Cement Driver

Job Description Job Description As a valued member of our team, you would collect and transport aggregate materials such as rock and sand to the Company’s plants as directed, ensuring full compliance with Company policies and procedures and with Federal, State and Local government laws and regulations. Any hired candidate will start out at our training rate of pay until they successfully graduate from training. TRUCK DRIVER FULL-TIME BENEFITS: • PPO/HMO Health Insurance, Medical, Dental, Vision, Life • PTO (Paid Time Off) • Overtime Pay • 401k Retirement Plan • Direct Deposit • Training Program • Strong Safety Program • Employee Referral Bonus • Employee Assistance Program TRUCK DRIVER ESSENTIAL RESPONSIBILITIES AND DUTIES: • Responsible for the safe and efficient delivery of material to and from ready-mixed concrete plants. • Perform Pre and Post trip inspections and maintain driver logs within the DOT guidelines. TRUCK DRIVER QUALIFICATIONS AND REQUIREMENTS: • Truck Drivers must have a valid Class A commercial driver's license with doubles/triples endorsements. • Truck Driver record must not contain any reckless driving offenses, leaving the scene of an accident, DUIs, etc. • Be able to communicate effectively with customers and Dispatch, while representing the company in a professional manner. CONDITIONS OF EMPLOYMENT: Successful Class A Truck Driver candidates must submit to post offer pre-employment physical examination, drug/alcohol screen, and background check. This Organization Participates in E-Verify Esta Organizacion Participa en E-Verify A&A Concrete Supply, Inc. is an EEO/AA (equal opportunity/affirmative action) company and does not discriminate on the basis of race, color, religion, religious creed, sex, sexual orientation, gender identity or expression, national origin, ancestry, age, physical or mental disability, medical condition, genetic information, marital or familial status, military or veteran status, or any other characteristic protected by under federal, state or local law in the programs or activities which it operates. A&A Concrete Supply, Inc. es una compañía EEO/AA (igualdad de oportunidades/acción afirmativa) y no discrimina por motivos de raza, color, religión, credo religioso, sexo, orientación sexual, identidad o expresión de género, origen nacional, ascendencia, edad, condición física odiscapacidad mental, condición médica, información genética, estado civil o familiar, estado militar o de veterano, o cualquier otra característica protegida por la ley federal, estatal o local en los programas o actividades que opera. zr

HVAC Wholesale Distributor Branch Manager Trainee

Job Description Job Description A fast growing, and family-owned HVAC Wholesale Distribution Company, Solar Supply LLC is looking to hire a branch manager trainee for our Opelousas, Louisiana branch. Previous HVAC and distribution experience is desired, but we can train the right candidate. This job is for a motivated, self-starter who has a desire to help our company grow relationships with our existing customer base, as well as possessing the skills to seek out and establish new accounts. The ideal candidate should have the ability to work efficiently while multi-tasking and working under pressure to meet deadlines, as well as having a pleasant and helpful personality that is needed to serve our customer base and lead our branch employees. Computer experience is required. This position and pay scale in this ad are for the training portion of this job only and will change upon the ideal candidate demonstrating the ability to properly assume the role of branch manager. The estimated time frame for possibly assuming the Manager's role is approximately in July of 2027. The Manager trainees pay scale is $18 per hour, possibly higher depending on previous HVAC experience. The initial training portion of this position will take place at our Lafayette, La. branch to start so you must be willing to travel between locations if necessary. Branch Manager, Wholesale Distributor Tasks Ensure the branch meets sales targets and establish strong relationships with customers. Oversee the work of branch employees, ensuring they are properly trained and that the branch is fully staffed. Analyze market and industry trends to make sure product pricing remains competitive. Manage the daily operation of a wholesale outlet and ensure orders are efficiently received, filled, and shipped. Monitor warehouse inventory levels, the reordering of items, and transaction record keeping. Please send all resumes through this ad Salary is $50k - $55k yearly, once becoming manager and will depend on previous experience. Benefits package includes a 401k program with matching funds, paid vacation and sick leave time off, select paid holidays, health insurance and managers are given a company truck to get to and from work. Please direct all inquiries through this ad only.

