Hospice care provides a critical environment for patients facing terminal illnesses. This study aims to explore how residential architectural elements can foster the home-like environment of hospice focusing on the cultural, climatic, and caregiving context of Kerala. While Kerala has established a successful model of home-based palliative care, the system remains insufficient for many end-of-life situations, it has very few dedicated hospices. The rate of population ageing is extremely rapid in Kerala. Current literature offers limited guidance on how the region’s distinctive residential architectural traditions can be translated into the design of hospice settings. Following a qualitative research design, this study analyses case studies of existing hospices, palliative care centres, and residential models within the Kerala context. Through spatial mapping and environmental quality assessments, the research identifies specific design factors and principles that support a home-like atmosphere. Findings reveal that spatial planning, indoor environmental quality, use of courtyards, and social interaction and cultural aspects are vital for establishing a sense of home, familiarity and belonging for residents. Introducing hospices that are rooted in residential architectural elements provides a culturally relevant solution with a dignified environment which helps in extending Kerala’s existing care model into physical, purpose-built typologies. This study initiates an architectural rethinking of hospice design in Kerala by proposing a framework and design recommendations that inform future architectural practices for a more humane, context-specific, home-like care environment.