Wound management at the end of life frequently has different goals than those typically addressed for promoting wound healing. Principles to guide the development of a plan of care are discussed along with case reports to illustrate these principles. End-of-life terms, avoidable and unavoidable skin failure events, and the role of physical therapy in integumentary prevention are defined and discussed. In many cases, end of life occurs over a protracted course of organ failure. This is often associated with hospice, but may occur in acute care, long-term care, and outpatient settings as well. Diseases such as cancer and chronic organ failure are typically associated with such an outcome. Organ failures such as chronic kidney failure, chronic heart failure, and respiratory failure lead to a gradual, but eventual, loss of homeostasis. As these systems fail, we must also consider the failure of the largest organ of the body as well—the skin. This report discusses the background necessary to develop a meaningful plan of care for integumentary issues that accompany end of life, beginning with definitions associated with end of life.