SOCW 6204 Week 10 Patient Advocacy Letter Example

Month Day, Year

Care Coordination Unit

State Medicaid Community Home Care Program

[Street Address]

[City, State ZIP]

Re: Request for overnight personal care hours, Rosette Augustin, program ID [number]

Dear Care Coordinator:

I am writing on behalf of Mrs. Rosette Augustin, a participant in your program, to request that her personal care hours be increased to include overnight coverage, from ten at night until seven in the morning, seven nights a week, for an initial period of 90 days. Without overnight help, she cannot safely remain in her home, and the alternative is long-term placement in a nursing facility, which she does not want.

Mrs. Augustin is 79. In the past three months she has had a hip fracture repaired surgically after a fall at home, three weeks of rehabilitation in a skilled nursing facility, and a hospital readmission for heart failure. She walks only short distances with a walker and tires after a few minutes. She lives by herself, 14 steps above the street. Her original fall happened at 2:00 a.m. on the way to the bathroom, and she lay on the floor for four hours before a neighbor heard her. Her physician has documented that she needs help with walking at night and with toileting.

Her family has done all it can. Her daughter lives nearby but works a rotating city transit schedule that puts her on evenings and nights two weeks of every month. She has agreed to manage her mother's medications, provide transport and help with bathing during her day-shift weeks, and she has been doing so. She cannot provide care overnight without losing her job, and her own health has begun to suffer; strain of this kind tends to grow when care demands spill over into a caregiver's work and family life (Pearlin et al., 1990). Her son lives in Florida and contributes financially.

Several supports are already in place. A home health agency visits three times a week for nursing and physical therapy. Mrs. Augustin has a medical alert device. A palliative care referral has been made, and she has completed a health care proxy naming her daughter. Her current personal care hours cover four hours each morning. The gap is the night. Support at home after a hospital stay for heart failure can prevent readmissions (Naylor et al., 2004), and overnight help would remove the main reason she cannot stay home.

Most people who need long-term care at home rely on unpaid family help, and formal services fill the gaps families cannot (Kaye et al., 2010). Mrs. Augustin's family is meeting her daytime needs; they cannot meet her overnight needs. I ask that you approve overnight personal care hours for 90 days, after which we will reassess with you. Her signed consent to share this information is enclosed, along with her physician's statement and the discharge summary. My direct line and email are below.

Sincerely,

[Signature]

[Name], MSW

Hospital Social Worker, [Composite Community Hospital]

Enclosures: Consent to release information; physician's statement of need; discharge summary

References

Kaye, H. S., Harrington, C., & LaPlante, M. P. (2010). Long-term care: Who gets it, who provides it, who pays, and how much? Health Affairs, 29(1), 11-21. https://doi.org/10.1377/hlthaff.2009.0535

Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), 675-684. https://doi.org/10.1111/j.1532-5415.2004.52202.x

Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583-594. https://doi.org/10.1093/geront/30.5.583