During the eleven years of my mother’s decline with dementia it was not until the final year of her life, through a serendipitous transfer to a new nursing home, that I met a doctor that actually started our conversation with the important question “what are your goals for her care?”. It was this doctor’s compassion and courage to face that question that enabled us to finally be sure that she would receive the non-aggressive but gentle and loving palliative care that she needed in her final days (she had expressed clear wishes about that years earlier). Her quality of life actually improved quite a bit in the year under his care. We were able to face her imminent passing fully informed and supported by the medical staff to be by her side to connect with her emotionally and to ease her passage and say goodbye. I am eternally grateful to that doctor and nursing home for helping us to make the best decisions in her last year. Sadly, that nursing home had to close down recently because they had been struggling financially for some time and they ultimately became victims of current economic conditions. There are very few nursing facilities in this community (in my experience) that can or will provide that kind of homelike attention and personal care . The medical community can certainly lead in helping patients and families to find this kind of care and to face these difficult questions.