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Are you ready for Hospice?

A serious illness can be overwhelming for the entire family – but that’s where hospice can help. Hospice is 100% covered by Medicare for all eligible patients and is covered by most Medicaid and commercial insurance plans. Anyone can refer a patient to hospice, and the evaluation is free.

QUIZ

1) Been hospitalized or gone to ER several times in the past 6 months?

Yes No

2) Been making more frequent phone calls to your physicians?

Yes No

3) Started taking medication to lessen physical pain?

Yes No

4) Started spending most of the day in a chair or bed?

Yes No

5) Fallen several times over the past 6 months?

Yes No

6) Started needing help with one or more of the following? (bathing, dressing, eating, getting out of the bed, walking)

Yes No

7) Started feeling weaker or more tired?

Yes No

8) Experience weight loss making clothes noticeably looser?

Yes No

9) Noticed a shortness of breath, even while resting?

Yes No

10) Been told by a doctor that life expectancy is limited?

Yes No

Name:

Email:

Hospice Candidate’s Zip Code:

Your Phone Number