How to discharge an 82M with diabetic ulcer?

Dear Dr. Meccam,

I am writing to inform you of Mr. McCarthy, an 82-year-old retired construction worker, who was admitted due to right food diabetic ulcer and underwent below-knee amputation and will be discharged today to your skilled nursing facility for acute care and physiotherapy.

Postoperatively, Mr. McCarthy has been recovering well. He is afebrile, and his wound is healing. Intravenous medications have been transitioned to oral antibiotics and opiates. However, his mobility is severely reduced following the amputation; therefore, he requires assistance with ADLs and routine care.

Currently, he is stable and ready to be discharged to your skilled nursing facility for acute care and physiotherapy. He will continue to need assistance for ADLs. The surgical site should be monitored for infection and drainage. He should also receive frequent turning to prevent pressure ulcers.

Of note, his wife wanted him to be discharged back to his home under her care; however, we did not consider it a safe discharge given his dementia and decreased mobility following the amputation. Our physiotherapy and occupational therapy staff agreed with our assessment. However, after some time at your facility, he can be reassessed for disposition to home or a long-term care facility.

I appreciate the care that you can provide to him. If you require any further information, please do not hesitate to contact me.

Yours Sincerely,