Registered Nurse Care Coordinator Sign on Bonus

Job Description Job Description 35 hours/wk. No weekends or major holidays unless on Subject to Call PTO - up to 5 weeks of PTO with vacation, sick, holidays and personal time 403b retirement plan medical insurance , dental, vision and ancillary products available life insurance AAA basic coverage RN (REGISTERED NURSE) CARE COORDINATOR Sign on Bonus EXPOSURE CATEGORY I BASIC PURPOSE & SCOPE : Under the supervision of the Senior RN Care Coordinator (SRNCC), the RN Care Coordinator is responsible for, but not limited to, coordination of case management, supervision of services staff, and provision of skilled nursing services. The RN Care Coordinator will comply with agency policy and procedures, as well as recommending employee development. RESPONSIBILITIES: Provides orientation, annual physical assessments, inservice education, supervision and evaluation to paraprofessional services staff and volunteers as may be assigned. Supervision and evaluation include the direct oversight and documentation of paraprofessional performance in the home, reporting unresolved performance issues of staff directly to the Senior RN Care Coordinator, coordinating supervisory matters relating to scheduling, and timely completion of assigned paraprofessional evaluations. Ensures delivery of services within the parameters defined by the patient plan of care and agency policy and procedure. Tracks and monitors that required supervisory or supervisory/assessment visits are completed for assigned patients/clients, and as requested, for paraprofessional staff. Develops and updates the plan of care and required documentation. Provides direct hands-on nursing care to patients, as defined in the Interdisciplinary Team (IDT) plan of care, as scheduled and requested. Conducts initial assessments of new referrals. Serves as a member of the IDT, providing insight regarding patient and family needs and anticipated needs. Serves as subject-to-call nurse on a rotating basis as assigned. Assists in volunteer or staff training and inservices as needed. Contacts IDT members on the behalf of patients and families as may be necessary. Maintains liaisons with regional community referral sources, vendors, and contracted service facilities/organizations, working diligently to ensure that a strong sense of collaboration and team building is evident. Prepares required reports and completes all documentation in a timely manner and in accordance with agency defined parameters. Maintains clinical excellence, consistently advancing knowledge base and clinical skill sets. 15. Adheres to and reflects organizational values in daily work. 16. Serves on agency committees as may be assigned. 17. Maintains an obligation to report wrongdoing/violation of agency policies, applicable federal, state and local laws, and regulations, pertaining to agency operations, to immediate supervisor or identified compliance officer. 18. Completes all mandatory in-service education programs and completes any other additional in-service hours that are minimally required for the position. The above examples of work may not be a complete statement of all assignments that may be inherent to the position. Other duties may be assigned as deemed necessary and appropriate by the Chief Nursing Officer or his/her designee. MINIMUM REQUIREMENTS: Current license and registration to practice nursing as a registered professional nurse in the State of New York. A minimum of two years full time or equivalent of recent applicable nursing experience is preferred. Ability to lift a minimum of 20 pounds, perform one person transfer under routine and emergency situations, reposition a bedbound patient alone, and able to sit, stand, bend, stoop, kneel, pull, reach, lift, and perform repetitive movements of the upper extremities. Effective oral and written communication skills. BLS certification. Acceptable driver’s license and automobile available for use with current insurance. Computer literacy and ability to work in an Electronic Medical Record. Availability by telephone

