Is Hospice The Answer?

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.

If you’re not sure whether you or your loved one might be eligible to receive hospice care, this brief questionnaire might help.

Have you or a loved one…

Been hospitalized or gone to the ER in the past 6 months?

Yes No

Been making more frequent phone calls to your physicians?

Yes No

Started taking medication to lessen physical pain?

Yes No

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

Yes No

Started feeling weaker or more tired?

Yes No

Been told by a doctor that life expectancy is limited?

Yes No

Your Name*

Email*

Hospice Candidate's Zip Code*

Your Phone Number

Doctor's Name

Are you interested in hospice for yourself or for a loved one?

Question / Comments

Time is Up!

Time's up

Need to Reach Us Immediately?

E-mail us at hospice@impacthc.org or call our 24/7 line at 888-341-9850.

By clicking submit, you consent to us following up with you by phone or e-mail regarding your hospice quiz and whether you are appropriate and eligible for hospice care. If after clicking submit, you decide you do not want to be contacted any further, please e-mail us at hospice@impacthc.org.

100% Privacy Guaranteed

Our Partners

Bringing together the best people, practices, and ideas to set the standard for healthcare in the home.

AGENCIES

A Plus
Crossroads
Forest Park
Los Robles

OUR COMPANY

About
Services
Careers
Resources

LOCATIONS

CONTACT

In compliance with applicable Federal civil rights laws, we do not discriminate based on race, color, national origin, age, disability, or sex, in health programs and activities.