I recently celebrated my two-year anniversary as an occupational therapist and have found myself reflecting many times during this period on what I have learned and felt during my tenure in a skilled nursing setting. Over this period, during which I have gained invaluable experience helping individuals function at their highest possible levels of independence, I have laughed, cried, and experienced many bittersweet moments. While a small percentage of my patients have been able to return home with adequate support systems in place, most of the individuals with whom I work are destined to live out their days at one of the three nursing homes in which I provide occupational therapy services due to progressive physical and/or cognitive conditions. In these cases, I strive to facilitate the development of skills that support optimal independence in order to preserve the dignity of each individual as well as decrease caregiver burden regarding often over-worked nursing staff. While I must take into consideration the concerns of family who may be resistant to the realities of a patient's physical and/or mental limitations, it is my responsibility not to give false hope about rehabilitation potential. The process of developing realistic goals for each individual under my care can be daunting as I strive to consolidate prior levels of function with current medical prognoses while taking into consideration the hopes and dreams of patients and their loved ones. Although the limitations associated with a certain medical condition may be obvious to me, I realize that an individual who is dealing directly with the realities of a disability may need time to process the stages of grief that accompany a new or chronic diagnosis. In these instances, it is helpful for me to imagine how I would feel if the individual were myself, a member of my family, or a close friend. In any case, I would want to know the truth. However, I would want the message to be relayed in a heartfelt way that demonstrates compassion and a sense of hope within reason. From this perspective, I strive to offer the best of both worlds: an evidence and experience-based evaluation of an individual's prospective need for assistance with recommendations of resources that will meet both the caregiver's and patient's needs for support on a variety of levels.