Out Patient Registered Nurse (RN) Case Manager - PRN

Job Description Job Description Out Patient Registered Nurse (RN) Case Manager - PRN Location: Bethlehem, GA Reports To: Director of Nursing (DON) Competitive Rates Job Summary: The RN Case Manager is responsible for providing direct patient care and case management for hospice patients. This includes assessing, planning, implementing, and evaluating patient needs in coordination with the interdisciplinary team. The RN Case Manager documents all clinical activities in the EMR, ensures the plan of care is up to date, and provides compassionate support to patients and families throughout the end-of-life journey. Essential Duties & Responsibilities: ● Perform initial and ongoing comprehensive nursing assessments of patients ● Develop individualized plans of care in collaboration with IDG, including goals, interventions, and frequency of visits ● Provide skilled nursing care, symptom management, and emotional support to patients and families ● Update plans of care as patient conditions change, ensuring alignment with patient goals and clinical indications ● Coordinate and communicate with the interdisciplinary team including social workers, chaplains, aides, and volunteers ● Prepare and submit accurate, complete visit documentation using our EMR within required timeframes (typically within 24 hours) ● Monitor and reconcile medication lists and DME needs with pharmacy and DME providers ● Educate patients, caregivers, and families on the disease process, medications, safety, nutrition, and hospice philosophy ● Participate in weekly IDG meetings and provide clinical updates on assigned patients ● Participate in on-call rotation and respond promptly to patient/family needs EMR ● Document all visits, symptom assessments, interventions, and care plan changes using standardized EMR templates ● Complete and update the Medication Administration Record (MAR) and communicate medication changes in EMR ● Record wound care, falls, vital signs, and psychosocial changes using appropriate task forms ● Submit narrative summaries and interdisciplinary notes as part of care coordination ● Review IDG dashboard for pending updates and enter notes from weekly IDG meetings ● Monitor outstanding tasks and ensure documentation is signed, locked, and compliant Regulatory & Compliance Responsibilities (GA): ● Ensure clinical care and documentation comply with Georgia Rule 111-8-37 and CMS CoPs ● Follow hospice standards for routine home care, continuous care, GIP, and respite levels of care ● Participate in QAPI initiatives and report variances or quality concerns to the DON ● Document supervision of aides as required under GA regulations Qualifications: ● Current Registered Nurse (RN) license in the State of Georgia ● Minimum 1 year of nursing experience, preferably in hospice, home health, or critical care ● Current CPR certification ● Valid driver’s license and reliable transportation ● Familiarity with EMR or similar system strongly preferred ● Strong critical thinking, communication, and organizational skills Core Competencies: ● Clinical skill in managing pain, symptoms, and end-of-life conditions ● Empathy and sensitivity to diverse cultural and emotional needs ● Efficient, accurate documentation and EMR fluency ● Team collaboration and conflict resolution ● Calm, composed presence during crisis or death

Registered Nurse (RN) - Cardiology

Job Description Job Description Registered Nurse (RN) - Cardiology Job Type: Full-Time | On-Site Location: Great Falls, Montana We have partnered closely with a prominent regional healthcare system to secure a full-time, dedicated nursing professional for their cardiovascular service line. We are currently seeking an experienced Cardiology Registered Nurse (RN) to join a specialized clinical team in Great Falls, Montana. This hospital-based position is ideal for an RN looking for a supportive environment that emphasizes excellent nurse-to-patient ratios, robust administrative backing, and a strong culture of teamwork and compassion. Tucked into a scenic Montana community known for an exceptional quality of life and outdoor recreation, this role provides an ideal balance of professional clinical development and personal lifestyle stability. Responsibilities: Provide high-quality, professional nursing care to cardiology patients in accordance with established clinical standards and evidence-based practices. Serve as the primary clinical liaison between patients, family members, medical staff, and specialized cardiovascular providers to ensure seamless care coordination. Assist providers with inpatient and/or outpatient cardiac care coordination, diagnostic testing management, and clinical follow-ups. Assess patient statuses, monitor cardiac rhythms, and manage complex cardiac medication regimens under provider direction. Educate patients and their families regarding cardiac diagnoses, prescribed therapies, procedural expectations, and lifestyle modifications. Maintain thorough, precise, and timely electronic documentation of all patient assessments, interventions, and care modifications. Qualifications: Education: Graduate of an accredited nursing program (Associate Degree in Nursing required; Bachelor of Science in Nursing preferred). Licensure: Active, unrestricted Registered Nurse (RN) licensure in the State of Montana (or immediate compact/endorsement eligibility). Certifications: Core certifications in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) are required. Required Clinical Knowledge: Solid working comprehension of EKG interpretation, cardiac arrhythmias, advanced cardiac medications, and standard cardiology procedures. Completion of a basic coronary care course is required. Experience: At least 2 years of dedicated cardiac or cardiovascular nursing experience is highly preferred. Core Skills: Proficiency with medical terminology, basic office equipment, accurate data entry/keyboarding, and electronic medical records (EMR) charting. Benefits: $10,000.00 Retention Bonus to support your transition and long-term commitment to the team. (Please note: This incentive is available for external candidates only) Comprehensive medical, dental, and vision insurance packages. Robust retirement savings plan with a generous employer matching contribution. Fully covered medical malpractice insurance. Generous paid time off (PTO) allocation to support a healthy work-life balance. Access to continuous clinical education and professional development pathways in cardiovascular care. Note on Compensation & Hiring Requirements: Final hourly compensation will be verified and determined by the organization based on your documented years of nursing experience. All job offers are contingent upon the successful completion of standard pre-employment screenings, including a criminal background check, drug screening, and health/immunization verification. \nCompany Description Kace Premier Medical Talent connects healthcare professionals with opportunities that match their skills, goals, and preferences. We provide responsive, personalized support throughout the hiring process. Company Description Kace Premier Medical Talent connects healthcare professionals with opportunities that match their skills, goals, and preferences. We provide responsive, personalized support throughout the hiring process.

