now feel more comfortable coping with the multiple health problems of older people, I have known many of these patients when they were younger, fitter, and brighter. Time ages and changes everyone and the staff only know this poor shadow of someone who was once just as bright and vivacious as they are. The architecture has changed, but the greatest difference is in the staff who now seem to have much more pride in their work. Thank goodness elderly care medicine has moved mainstream. The improvements are enormous. But, I still haven’t got over my dislike of pot plants.

Domhnall MacAuley is primary care editor, BMJ.