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Challenging · Referral · Nursing

Dementia, an exhausted carer and an unsafe home

This case practises: Plain words for a non-clinical reader · Purpose up front · Leaving out what the reader doesn't need · Writing for what the reader already knows

Writing task

Today's date: 7 December 2026. You are the registered nurse on Ward 6 (Medicine for Older People), Hillside Hospital. Write a letter to Mr Tomasz Nowak, Community Social Worker, Hillside Council Adult Social Care, Civic Centre, 1 Market Square, Hillside, requesting an urgent assessment of Mrs Whitfield's care and safety needs before her planned discharge. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.

Case notes

In the test you get 5 minutes to read, then 40 minutes to write.

Patient details
- Mrs Agnes Whitfield, DOB 15/09/1943 (83 y.o.)
- 27 Larkspur Road, Hillside (2-storey house)
- Admitted via ED 29/11/2026; Ward 6 since 30/11; medically fit for discharge approx. 10/12/2026

Social background
- Lives with husband George (84), her only carer
- George diagnosed with prostate cancer 11/2026 - daily radiotherapy for 4 weeks from 15/12/2026
- Daughter lives in Scotland; visits twice a year
- Former school secretary; enjoyed bridge club, stopped 2025
- Has a cat
- George: retired postman; volunteers at church on Sundays
- Married 60 years; anniversary party 06/2026
- George holds lasting power of attorney (health and welfare)

Medical history
- Alzheimer's dementia (2021) - donepezil 10 mg nocte
- Hypertension - amlodipine 5 mg OD
- Osteoarthritis knees
- Cataract surgery both eyes 2019
- Hearing aid L ear
- Flu vaccine 10/2026

ED 29/11
- Found by police at 02:00, 1 km from home, in nightdress
- Temp 34.8 °C; dehydrated; UTI (E. coli) - IV fluids, IV then oral antibiotics (completed 04/12)
- CRP 112 → 18 (05/12)
- Chest X-ray clear; ECG sinus rhythm; blood glucose normal

Ward
- Confusion now back to her usual level
- Mobilises independently; at risk of wandering - leaves ward if unsupervised
- Needs prompting to wash, dress and eat; weight 51 kg (56 kg in June per GP)
- Mental capacity assessment 02/12: lacks capacity to decide on her care and accommodation

Information from George
- 01/12: says he is "coping fine"
- 03/12 (with nurse, alone): admits he is exhausted, sleeping 3-4 h/night; she gets up most nights and tries to go out
- She has left the gas cooker on twice in the past month
- Fridge often empty; unopened bills; no outside help at present

OT home visit 04/12
- House cluttered; steep stairs; no door alarm
- Recommends gas safety cut-off device and door sensor alarm

Plan
- Social worker: urgent assessment before discharge (approx. 10/12)
- Consider care package (visits 4 times daily) and/or respite placement during George's radiotherapy
- Carer's assessment for George
- Arrange gas cut-off and door alarm
- Best-interests meeting with George (attorney) and daughter (by phone)

Write your letter

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Model answer Try writing your own letter first
Mr Tomasz Nowak
Community Social Worker
Hillside Council Adult Social Care
Civic Centre
1 Market Square
Hillside

7 December 2026

Dear Mr Nowak,

Re: Mrs Agnes Whitfield, DOB 15/09/1943

I am writing to request an urgent assessment of Mrs Whitfield's care needs before her planned discharge around 10 December, as her husband can no longer care for her safely at home.

Mrs Whitfield, who has dementia, was found by police at 2 am, wandering in her nightdress 1 km from home. She was very cold and had an infection, which has been treated. She walks independently but needs prompting to wash, dress and eat, and she has lost 5 kg since June. She was assessed as lacking capacity to decide on her care, and her husband holds lasting power of attorney.

Her husband, George, is her only carer. He first said he was coping, but later admitted that he sleeps only three to four hours a night because she tries to go out. She has also left the gas cooker on twice. He starts daily cancer treatment for four weeks on 15 December.

I would be grateful if you could consider a care package or respite placement, arrange a carer's assessment for him and organise a gas cut-off device and door alarm.

Yours sincerely,

Registered Nurse
Ward 6, Medicine for Older People
Hillside Hospital

What the reader needs

  • Urgent assessment before planned discharge around 10 December
  • Dementia; found wandering outside at night by police, very cold
  • Husband is her only carer, exhausted, sleeping 3–4 hours; starts daily radiotherapy for 4 weeks from 15 December
  • Safety risks at home: left the gas cooker on, tries to go out at night, no door alarm
  • Needs prompting to wash, dress and eat; has lost 5 kg
  • Lacks capacity for care and accommodation decisions; husband holds lasting power of attorney
  • Request: care package or respite placement, carer's assessment, gas cut-off and door alarm

Details to leave out

  • Former job, bridge club, cat
  • Blood test and culture results
  • Antibiotic and fluid details
  • Blood pressure and knee conditions
  • Cataract surgery
  • Medication names
  • Exact body temperature
  • Husband's former job, church, anniversary
  • Hearing aid and flu vaccine
  • Normal test results

One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.