Home Healthcare Nurse - LPN or RN

Job Description Job Description We have an exciting opportunity for a nurse to make a HUGE impact in our client's life. We are looking for a nurse that is ready to take a step back from the chaotic hospital environment and work one-on-one with a adult male in their home. This individual is a high-functioning MVA survivor who requires assistance with medication compliance and other basic needs during 12-hour shifts in his smoke-free home. He shares his home with a small dog, which he enjoys taking for walks and playing with outside. He is also very involved in his church and attends services at least twice a week. He will require his nurse to accompany him to his medical appointments and outings as needed. Centria Healthcare, the number one provider of Private Duty Nursing in Michigan , is looking for exceptional RNs and LPNs just like YOU to join our private duty, pediatric nursing team in the Ionia, Sunfield, Lansing MI area! Why Choose Centria? At Centria, we pride ourselves on hiring excellent nurses and providing them with access to a diverse patient population that they might not encounter in traditional facility or hospital settings. Our success is driven by our comprehensive training program designed to prepare nurses to deliver comfortable, confident, and positive outcomes for our clients. About the Role: We have immediate needs for private duty nurses (RNs or LPNs) in the West Bloomfield Township area to provide home care to pediatric patients. Our pediatric population ranges in ages from birth to 21 years of age. Weekly Pay Create Your Own Schedule : Although this specific position is a day shift, in general, we never mandate shifts, giving you the flexibility to balance work and personal life. Supportive Environment : New to home care? We have dedicated staff invested in your success. Healthy Work-Life Balance: Providing 1-on-1 care promotes a balanced and fulfilling professional life. Growing Company: We are expanding rapidly and are excited to welcome great individuals to our team. Don't Have a Lot of Experience? No Problem! Whether you're new to home care or need a refresher on trach care, we offer training opportunities and the chance to shadow experienced nurses to gain the comfort level needed to provide optimal care. What We Offer: Competitive pay Comprehensive training programs Supportive and caring work environment Opportunities for professional growth and development Who We Are Looking For: Caring, professional, and dedicated RNs and LPNs Nurses passionate about providing exceptional care Individuals who value a healthy work-life balance and want to make a positive impact on their clients' lives Responsibilities Perform duties outlined in patient's plan of care TBI SCI rehabilitation Geriatric care Ventilator and Tracheotomy care (Training Provided) Gastrostomy tube care (Training Provided) Dispensing medications Observe client’s physical, mental and emotional conditions. Report any changes Document observed changes Communicates effectively with Clinical team to increase optimal outcomes Maintains professional nature within the home setting Required Qualifications, Skills, and Knowledge Excellent oral and written communication skills Ability to follow verbal and written instructions Ability to utilize computers/tablets and computer software Current state license as an RN or LPN Valid driver’s license and reliable transportation Current negative TB skin test or negative chest X-ray CPR certified Benefits we have to offer: - Full-scale Benefits Package: Medical Dental Vision Sick Pay Flexible schedule Paid training Virtual Orientation Electronic charting Dedicated staffing specialists Employee Assistance Program (EAP) Referral bonus COVID supply support Tuition Assistance Program 24/7 On Call support Highest quality metrics in the industry Opportunities for advancement within the organization About Centria: Founded in 2009 and headquartered in Farmington Hills, Michigan, Centria Healthcare is a leading provider of home-based catastrophic injury and rehabilitation care, private duty nursing, and supportive living services across the state of Michigan. Centria coordinates among multiple disciplines for its rehabilitation services including physical therapy and occupational therapy. Transcending beyond the role of traditional home healthcare providers, Centria has established itself as a market leader through its diverse expertise spanning from the rehabilitation of those who have experienced a Traumatic Brain Injury or Spinal Cord Injury to children dependent on technology. Centria has developed the most comprehensive programs to care for individuals involved in the most serious accidents with potentially long-term complications relating to those accidents. All applicants receive consideration of employment without regard to race, color, creed, religion, age, sex, national origin, ancestry, disability, veteran status, size, height, weight, marital status, family status, gender identity or expression, affectional or sexual orientation, genetic information, or any other legally protected status Job Types: Full-time, Part-time Pay: $28.00 - $33.00 per hour Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Employee discount Flexible schedule Flexible spending account Health insurance Life insurance Paid sick time Paid time off Referral program Tuition reimbursement Vision insurance Medical Specialty: Critical & Intensive Care Home Health Pediatrics Physical Setting: Acute care High acuity unit Long term care Private practice Job Types: Full-time, Part-time Benefits: Dental insurance Flexible schedule Health insurance Referral program Vision insurance Medical Specialty: Home Health Pediatrics Wound Care License/Certification: Michigan LPN or RN license (Required) \nCompany Description Centria Healthcare is always looking to hire caring, professional and dedicated staff. A healthy work life balance is considered in the structure of our organization. We want our clients and staff healthy and happy. We love what we do and have a high expectation of service. We are growing tremendously and are looking forward to adding great individuals to our team. We understand that our employees are our greatest asset. Company Description Centria Healthcare is always looking to hire caring, professional and dedicated staff. A healthy work life balance is considered in the structure of our organization. We want our clients and staff healthy and happy. We love what we do and have a high expectation of service. We are growing tremendously and are looking forward to adding great individuals to our team. We understand that our employees are our greatest asset.

