Academic journal article Social Work

Discharge Planning Revisited: What Do Social Workers Actually Do in Discharge Planning?

Academic journal article Social Work

Discharge Planning Revisited: What Do Social Workers Actually Do in Discharge Planning?

Article excerpt

Discharge planning in hospitals is still performed primarily by social workers despite the growing tendency of others to assume this responsibility (Iglehart, 1990). Cost-containment measures such as the Medicare prospective payment system enacted in 1983 have placed discharge planning in a central role within the hospital, enhancing the importance and prestige of those engaged in this activity. Social work's longstanding ambivalence about whether discharge planning is truly a professional activity has given way to the realization that if social work does not assume responsibility for discharge planning, the profession's role in a cost-conscious hospital would be severely limited.

The enhanced importance of discharge planning, however, has not resulted in an increased understanding of what it is that social workers actually do when they engage in discharge planning. Although numerous articles have been published about the role and function of discharge planning, most have focused on conceptual--theoretical discussions of what discharge planning is or should be and not on empirical investigations of what social workers actually do in this activity. With the exception of two empirical studies, both completed more than 20 years ago (Carter & Jinks, 1972; Heyman, 1961), little empirical data have been available. Empirical research on discharge planning is essential if the profession is to explain its role and function to others in the health care system and to educate and develop professional expertise in this area.

This study sought to find out from social workers engaged in discharge planning what tasks they performed and how important those tasks were in carrying out their jobs as discharge planners.

Social Work Role in Discharge Planning

Traditionally discharge planning has been conceptualized as helping patients make the transition from the hospital to the community. More recently discharge planning has been redefined as "social health care management," a concept that includes a continuum of services from preadmission to posthospital planning (Blumenfield & Rosenberg, 1988). This article uses the more traditional definition of discharge planning.

The literature regarding the social worker's role in discharge planning can be arranged on a conceptual continuum ranging from an activity involving only concrete resource provision to one involving only counseling. In the middle of the continuum discharge planning is viewed as involving both concrete resource provision and counseling.

Arguing that discharge planning involves only the provision of concrete resources, Heyman (1961) stated that lesser-trained staff (case aides) can provide discharge planning except in special situations when disturbed relationships interfere with routine planning. Carter and Jinks (1972) found that social workers described discharge planning as the most unsatisfactory aspect of work in hospital settings; they identified this activity with "body moving" or "being used by doctors to merely clear the beds". It is interesting to note that data derived from both studies characterize the social worker's role as concrete resource provision.

In the middle of the discharge planning continuum, the authors integrate concrete resource provision with clinical assessment and intervention. Because the discharge plan cannot be made in a vacuum, it must consider the psychosocial needs and abilities of the patient and family (Schreiber, 1981). The social worker's first task is to complete a psychosocial assessment (Bonander, 1981; Shulman & Tuzman, 1980). The social worker then engages the patient and family in a decision-making process to formulate a discharge plan (Kane, 1980; Rehr, 1986; Schlesinger, 1985; Zelinka, 1982). The social worker also acts as a coordinator, helping the medical team understand the patient's psychosocial needs and helping the patient understand the medical care plan (Lawrence, 1988; Shulman & Tuzman, 1980). …

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