Urgent aged care referral after hip replacement
You are the discharge coordinator for an orthopaedic ward. Mrs Doris Nkemelu, 82, was admitted 8 days ago after a fall at home. She had a hemiarthroplasty for a fractured neck of femur. She lives alone in a first-floor flat with no lift and six steps to the front door. She is now mobilising with a frame and one-person assistance, and needs supervision for transfers. Her Abbreviated Mental Test score is 7/10. Her daughter lives 45 minutes away and works full-time. Mrs Nkemelu has had two falls in the last three months and says, “I’ll manage; I’ve always managed.” Her medications are apixaban, metoprolol, ramipril, atorvastatin and PRN oxycodone. Discharge is planned in 48 hours. The occupational therapist has recommended grab rails and a shower chair, but no home care package is in place.
1. Explain which case details you would select for an urgent referral to the aged care assessment team (ACAT) and why. Include three details you would leave out or handle cautiously.
Read the worked answer
Details to include
- Recent fracture and current function: hemiarthroplasty, frame with one-person assistance, supervision for transfers. This shows a new, measurable care need.
- Home environment: first-floor flat, no lift, six steps. This is a concrete environmental barrier to safe discharge.
- Cognitive screen and falls history: AMT 7/10 and two falls in three months. These establish risk and the need for a comprehensive assessment, not just equipment.
- Support and patient preference: daughter 45 minutes away and working full-time; Mrs Nkemelu says she will manage alone. This reveals a gap between her stated preference and the assessed risk.
- Medications: apixaban and PRN oxycodone are relevant to falls and bleeding risk, but I would not list every drug unless asked.
Handle cautiously or leave out
- The acute surgical detail of the hemiarthroplasty can be summarised; the referral does not need operative notes.
- Avoid labelling her as ‘non-compliant’ or ‘confused’. Report the AMT score and behaviour objectively.
- Do not include the daughter’s work schedule as a reason to criticise the family; use it to show limited availability of support.
2. Write the referral letter to ACAT. Use a formal letter structure and prioritise the risks.
Read the worked answer
[Your name] [Ward/service] [Date]
Aged Care Assessment Team [Service address]
Dear Sir/Madam,
Re: Mrs Doris Nkemelu, 82 years
I am writing to request an urgent comprehensive aged care assessment for Mrs Nkemelu, who is due for discharge in 48 hours following a hemiarthroplasty for a fractured neck of femur.
Mrs Nkemelu lives alone in a first-floor flat with no lift and six steps to the entrance. She mobilises with a frame and one-person assistance and requires supervision for transfers. Her AMT score is 7/10. She has had two falls in the last three months. The occupational therapist has recommended grab rails and a shower chair, but no home care package is currently in place. Her daughter lives 45 minutes away and works full-time. Mrs Nkemelu states that she will manage alone, which raises concern about her safety and insight.
Her medications include apixaban, metoprolol, ramipril, atorvastatin and PRN oxycodone. Please assess her eligibility for personal care, nursing support, equipment and social work, and advise whether supported discharge or residential respite is required.
Yours sincerely,
[Name] [Role]
Why this order: the letter leads with the discharge deadline and the main risks, then gives functional and environmental evidence, then the patient’s own view. The request is specific enough for ACAT to triage.