Self Assessment

How would I know when it is appropriate to contact Hospice for a loved one?

The following self assessment can help you decide if the time is right to talk to your family and physician about Eden Hospice Care and support for you or your loved one.

Check all the statements that if you have experienced recently.

Lately I need help with:

In Addition:

If you checked four or more of these situations, you could benefit from Hospice care. Please contact our service at: 213-596-9119. Anytime, 24 hours a day and 7 days a week.

Medical Conditions

Hospice Care is strongly recommended if the following specific diagnosis statements apply to you or your loved one’s situation:

Cancer

• Rapidly weakening and the malignancy is progressing
• Mainly in bed and unable to do normal work
• Treatment is no longer fully effective
• Confusion and reduced intake

Dementia

• Cannot walk without personal assistant
• Unable to speak in complete sentences
• Urinary and fecal incontinence
• Loss of ability to smile
• One or more of the following condition in the past year:
• Aspiration pneumonia
• Multiple pressure ulcers
• Recurrent fever

Heart Disease

• Have advanced congestive heart failure or advanced coronary disease with frequent episodes of angina
• Have an abnormal heart due to disease and suffers significant symptoms of fatigue, shortness of breath or functional decline
• Unable to carry on any physical activity without discomfort
• Swelling in ankles worsening over last 3 weeks

Pulmonary Disease

• Have disabling dyspnea at rest
• Have poorly or unresponsive to bronchodilators
• Have made repeated trips every few months to the emergency room for respiratory failure or lung infections
• Have been repeatedly hospitalized every few months and no longer wishes to be hospitalized

HIV/AIDS

• Repeated Emergency room visits for the same problem
• Repeated hospitalizations
• Serious co-morbid illness such as anal or cervical cancer, lymphoma or heart disease
• Tachycardia (too fast heart beat) at rest

Liver Disease

• Sudden or progressive loss of functional independence
• Reduced appetite or weight loss
• Inability to work
• Breathing difficulties
• Altered mood and behavior
• Mainly sit or in bed
• Confusion, cognitive impairment

Neurological Disease

• Need for pureed foods
• Severe difficulty breathing
• Need for assistance with personal care and eating, or total dependence activity
• Rapid progression to wheelchair or bed-bound

Stroke or Coma

• Severely reduced consciousness level
• Avoid feeding tubes and mechanical ventilation
• Poor nutritional status with inability to maintain sufficient fluid and calorie intake
• Inability verbal responses

Renal Failure

• Feeling more sleepy or lethargic
• Become confusion to disorientation, anxiety or delirium

For Whom

Criteria

Who is eligible to receive hospice service?

• Patient diagnosed with limited life expectancy
• Patient and family want to pain and symptom management rather than cure
• Patient qualified by physician (patient is expected to live 6 months or less)
• Patient and family focus on their quality of life
• Patient and family want to receive personal care at home

What Kind of illnesses?

• Cancer
• Stroke/ Coma
• Alzheimer’s disease
• Heart disease
• Liver disease
• Lung disease
• Kidney disease
• Neurologic disease
• Multiple sclerosis
• AIDS/HIV
• ALS (Lou Gehrig’s disease)