Recognizing that spiritual needs often emerge in health care settings, the Joint Commission requires spiritual assessments in numerous organizations frequented by older adults. Given that many gerontological practitioners have received little training in identifying spiritual needs, a qualitative meta-synthesis (N = 9 studies) was conducted to identify and describe older adults’ perceptions of their spiritual needs in health care settings. Five interrelated categories emerged: (a) spiritual practices; (b) relationship with God; (c) hope, meaning, and purpose; (d) interpersonal connection; and (e) professional staff interactions. The implications of the findings are discussed as they inform the spiritual assessment process.