ADDRESS

1875 Connecticut Avenue NW

Suite 540

Washington, DC 20009

PHONE/FAX

Tel: 202-966-3720

Fax: 240-839-3391

CFC #80571

© 2019 The Washington Home & Community Hospices, Inc.

QUALIFYING FOR HOSPICE

Does my loved one qualify for hospice care?

If your loved one has a serious illness with a life-expectancy of six months or less, and a cure is no longer an option, your family can elect to receive hospice care. If you'd like for our team here at The Washington Home & Community Hospices  to help guide you during this journey, contact us today—we're here for you!

 

Hospice Assessment Worksheet

This assessment worksheet may help you decide if now is the time for you to talk to our Care Navigator about hospice as a healthcare option for your loved one:

Please check all of the statements that apply to your loved one:

_____ 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, your loved one may benefit from Community Hospices’ experienced comfort care at no cost to you. After checking with your loved one’s doctor, we’ll come to where you live to talk confidentially with you and your loved one about how we can help. There’s never any obligation or cost to 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 use it to start a discussion with your doctor about healthcare options for your loved one.  Finding the right help for the person you love begins with a simple conversation. 

Call Our

Care Navigator

866-234-7742

Resources

You’re not in this alone.

Does it matter where we live? 

You can find hospice providers wherever you live. There are more than 14 hospices serving Montgomery and Prince George’s County residents and District residents.  At this time, our Community Hospices’ services are available to residents of the District of Columbia and Montgomery and Prince George’s Counties in Maryland.  We come to wherever your loved one is: house, apartment, group home, assisted living facility or nursing home. 

 

How do we get hospice care started?

 

Getting hospice care is quick and convenient.  Call 866-234-7742 and ask to schedule a confidential, no-obligation, private medical assessment in your home or wherever your loved one is.  You can also fill out our referral form and fax it to us at 202-895-0154 and we’ll get in touch with you right away.  Anyone can ask for a hospice assessment. You can call for yourself or a loved one. Your doctor can refer your loved one to hospice or, if your loved one is in the hospital, the hospital social worker or discharge planner can refer your loved one to hospice.