Illness often creeps up over time and sometimes progresses more rapidly than we expect. Even those involved in the healthcare industry do not see signs until issues have progressed. Sometimes it’s more important to ask difficult questions early on that to be surprised later. A client of mine with Parkinson’s disease had a fall in mid-November, was hospitalized and then sent to a rehabilitation facility. While the family was hoping he would be able to return home, issues with balance and walking made this unlikely. The individual was permanently placed in a long term care unit and his wife continued to live in an assisted living facility in the community. Over the period of 4-weeks, the individual began sleeping more and eventually lost weight. A hospitalization stay during week three brought up the subject of end of life care. Hospice was brought in and the individual was given a life expectancy of less than one week. This was a surprise not only to the health care facility but also to the family. This beckons the question of when do we know that hospice is appropriate?