The number of older inmates in US correctional facilities is increasing and with it the need for quality palliative health care services. Morbidity and mortality are high in this population. Palliative care in the correctional setting includes most of the challenges faced in the free-living community and several unique barriers to inmate care. Successful models of hospice care in prisons have been established and should be disseminated and evaluated. This article highlights why the changing demographics of prison populations necessitates hospice in this setting and highlights many of the barriers that correctional and consulting physicians face while providing palliative care. Issues specific to palliative care and hospice in prison include palliative care standards, inmate-physician and inmate-family relationships, confidentiality, interdisciplinary care, do-not-resuscitate orders and advance medical directives, medical parole, and the use of inmate volunteers in prison hospice programs. We also include practical recommendations to community-based physicians working with incarcerated or recently released prisoners and describe solutions that can be implemented on an individual and systems basis.