QUALIFYING FOR HOSPICE
Do I qualify for hospice care?
If you have a serious illness where a cure is no longer an option, and your doctor has estimated that you have six months or less to live, you may qualify for hospice care.
Does it matter where I live?
Community hospices representatives can come to wherever you live: house, apartment, group home, assisted living facility or nursing home.
You are not in this alone.
This assessment worksheet can help you decide if now is the time for you to talk to our Care Navigator about hospice as an option for you.
Please check all of the statements that apply to you:
_____ I need help getting out of bed
_____ I need help showering or bathing
_____ I need help getting dressed
_____ I need help walking
_____ I need help preparing meals
_____ I need help eating
_____ I’ve lost weight
_____ I’m becoming weaker and more fatigued
_____ I’m often short of breath even when I’m resting
_____ I’m using oxygen most of the time
_____ I spend a lot of time sitting or in bed
_____ I have swelling in my legs and/or feet
_____ I’ve fallen several times in the past few months
_____ I’ve been to the hospital several times in the past year
_____ My pain medications aren’t as effective anymore
_____ I’m really tired and I just want to be comfortable
_____ I don’t want to have any more surgery
_____ I don’t want any more chemotherapy
_____ I don’t want any tubes or IV’s to feed me
_____ I’m calling my doctor a lot more than I used to
_____ My doctor says that my life expectancy is limited
If you checked four or more of these statements, you may benefit from Community Hospices’ experienced comfort care at no cost to you. After checking with your doctor, we’ll come to where you live to talk confidentially with you about how we can help. There is never any obligation or cost you. It would be our privilege to help you make an informed choice. You’re not in this alone.
You may want to print this worksheet and take it with you to your next doctor’s appointment to start a discussion about your healthcare options. Finding the right help for you begins with a simple conversation.