PACU RN

Job Description Job Description RN - PACU (ORTHOPEDICS) PER DIEM GENERAL SUMMARY OF DUTIES: Contributes to Lynbrook Surgery Center by utilizing the nursing process in planning, executing, and evaluating the nursing care given to the surgical patient during the post-operative period. Plans and delivers safe, effective nursing care until the patient is transferred to/from his/her care to the surgical RN and discharge. Responsible for the surveillance, analysis and mitigation of infections, and the development and implementation of policies and procedures that ensure rigorous infection prevention and control standards within the Surgery Center, in compliance with state, federal and other regulatory agencies requirements, and the Surgery Center's standard of care and mission and goals. KNOWLEDGE, SKILLS & ABILITIES: Responsible for delivery of professional nursing care for assigned patients Performs nursing assessment Formulates nursing diagnosis/care plan Implements/evaluates care plan for all assigned patients Administers medications and interventions within scope of practice Demonstrates attention to detail by ensuring that all documentation is legible, complete, and accurate. Knowledge of organizational policies, procedures, systems, and objectives. Has knowledge of patient rights and strives to improve patient outcomes by respecting each patient’s cultural, psycho-social, and spiritual values. Knowledge of applicable regulatory, compliance, and accreditation standards and requirements. Possesses critical thinking skills. Demonstrates a willingness to listen to others and openly expresses respect for differing opinions. Demonstrates leadership, effective organizing, and planning skills. Effective problem solving skills to include data analysis and judgment to make effective decisions. Ability to work with minimal supervision. High Impact Communication - Effective oral and written communication skills Computer Skills – Knowledge and basic use of computer skills. Maintains high level of confidentiality at all times. Ability to build trust and gain respect through effective team leadership and participation skills. Develops reviews and updates all policies and procedures on Infection Control. Obtains input from Medical Director and other Department Heads in planning and implementing an Infection Control Training Program. Develops updates and enforces procedures for reportable and non-reportable infections. Prepares and provides quarterly summaries of all infections to the Infection control committee. EDUCATION: Graduate from an accredited school of professional nursing. EXPERIENCE: Ambulatory surgery center experience, a plus. CERTIFICATION/LICENSE: Active RN license as required by state of New York. Valid BCLS Certification upon employment. online certification not acceptable. ACLS & PALS as required by facility.

