Clinicians may be alert to the palliative care needs of patients with metastatic cancer but may not realize that a dementia diagnosis is also a sentinel event for planning end-of-life care. Patients with malignant conditions have a relatively short period of declining health before death (6–7), but in patients with dementia, health declines over a long period, and it is difficult to determine when they have entered the last months of life and become eligible for Medicare coverage of hospice care (6, 8). This observation may explain why fewer patients with dementia receive a referral to hospice than patients with cancer (9). Certainly, physicians should consider hospice referral for patients with dementia whose illness has features that suggest very limited life expectancy, such as inability to ambulate, eat, or communicate without assistance; decubitus ulcer; and recurrent pneumonia (10–11). However, patients with dementia and their caregivers often have significant needs for palliative care services long before the patient is eligible for hospice. Many patients with dementia are not able to obtain the palliative services they need, such as assistance with activities of daily living, day health services, and respite care. As a result, caregivers shoulder most of the burden of caring for a patient with dementia (12–16).