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Email us

info@goldengatehospice.com

Call us

(747) 282-1515

info@goldengatehospice.com

(747) 282-1515

Instructions: Answer each question honestly. At the end of the test, tally your score to see the recommendation. Regardless of your score, remember to contact us at Golden Gate Hospice in Los Angeles for a free assessment and guidance from a physician and our professional team. With us, hospice care, including hospice at home, is at no cost to you.

1. 
Has the patient been diagnosed with a chronic illness?

2. 
Are the patient's illnesses or conditions worsening despite treatment?

3. 
Has the patient been frequently admitted to the hospital or visited the emergency room in the past few months?

4. 
Have the patient and doctor decided to get support at home?

5. 
Has the patient experienced a significant decline in mobility or ability to perform daily activities?

6. 
Has the patient been diagnosed with dementia, Alzheimer’s, or Parkinson’s disease?

7. 
Is the patient too frail or ill to visit the doctor’s office?

8. 
Is the patient experiencing uncontrolled pain or other distressing symptoms like shortness of breath or nausea?

9. 
Has the patient experienced a significant decline in mobility or the ability to perform daily activities?

10. 
Does the patient require assistance with most or all personal care tasks?

11. 
Has the patient experienced significant weight loss or decreased appetite over the past months?

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