Palliative and long-term care facilities operate at the intersection of resource-intensive healthcare delivery, chronic and serious illness, residential care, complex medication use, food and nutrition services, building operations, procurement, transport, waste generation, and patient-centered decision-making. Environmental sustainability in these settings therefore cannot be reduced to energy efficiency or waste reduction without considering clinical appropriateness, resident autonomy, comfort, workforce practices, organizational capacity, and end-of-life ethics. This scoping review maps the environmental, organizational, professional, and patient-centered evidence relevant to sustainable healthcare practices in palliative and long-term care facilities. It examines energy and the built environment, materials and waste, pharmaceutical waste, food systems, water stewardship, transport and procurement, nursing practice, governance, implementation, equity, and ethical boundaries. A structured scoping-review approach was used to map heterogeneous evidence spanning direct palliative and long-term care studies together with clearly distinguished transferable healthcare-sustainability evidence. Study designs, settings, professional groups, sustainability domains, implementation conditions, limitations, and applicability boundaries were charted. Evidence was synthesized thematically without quantitative pooling because the literature included environmental accounting, observational research, qualitative studies, mixed-method investigations, implementation studies, reviews, and conceptual or ethical analyses. The evidence indicates that sustainability in palliative and long-term care is multidimensional. Direct evidence is strongest for selected areas such as hospice carbon accounting, long-term-care food environments, physical care environments, and organizational implementation, while several operational domains rely substantially on evidence transferred cautiously from broader healthcare settings. Environmental gains can also intersect with clinical safety, resident preference, accessibility, workforce workload, and end-of-life priorities. Sustainable palliative and long-term care requires coordinated attention to environmental performance, organizational systems, clinical appropriateness, and patient or resident priorities. Current evidence supports a domain-based approach to identifying environmental pressures and implementation opportunities, while substantial uncertainty remains about setting-specific effectiveness, trade-offs, and equitable implementation.
