Academic journal article Health and Social Work

Racial Differences in Discharge Planning

Academic journal article Health and Social Work

Racial Differences in Discharge Planning

Article excerpt

Discharge from the hospital is an important transition in the continuum of care for elderly patients, with discharge planning as the critical process for meeting patients' needs in the posthospital environment. In preparation for discharge, the social worker, patient, and family pursue options and make decisions about posthospital care. Most patients discharged from the hospital enter home care and receive a mix of informal and formal services. Patients not going home are likely to enter some form of institutional care.

Studies show that African American and white older adults differ in their use of institutional and noninstitutional care (see Belgrave, Wykle, & Choi, 1993), including informal and formal services received following hospitalization (Chadiha, Proctor, Morrow-Howell, Darkwa, & Dore, 1995; Morrow-Howell & Proctor, 1994). In spite of evidence of racial differences in posthospital service utilization, virtually no empirical study has examined racial differences in the discharge planning processes used by the social worker, patient, and family to pursue and develop various options for posthospital care.

Several investigators have conceptualized discharge planning in terms of decision making, demonstrating that outcome is enhanced by patient and family perceptions of a range of alternatives and involvement in the decision-making process (Abramson, 1990; Arenth & Mamon, 1985; Dunkle, Coulton, MacKintosh, & Goode, 1982; Morrow-Howell, Proctor, & Dore, 1993; Proctor, Morrow-Howell, Albaz, & Weir, 1992). In taking steps toward eventual care arrangements, discharge planners may assess a variety of patient needs and strive to meet them by organizing health and social services (Arenth & Mamon, 1985). Ideally, the patient and family members along with the discharge planner are involved in assessing needs and deciding options for posthospital care plans (Dunkle et al., 1982).

The study discussed in this article approached discharge planning as a decision-making process in which social workers, patients, and families discussed, pursued, and selected potential alternatives for posthospital care. Because cases varied in terms of the eventual discharge plan, it was assumed that the number of options pursued; the extent to which patients, families, and the social worker discussed alternative options; and the reasons for finally selecting one option varied also. Given reported racial differences in the actual arrangements for posthospital care, this analysis focuses on differences in the care options pursued by patients, family members, and discharge planners. It also examines whether African American and white older adults showed different preferences for nursing home care in discharge planning. Because the discharge planner has an integral role to play in assisting families with options and decision making about the care of their elderly relatives, findings from this study will provide social work discharge planners with new knowledge about possible racial differences in this decision-making process.


The literature documenting racial differences in service utilization, including institutional and noninstitutional care, informed this study. Use of medical and supportive services is viewed as important to both health and social outcomes, particularly for sick older adults in the vulnerable period following hospitalization (Andersen, 1995). Yet the literature indicates consistently that African American families may underuse services that could enhance the quality of their care.

Institutional Care

African American elderly people use nursing home care less than white people, as evidenced by their underrepresentation in nursing homes (U.S. Department of Health and Human Services, 1990; Yeo, 1993). Racial differences in nursing home use have been documented consistently for over a decade. For example, the percentage of African Americans in nursing homes in 1980 was 3 percent for those age 65 and over and 12 percent for those 85 and older, compared with 5 percent for white people age 65 and over and 23 percent for those 85 and over (Yeo, 1993). …

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