For most people with advanced dementia, a hospital admission at the end of life is unlikely to improve comfort or extend life meaningfully and may cause significant distress. The unfamiliar environment, noise, clinical procedures, and separation from known carers can be deeply disorienting. Most deaths in advanced dementia are from infections such as pneumonia or urinary sepsis, which can often be managed palliatively in a care home with appropriate medication and comfort care. Hospital is appropriate when a specific treatable condition arises that cannot be managed in the care home setting and where treatment is consistent with the person’s wishes and best interests. Having a clear advance care plan that includes a preferred place of care and death makes this decision easier for families and for medical teams when the moment comes.