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This article explores the key elements of quality end-of-life care for residents with dementia and describes policy barriers. The most import elements are good communication and decision making about medical treatments and care. Proper management of symptoms of dementia involves identifying and assessing symptoms, monitoring the resident's condition, and ensuring practitioner skill. Psychosocial support for the resident involves positive, meaningful interaction with staff, which requires special staff training. Recognition of the death of a resident and bereavement support is important for the family. Experts identified 4 major public policy barriers to palliative care: use of the Medicare Part A skilled nursing facility benefit, Medicare hospice eligibility criteria, certain aspects of the quality assurance system, and inadequate provider reimbursement.