Experienced End Dump Driver - Manual 10 Speed Driver

Job Description Job Description We are seeking a highly skilled and experienced End Dump Driver (Manual 10 Speed) to join our team in the Construction industry. As a Driver, you will be responsible for transporting materials and equipment to various job sites in a safe and timely manner. Your primary goal will be to ensure that all deliveries are made on time and in accordance with DOT regulations. You will be an integral part of our team, working closely with our Transportation Management department to ensure that all deliveries are made efficiently and effectively. Minimum Qualifications: Manual 10 speed Valid Commercial Driver's License (CDL) Class A Experience driving Dump Trucks and Box Trucks Knowledge of DOT regulations Ability to read maps and follow directions Excellent communication and interpersonal skills Preferred Qualifications: Experience in the Construction industry Familiarity with local roads and traffic patterns Ability to operate heavy equipment Responsibilities: Transport materials and equipment to job sites in a safe and timely manner Ensure all deliveries are made in accordance with DOT regulations Maintain accurate records of deliveries and vehicle maintenance Communicate effectively with Transportation Management department to ensure efficient delivery schedules Perform pre-trip and post-trip inspections of vehicle to ensure safety and compliance with regulations Travel : Frequent long-distance travel, often requiring extended periods away from home. Work Schedule : May include weekends, nights, and holidays, depending on delivery schedules. Physical Demands : The role involves physical activities such as loading/unloading cargo, securing loads, and performing vehicle inspections. Safety Protocols : Strict adherence to safety standards is essential to prevent accidents and ensure the safety of all personnel involved. Skills: As a Driver, you will utilize your skills in Truck Driving, DOT Regulations, CDL License, Transportation Management, and Map Reading on a daily basis. You will be responsible for ensuring the safe and timely delivery of materials and equipment to job sites, while maintaining accurate records and communicating effectively with our Transportation Management department. Your ability to operate heavy equipment will be an asset to our team. We are looking for a highly skilled and experienced Driver who is committed to safety, efficiency, and excellence in all aspects of their work.

Registered Nurse - Hospice

Job Description Job Description Primary functions include administering nursing care for patients of all ages in their place of residence and coordinating care with the Interdisciplinary Group/Team, patients, families, and the referring agency. Assumes the responsibility for, and participates in, the coordination of care. Job Qualifications: Current Texas license as a Registered Nurse (RN) is required One year of experience as a registered nurse in a clinical care setting. Hospice experience preferred. Current driver’s license. Nursing skills as defined by generally accepted standards of practice. Good interpersonal skills. Specialized skills preferred in palliation and end-of-life. Must read, write, and comprehend English. Reliable transportation and valid auto liability insurance. Essential Functions: Initial and ongoing comprehensive assessments of the impact of the terminal disease on the patient's physical, functional, psychosocial, and environmental needs as evidenced by documentation, clinical records, case conferences, team report, evaluations, and ADLs (i.e., risk for grief, cultural and spiritual, verbal, and non-verbal). Applies specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient’s eligibility. Implements/develops/documents the plan of care to ensure quality and continuity of care and recommends revisions to the plan, as necessary. Consults with and educates the patient and family regarding the disease process, self-care techniques, end-of-life care, nutrition, and dietary needs. Prioritize any needs with the members of the IDG/T. Provide training to other staff as needed. Environmental and Working Conditions: Works in patients’ homes in various conditions; possible exposure to blood, bodily fluids, and infectious diseases; ability to work a flexible schedule; ability to travel locally Physical and Mental Effort: Prolonged standing and walking are required, with the ability to lift up to 50 lbs and move patients. Requires working under stressful conditions to meet deadlines and patient needs, make quick decisions, acquire resources, and meet patients' and families' individualized psychosocial needs. Requires eye-hand coordination and manual dexterity. \nCompany Description Anchor Hospice is committed to serving and educating our community in understanding that palliative care and hospice are part of the healthcare process. Hospice is a philosophy of care that focuses on the physical, emotional, psychosocial and spiritual needs of persons facing a life-threatening illness. The goal of care is the palliation or lessening of pain, discomfort and other symptoms associated with the illness when a cure is no longer considered an option. Company Description Anchor Hospice is committed to serving and educating our community in understanding that palliative care and hospice are part of the healthcare process. Hospice is a philosophy of care that focuses on the physical, emotional, psychosocial and spiritual needs of persons facing a life-threatening illness. The goal of care is the palliation or lessening of pain, discomfort and other symptoms associated with the illness when a cure is no longer considered an option.