The graying of America will lead to an unprecedented and overwhelming number of people with dementia. As the numbers of persons with advanced dementia continue to rise, hospice and palliative care clinicians struggle to offer the same excellent care afforded patients with more common hospice diagnoses. Challenging behaviors occur in up to 90% of persons with dementia and are distressing for patients and caregivers alike. Nursing theories and emerging evidence-based practices offer guidance to help clinicians recognize, interpret, and respond to the palliative care needs of persons with advanced dementia. Caregivers must explore the possible causes for behaviors by considering a wide array of potentially unmet physical, psychological, emotional, spiritual, and environmental needs in the person with advanced dementia. Pain is a common cause for challenging behaviors in these individuals, yet it frequently goes unrecognized and/or undertreated. This article uses a case study to illustrate a common challenge faced by clinicians serving patients with advanced dementia and provides a detailed discussion on current best practices to improve palliative care for persons with advanced dementia and their caregivers.