As terminal care receives increasing attention from clinicians and is formalized in benefit packages, studies of the various patterns of care during the final days of life are needed urgently. This descriptive study examined the relationships among patient symptoms, family anxiety and fatigue, and patterns of hospice service utilization and compared patients who were and were not institutionalized for inpatient hospice care. Two groups of 50 patients from the Connecticut Hospice Home Care Program were chosen randomly for retrospective chart review. They were compared on six symptoms (pain, nausea/vomiting, elimination problems, respiratory deficit, nutritional deficit, and mental status deficit), two family coping parameters (anxiety and fatigue), and resource utilization (frequency and duration of home visit by discipline, telephone contact, and place of death) during the final 10 days of life. Patients who required periods of institutionalization experienced more individual symptoms and more combinations of symptoms, and their families exhibited greater anxiety and fatigue in response to uncontrolled symptoms. In addition, this group demanded higher service intensity during the last days of life. Limitations of the study and implications for practice, administration, and research are discussed.