Beyond the Bedside: Addressing Structural Gaps in the Care of Undocumented, Seriously Ill Patients.

Undocumented patients face structural constraints to accessing life-sustaining treatments in the subacute setting due to gaps in health care coverage. We present the case of a 38-year-old Spanish-speaking woman with short bowel syndrome, dependent on prolonged parenteral nutrition after critical illness, who faced additional challenges as an undocumented and uninsured patient. Despite medical stabilization and a consistent desire to pursue life-prolonging care, discharge planning was complicated by a health care system not designed to support individuals without legal status or insurance. This case illustrates the role of palliative care teams in bridging structural gaps through interdisciplinary collaboration and institutional advocacy.