Terminal illness poses a tremendous challenge to patients, their families and their health care providers. It is often difficult to determine when hospice is appropriate. Timely referrals are beneficial to both patient and caregivers as a way to offer improved care and support at end of life; when multiple, complicated, co-morbid states affect care. This is especially true when a patient's psychosocial background would otherwise make it difficult to ensure proper comfort and quality of life. In this report, we present an 86 year old man with a history of right-sided breast cancer, bipolar disorder and dementia. Patient is 20 years status-post a total mastectomy. He declined adjuvant radiation, chemotherapy, and hormone therapy, and did not pursue any further medical follow-up. Patient now presented with a rapidly enlarging, ulcerating right anterior chest wall tumor. Surgical biopsy revealed recurrent infiltrating ductal carcinoma of the breast. Patient was started on tamoxifen and palliative radiation. An oncology evaluation determined that he is not a candidate for curative treatment. Patient's primary caregiver (wife) concurrently suffers from dementia, one son is Bipolar, and the second son is out of state. A full geriatric assessment concluded that based on the patient's medical and socioeconomic history, he is an ideal candidate for hospice. With the family's consent, he was enrolled in one of our local hospice organizations. Currently, he is in a skilled nursing facility with hospice.