u/ndisnxksk

I know that generally new grads are told not to do HH right out the gate. What are valid reasons for this, other than the fact that you need to be comfortable with red flags and determining whether or not the pt is appropriate to be seen by PT? If I felt comfortable with this in clinicals and feel pretty confident in myself, what would a new grad be missing other than experience?(not to de-value experience, just wondering). I know that sometimes they will not even hire new grads but some do.

Here's why I am thinking about HH:
- first of all, I need something PRN or part time right now. I graduated 2 weeks ago and I am going through being a caretaker and the death of my dad, which will be happening very very soon. I mentally and physically cannot jump into a full time position right now.
- I do really enjoy acute care (and neuro too), and do not want to work in ortho whatsoever. However, acute care may be too busy and heavy for me right now and my grieving brain. It may also be very fulfilling for me. I am worried about having to take on a high case load, even if I am only PRN or part time and feeling like I can't function properly.
- I like the flexibility and pace of HH, the fact that you can decompress between patients and kind of give each patient as little or as much time as they need. and that I could truly make it a part time gig, rather than doing 10 hour days in acute care just to make it part time.
- I like that so much of the job would be education and giving people my knowledge when they really need it most.
- I like that you get to consider so many other factors like home/community environment, psychosocial, etc. moreso than outpatient. And that treatments might be able to be tailored directly to those things instead of simply trying to replicate it in the hospital or outpatient environment.

my dad is nearing the end of his battle with glioblastoma, I feel overall his symptoms from it were quite manageable and he has not truly suffered directly from the cancer until the last few days, in which he has been in the process of active dying. I have been closely following the brain hospice timeline, but of course he does not exactly fit. His timeline is below and I am wondering if anyone could just give their best guess of the time we have remaining. Partle because I need somewhere to write all this, partly because I want to hear from others, and partly because I don't know what else to do with myself right now.

-4/29: staff at his assisted living facility sent him to the hospital for tachycardia and difficulty speaking. At this point, he was somewhat catatonic but about a day. Then over the next 2-3 days he improved but was still under his previous baseline. However he reached the point that he was walking, walking, performing ADLs with very minimal assistance. Everyone thought that it would be okay to try a SNF to get some PT, mostly just to try to get him back to his ALF

-5/6-5/9 (just a few days ago from today) at the SNF. First day working with OT and PT, able to walk and participate in rehab. Then there seemed to be a rapid decline. Part of me beleives it is because of the poor care he receieved. When he started experiencing decline and NOBODY in the staff cared to notice, I quickly had him discharged and put on hospice. Here is what we saw:
Became largely incontinent. Increased sleepiness and weakness, suddenly unable to stand and eat on his own. could not even hold his own head up. Less talking. Difficulty swallowing and unable to take pills. Eating and drinking very small amounts.

-5/9: Quickly had him discharged back to his ALF and on hospice. As soon as we returned him to his room there, he began talking more clearly. Though it was bed time, so I stayed with him until he fell asleep.

-5/10: Thought there was improvement simply from being back in his familiar room. However now I know this was the "terminal rally". When I came that morning, he was able to stand and help me with transfering him into his wheelchair. He was talking so much, asking me to scratch his back, saying things without being prompted. He even fed himself scrambled eggs and a whole fruit cup. He drank a ton of gatorade. He brushed his own teeth (with some help for set up), gurgled water to get the mucous out of his throat. Had several visitors. This did quickly wear him out, I got him back in bed for a nap and since then he has been bed-bound.

-5/11: sleeping so much more. having frequent seizures and breathing abnormalities, though I don't think I have heard the death rattle. More like a really long groan as if trying to cough/breathe? then some apnea, then normal breathing. Still able to say I love you, though very quiet and difficult to understand. Sleeping with eyes partly open. Unable to use a straw, but was able to say he wanted to try some liquids and had a few very very small drops from a spoon. Able to verbalize that he wanted more. Through the late evening and the night seemed to be unresponsive to the caretakers (from what I could see on the camera we have set up), but still snoring/sleeping. Developed a fever and they put a cold wash cloth on his forehead overnight.

-5/12 No update yet today, my mom is headed there now and family will be rotating throughout the day. I did see him have a fairly large seizure when watching on the camera while the hospice nurse was with him.

I believe it is the final 8-48 hours according to the brain hospice timeline. I just want it to be soon, I want him to be free from his body.

I am writing this in a bit of a panic, just hoping for some perspectives and reassurance. we are waiting back for a call from the oncologist for professional guidance as well.

I think it is time to transition my dad to hospice. I am wondering, in your opinions and experiences, how did you know when it was time? how did you know when they were going to pass, in terms of days (not weeks or months).
context: my dad was living independently at an ALF, only care he received was medication management due to memory issues. that was up until last week when a worker there sent him to the hospital due to rapid heart rate and inability to speak. In the hospital for a few days, he gradually progressed and was able to walk and talk again so we transferred him to a SNF. Since arriving at the SNF, there has been major decline especially over the last 2 days. He has largely lost bowel and bladder control and is very weak (can stand with assistance for stand pivot transfers). Seems like he is really only able to use his right arm. Cannot keep his head lifted and is requiring assistance for feeding, and can only take a few bites at each meal. Difficulty swallowing and trerefor increased coughing. This has all happened over 2-3 days. Leading me to believe that the end is near.

I want him to get more assistance because I don’t think the skilled facility can provide what he needs. I don’t have a home that I can bring him to for him to pass. I don’t know what this will look like for hospice, and how to increase the quality and frequency of his care. Ideally I would like for him to be able to pass in his room at the ALF where he has been for the past several months.

edit: we did initiate hospice same day that I posted this. I pretty good about this decision and we were able to get my dad back to his apartment that be was living at the assisted living facility, but with hospice on board. Thank you all

I desperately need to start therapy, my dad is dying of brain cancer. I just finished grad school so I am covered by that insurance U of U blue cross blue shield) for a maximum of a few more weeks, then I have to switch to a Cigna plan. does anyone know how I can navigate finding a therapist that I can stick with and will take both insurances? I know there is a website that has a big list of local therapists and what insurances they take but 1. that is so overwhelming right now and 2. I don’t remember that website. like I said I really need to talk to someone asap :(

edit to say I’m specifically asking on the SLC page because maybe someone has some local resources? Idk

first of all, I’m about 90% confident that I failed the April npte. I know I missed the most simple questions after looking them up afterward. so I’m basically already planning to take it again in July. however I’m also trying to be ~positive~ and hoping that I’ll pass.

in the meantime, I don’t know what to do with myself. I’m six to my stomach from anxiety about it all, can’t sleep, having nightmares about it, and I’m extremely anxious if I can’t get a job because I failed due to not passing. how will I pay rent, groceries, everything for the next few months?

i need advice!! Either what are you doing right now to keep yourself sane as we wait for results, or if you have previously failed and your life didn’t end i could use some words of encouragement in any way.

it is to my understanding that the retired PEAT is the single most accurate practice test to the NPTE. I only have 1 PEAT left to take before I take the exam next week and it's a practice form.
I feel that the retired forms have been significantly easier for me, i passed by first one (barely) with a 605 and my second with a 630-something, but failed the practice form between the two. My question is.... should I pay the $100 (my parent would pay it, they offered) to buy another retired form to take instead of the practice form? I don't think that I can mentally handle getting a low/borderline passing score on the practice form right before the NPTE next week... but are they that different? thoughts??