Research shows that few social workers are interested in working with cognitively impaired older adults, such as those with Alzheimer's disease or a related dementia. As the number of individuals with dementia grows, the demand for social workers to provide services to patients with dementia will increase. Although much attention has been given to the needs of individuals with early- and middle-stage dementia, little attention has been directed toward patients at the end stages of the disease. Even less is known about how professionals, particularly hospice social workers, form therapeutic relationships with these patients given their severe cognitive impairment. This qualitative study, based on a focus group methodology, examined how hospice social workers find meaning in their therapeutic relationships with patients with end-stage dementia. Two primary themes emerged, each containing three subthemes, that captured the barriers to and strategies for forming meaningful relationships with patients with end-stage dementia. The results of this study have implications for hospice social workers and social workers in other health care settings and the types of training they need to strengthen their practice with cognitively impaired populations.