Neuropsychiatric symptoms (NPS) are common in dementia, although little is known about their prevalence and treatment near the end of life. This study used a retrospective review of the medical records of 123 hospice-eligible nursing home residents with advanced dementia to investigate the prevalence of NPS and NPS-targeted pharmacological and non-pharmacological treatments. The most prevalent NPS were agitation or aggression (50.4%), depression (45.5%), and withdrawal/lethargy (43.1%). Of the 105 (85.4%) residents who exhibited one or more NPS, 90.5% were receiving at least one NPS-targeted treatment, yet 41.9%, received no documented non-pharmacological NPS-targeted care. The majority of documented non-pharmacological care focused on safety and explanations or instructions given to residents. Given the high prevalence of co-morbidities, associated risks for medication interactions or serious side effects, and potential low-risk benefits of psycho-behavioral care, these findings raise concerns about how to best increase the provision and documentation of non-pharmacological care in advanced dementia.