🖨️How to Use This Checklist
• First: Download the PDF using the "Download PDF Checklist" button above
• Print the downloaded PDF for best formatting and page breaks
• Check off questions as you ask them or get answers
• Use the notes section to record important responses
• Bring this printed checklist to meetings with providers
• Keep completed checklists for future reference
🎯Pain and Symptom Management
4 questions to cover
1. What can be done to manage my loved one's pain and discomfort?
Why this matters: It's crucial to understand the hospice team's approach to pain and symptom management. This will help ensure your loved one receives the care they need to remain as comfortable as possible.
2. How will you monitor and evaluate my loved one's pain levels?
Why this matters: Ongoing monitoring and assessment of pain and symptoms is essential. Asking about the team's process will help you stay informed and advocate for your loved one's needs.
3. What medications will be used to manage pain and other symptoms?
Why this matters: Knowing the specific medications and treatments planned for pain and symptom management will help you understand the care approach and make informed decisions.
4. How will you adjust medications or treatments if my loved one's needs change?
Why this matters: It's important to understand the hospice team's flexibility and responsiveness in adapting care as your loved one's condition evolves. This will ensure their comfort is prioritized.
Additional Notes for Pain and Symptom Management:
💡Emotional and Spiritual Support
3 questions to cover
1. What type of emotional and spiritual support do you provide for patients and families?
Why this matters: Hospice care goes beyond just medical support. Asking about the team's approach to emotional and spiritual care can help ensure your loved one's holistic needs are addressed.
2. How can I, as a family member, be involved in providing emotional support?
Why this matters: Involving family in the emotional and spiritual care process can be deeply meaningful. Understanding the team's guidance on this will help you play an active, supportive role.
3. Do you have resources available for grief counseling or support groups?
Why this matters: Grieving the loss of a loved one is a difficult process. Asking about the hospice team's bereavement support can help you and your family access the resources you may need.
Additional Notes for Emotional and Spiritual Support:
🔍Care Coordination and Communication
4 questions to cover
1. Who will be part of my loved one's hospice care team, and what are their roles?
Why this matters: Knowing the various members of the hospice team and their responsibilities will help you understand the breadth of care and support available for your loved one.
2. How often will the hospice team communicate with me about my loved one's condition and care plan?
Why this matters: Establishing clear communication expectations is crucial to staying informed and involved in your loved one's care. Asking about the team's approach will ensure you're kept up to date.
3. What is the process for making changes or adjustments to the care plan?
Why this matters: Hospice care should be flexible and responsive to your loved one's evolving needs. Understanding the process for modifying the care plan will empower you to advocate for your loved one's comfort.
4. How can I best coordinate care and communicate with the hospice team?
Why this matters: Effective coordination and communication between the family and hospice team is essential. Asking for guidance on the best ways to stay involved and informed will help ensure a smooth care experience.
Additional Notes for Care Coordination and Communication:
⭐End-of-Life Care
3 questions to cover
1. What can I expect during the final days or hours of my loved one's life?
Why this matters: Knowing what to expect as your loved one's condition declines can help you and your family prepare and provide the best possible support during this difficult time.
2. What are the signs that my loved one is nearing the end of life?
Why this matters: Understanding the typical end-of-life signs and symptoms will help you recognize when your loved one is approaching their final days, allowing you to make the most of the time you have left.
3. How will you ensure my loved one's comfort and dignity in their final days?
Why this matters: Maintaining your loved one's comfort and dignity is of utmost importance. Asking the hospice team about their approach to end-of-life care will give you peace of mind that your loved one's needs will be met.
Additional Notes for End-of-Life Care:
📋Practical Considerations
3 questions to cover
1. What are the hospice admission requirements, and how do we get started?
Why this matters: Understanding the process and requirements for hospice admission will help you navigate the transition to hospice care smoothly and ensure your loved one receives the support they need.
2. What costs or financial considerations are involved with hospice care?
Why this matters: Discussing the financial aspects of hospice care, including any out-of-pocket expenses, will help you plan and budget accordingly during this difficult time.
3. What should I do if I have concerns or issues with the hospice care being provided?
Why this matters: Knowing the proper channels to voice any concerns or grievances will empower you to advocate for your loved one's needs and ensure the highest quality of care.
Additional Notes for Practical Considerations:
📊 Summary & Next Steps
Key Concerns Identified:
Follow-up Actions:
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