This woman told her husband that what she really wanted, he said, was a sun room where she could spend her last days sitting and looking out at the woods and the mountains. “He undertook the creation of a Florida room off their deck, and built it himself over the course of two weeks, so he could move her out there,” Dr. Milch said. “All I could think of was in the winter of their discontent, he brought an endless summer.”

For someone else, of course, the final idea of home might be something very different. The crucial thing, said Dr. Cheryl Phillips, a past president of the American Geriatrics Society and the chief medical officer for On Lok Lifeways, a nonprofit organization that provides services for the frail elderly in greater San Francisco, is finding out what makes the person who is dying feel most at ease. “If there was one thing that would make a difference, what would it be?” she said. “It’s amazing how creative people can be to make these special wishes come true.”

Warm Sand in Winter

Virginia Fry, a counselor who has been the director of the Hospice and Palliative Care Council of Vermont for 30 years, believes people should have a bucket list for the environment where they spend their last days  including what it should look like, and how it should sound and smell. Smell is particularly important because the odors of illness can be intrusive, Ms. Fry said. Often, people try to mitigate that problem by putting out bowls of potpourri or dabbing essential oils on light bulbs.

To create a happy environment for a woman in Vermont some years ago, Ms. Fry and her organization went way beyond potpourri. The woman dreamed of going to Hawaii, but she did not have the money, Ms. Fry said, and she was too ill to travel. And so the hospice organization brought Hawaii to her  a particular challenge in a Vermont winter. Ms. Fry asked what the woman’s favorite colors were and bought Hawaiian fabrics that could be wrapped around her like a gown (this outfit had to accommodate her IV pole). Tiki torches were mounted in the snowbanks leading to the house. Visitors were asked to wear shorts and Hawaiian shirts, and to make the home smell like Hawaii, they were offered copious amounts of coconut oil. The organization’s board of directors had a 40-orchid lei flown in from Hawaii  the first fresh flowers the woman had ever had in the house, she told them. A recording of crashing waves and an erupting volcano played in a continuous loop, and meats grilled with pineapple were served.

“We had what it looked like, what it smelled like, but we were stuck at the sense: how does Hawaii feel?” Ms. Fry said. “We decided it was hot sand on the feet, so one of our staff members took her driveway sand and heated it in the oven for four hours until it became powdery. Then we laid down sheets with electric pads on top of them, then another sheet on top of that, then the sand on top of the that, so the sand covered an area of about three feet.”

Where was the owner of the house when all this was happening?

“She was directing it,” Ms. Fry said. “You want the patients to be directing, because they lose power by being patients, so anything that restores the sense of control is therapeutic.”