Hospital and Clinic
Hospice Readiness Questionnaire
If you're not sure if hospice is right for you and your family, this brief questionnaire can help.
Have you or your loved one:
- Been hospitalized or gone to the emergency room several times in the past six months?
- Been making more frequent phone calls to your physicians?
- Started taking medication to lessen physical pain?
- Started spending most of the day in a chair or bed?
- Fallen several times over the past six months?
- Started needing help from others with:
- Getting out of bed
- Started feeling weaker or more tired?
- Experienced weight loss making clothes noticeably looser?
- Noticed a shortness of breath, even while resting?
- Been told by a doctor that life expectancy is limited?
If any of these apply, there's a good chance that hospice care is the right answer for you and your loved ones. Requesting hospice services can be made by the person needing hospice services, family, physician, clergy or social service agencies.