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.

Hospice Assessment Worksheet

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. 


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Suite 540

Washington, DC 20009


Tel: 202-966-3720

Fax: 240-839-3391

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