Free Nursing Home Admission Application Letter Template
Nursing Home Admission Application Letter
[Your Address]
[Your City, State, Zip Code]
[Your Email]
[Your Phone Number]
[Current Date]
[Admissions Coordinator Name]
[Title]
[Nursing Home Name]
[Nursing Home Address]
[Nursing Home City, State, Zip Code]
Dear [Admissions Coordinator Name],
I trust this letter finds you well. I am reaching out to express my earnest interest in securing a place for my [Mother/Father/Relative's Name], [Your Client Name], within your reputable institution, [Nursing Home Name]. The purpose of this Nursing Home Admission Application Letter is to explore the possibility of [Your Client Name] becoming a valued member of your community, benefitting from the unparalleled care and supportive environment your facility is renowned for.
[Your Client Name] has been courageously battling [Name of Condition], a journey marked by both resilience and significant challenges. Recent developments have seen a notable decline in their capability to perform daily activities independently, necessitating a level of specialized care and assistance that surpasses our family's current capacity. It is with this context that I am prompted to seek a place where [Your Client Name] can receive the professional care they deserve.
Your esteemed facility, [Nursing Home Name], came to our attention through recommendations from our healthcare provider, [Healthcare Provider Name], and several close acquaintances whose opinions we deeply trust. We are particularly drawn to your [Specific Service or Program], which we believe aligns seamlessly with [Your Client Name]'s current needs and medical requirements.
Below is a detailed medical history and a list of medications that [Your Client Name] is presently taking, prepared in consultation with their primary care physician, [Your Client Representative]:
Brief Medical History:
|
Condition/Diagnosis |
Details |
|---|---|
|
Alzheimer's Disease |
Diagnosed in [Year], with progressive cognitive decline and memory impairment. |
|
Surgical History |
Hip replacement surgery in [Year], with post-surgical infection treated with antibiotics. |
|
Hospitalizations |
Two admissions in [Year] for urinary tract infections and dehydration, treated with IV antibiotics and fluids. |
|
Physical Limitations |
Requires a walker, assistance with daily activities, prone to falls. |
|
Cognitive Status |
Moderate to severe memory loss, disorientation, difficulty with complex tasks, and sundowning syndrome. |
Current Medications:
|
Medication |
Dosage |
Purpose |
|---|---|---|
|
Donepezil (Aricept) |
10 mg daily |
Alzheimer's disease |
|
Memantine (Namenda) |
20 mg daily |
Memory enhancement |
|
Losartan (Cozaar) |
50 mg daily |
High blood pressure |
|
Metformin (Glucophage) |
1000 mg twice daily |
Type 2 diabetes |
|
Calcium + Vitamin D3 Supplement |
600 mg + 400 IU daily |
Osteoporosis prevention |
|
Sertraline (Zoloft) |
50 mg daily |
Depression |
|
Melatonin |
5 mg at bedtime |
Sleep disturbances |
Understanding the critical nature of this transition for both [Your Client Name] and our family, we are fully committed to engaging in your comprehensive assessment process. We are prepared to provide any additional information, partake in interviews, and facilitate assessments as deemed necessary by your admissions team.
The prospect of [Your Client Name] finding a new home within [Nursing Home Name] brings us hope during this challenging time. We are confident in the quality of care and the nurturing environment your facility offers and eagerly anticipate the opportunity for [Your Client Name] to thrive under your expert care.
Thank you for considering our application. We are looking forward to your prompt response and are hopeful for a positive outcome. Please do not hesitate to contact us at [Your Number] or [Your Email] to further discuss [Your Client Name]'s application or to arrange a meeting.
Warmest regards,
[Your Name]
[Your Number]
[Your Email]
