People with cognitive impairment at the end-of-life care (EoL care) often have their pain underdiagnosed and undertreated due to the lack of knowledge and lack of guidelines for systematic pain assessment. According to recommendations from The National Board of Health and Welfar [Socialstyrelsen] (2013a), systematic pain assessments in EoL care should have high priority in providing optimal treatment of pain. In Sweden, about 90,000 people die annually and it is estimated that about 80% of these would benefit from palliative care (The Swedish Palliative register, 2018). According to Statistics Sweden (2018), the expected number of people older than 65 years in 2030 will increase, especially those over 80 years. This indicates an increasing need of further development of palliative care. Good palliative care at the EoL means symptom relief of physical and mental pain, relief of social and existential problems, a multi-professional collaboration in taking care of people, as well as good communication and relationship with the patient and relatives (The National Board of Health & Welfar [Socialstyrelsen], 2013a, 2013b). 2 | BACKG ROU N D Many people living in nursing homes for the elders in Sweden have dementia and cognitive impairment (Lovenheim, Sandman, Kallin,