Discharge planning for homeless patients: A social work practice dilemma

Abstract

Hospitals, functioning under the DRG prospective payment reimbursement system, must be concerned with effecting timely discharges for their patients. The homeless are particularly vulnerable under this system due to their medical indigence, absence of adequate living arrangements and supportive family, and poor general health. All of these risk factors point to a need for an extended length of hospital stay.;Very little has been documented to enhance our understanding of what happens to the homeless, whose social situation, according to the DRG discharge mandates, can be given no more time and consideration than the domiciled patient in planning their discharge. This serious contradiction directly influences the work of medical social workers who are the key providers of discharge planning services.;The study compares current medical social work discharge planning practice for both homeless and domiciled patients based on a quantitative analysis of responses to a questionnaire devised by the author for this purpose.;The conceptual framework for the study was developed from sociological, organizational behavior and social work theoretical perspectives.;The outcome of the research study confirms the author's hypotheses that there were differences in social workers' provision of discharge planning services to homeless individuals when compared with domiciled patients, and that there were differences in the social workers ideological orientation to conflict in the practice of discharge planning.;The study concluded that there was a significant relationship between the social workers ideological orientation to conflict in discharge planning practice and their attitudes and perceptions of discharge planning, their hospital's organizational climate, and their provision of discharge planning services to patients.