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1. Care Quality & Compassion
How would you rate the quality of care provided by the hospice staff?
Excellent
Good
Fair
Poor
Did the hospice staff treat you and your family with compassion and respect?
Excellent
Good
Fair
Poor
2. Communication & Information
Were you and your family provided with clear and understandable information about the patient’s condition and care options?
Excellent
Good
Fair
Poor
Did the hospice staff communicate with you in a timely and appropriate manner?
Excellent
Good
Fair
Poor
3. Support for Family Members
Did the hospice staff provide adequate emotional support for you and your family?
Excellent
Good
Fair
Poor
Were you provided with resources or guidance for coping with the emotional and practical aspects of care?
Excellent
Good
Fair
Poor
4. Pain & Symptom Management
How well did the hospice team manage the patient’s pain and other symptoms?
Excellent
Good
Fair
Poor
Were the patient’s physical comfort needs consistently met?
Excellent
Good
Fair
Poor
5. Responsiveness & Accessibility
Was the hospice staff available when you needed them, including after-hours support?
Excellent
Good
Fair
Poor
Did you feel the hospice team was responsive to any concerns or questions you had?
Excellent
Good
Fair
Poor
6. Respect for Patient’s Wishes
Was the hospice team respectful of the patient’s personal, cultural, and spiritual preferences?
Excellent
Good
Fair
Poor
7. Family Involvement
Did the hospice team involve you in care decisions and respect the family’s role in the patient’s care?
Excellent
Good
Fair
Poor
8. Bereavement and After-Care Support
Did the hospice offer sufficient support for grief and bereavement after your loved one passed?
Excellent
Good
Fair
Poor
9. Overall Experience
How satisfied are you overall with the hospice care provided?
Excellent
Good
Fair
Poor
Would you recommend this hospice agency to others?
Excellent
Good
Fair
Poor