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Like many nursing homes, the Parker Jewish Institute in New Hyde Park, N.Y., was having problems with some of its patients with dementia wandering at night. The staff worried about falls, but they didn't want to hand out more psychotropic medicines. But one night in 2007, a nursing assistant accidentally stumbled on a solution.

In the era of modern medicine, there is often no easy way to navigate between an acceptable quality of life and a death with dignity. But palliative care specialists, relatively new players on the health care scene, offer comfort, support, pain control and, if requested, spiritual counsel, helping people sort through often confusing and ambiguous medical options.

Living wills and advance directives were the hope for end-of-life decision-making decades ago. But a 2004 survey by FindLaw found that 36 percent of Americans have a living will, and even when people have filled out living wills, doctors often ignore them.

Palliative services are designed to help patients and their families sort through their options - ome of which may help restore the patient, while others may increase suffering for a minimal health benefit.

A directive passed last November in Tulsa, Okla., raises fresh questions about the ability of patients to have their end-of-life treatment wishes honored - and whether and how a health care provider should comply with lawful requests not consistent with the provider's religious views.

It is not clear why it's happening, but some hospice officials blame both a bad economy and Medicare rules that unintentionally discourage doctors from referring all but those who are about to die.

A new study says almost one out of three adults in the U.S. currently serves as a caregiver. The time and energy they put into caregiving becomes like an unpaid job.