Decision-making for hospital discharge planning: A study of one urban hospital

Elizabeth Louise Clemens, University of Pennsylvania


The social process involved in the transfer of elderly patients from hospital to post-hospital settings has received little systematic study. Advocacy groups claim discharge planners often perceive the planning process to be helpful when patients and families do not. An exploratory descriptive study of discharge planners' and family caregivers' perceptions of discharge planning decision-making process and outcome was conducted. Planners and caregivers formed significantly different perceptions of the process. Planners greatly overrated the amount and adequacy of information shared about patients' post-hospital health care, choice of discharge to home or nursing home, time to decide and caregiver influence in the decision. Family caregivers perceived that nursing homes were forced on elderly patients by social workers and physicians. DRG's, physicians, and the hospital's discharge planning protocol appeared to exert pressure on social workers to coerce competent patients into nursing homes. Excessive concerns by hospital staff about patient safety after discharge and coercion to achieve safety through placement may override patients' rights to autonomy and self-determination, violating the NASW Code of Ethics. Ethical implications for discharge planning practice and public policy are drawn from the findings. Directions for future research are identified.

Subject Area

Social work|Health care|Gerontology

Recommended Citation

Clemens, Elizabeth Louise, "Decision-making for hospital discharge planning: A study of one urban hospital" (1991). Dissertations available from ProQuest. AAI9125557.