The stages of life are now many, each having its own boundaries, logic, and a prescribed perspective of appropriate relations amongst and between members of the many stages. Just as there is a developing curriculum for the young, there is a developing curriculum in the area of elder care. Within the paradigm of staged human development, the end stages of life are just as much stages as the beginning. There is a vocabulary, a set of attitudes and behaviors, and an understanding of people in the last stages of life that is different now than it has been in the past. As a culture we have, as evidenced by our language, been aware of the end stage cognitive developments of our lives for a long time. This article presents a brief history and an examination of institutionalized elder care in the United States. For this analysis just two of many transitional care-giving techniques applicable to people with dementing illness were examined. The two transitional care-giving practices were the change from Reality Therapy to Validation Therapy and diaper changing schedules to bathroom schedules. The author discovered through conversations with care givers at three different facilities, that care givers of patients with dementing illness continued to view patients through the old senility paradigm, thus clinging to outdated, and inhumane care practices regarding toileting, and disorientation of patients with dementing illness. The author points out that old patterns of care givers behavior toward patients suffering from cognitive decline in the end stages of life are incredibly resistant to change.