Abstract
Delirium affects an enormous number of patients at end of life and entails great physical, emotional, and financial burdens. Existing algorithms approach this phenomenon simplistically with the primary goal of identifying and treating the underlying cause. However, many episodes of delirium are multifactorial and not so easily resolved. Much has been written about controlling for physical and pharmacologic causes, but there has not been much attention paid to the interaction of the care setting in managing delirium. This case study illustrates some of the challenges in caring for a patient with refractory delirium in a skilled nursing facility.