Bill is a 67-year-old retired steel worker who has smoked for over 50 years. Although he developed heart disease that required by-pass surgery twice, he continued to smoke. Bill was hospitalized after he became severely short of breath and passed out, which frightened his wife, Helen. Bill was found to be in respiratory failure from COPD with bilateral pneumonia and heart failure. Upon discharge from the hospital, his hospitalist indicated that Bill would need further counseling and support to help understand the nature of his progressive disease and his continued resistance to treatment options including pulmonary rehab, home oxygen, smoking cessation and advanced care plan options. Bill’s wife was very anxious that he may collapse again at home. A Heartland Advanced Disease Management nurse practitioner was consulted. She began discussion regarding what Bill and Helen understood from the hospitalist regarding Bill’s condition. The NP addressed the nature of Bill’s disease, ways of coping and treatment options available. She also recommended an Alert Bracelet and First Responder Alarm and provided Helen with a referral to a support group. Bill agreed to the use of supplemental oxygen therapy and is now on a combination bronchodilators and inhaled corticosteroids for symptom management of chronic, progressive dyspnea.