By Ebenezer Cudjoe and Daniel Gyedu
Assisting patients with timely arrangements for their post hospital care continues to be a, if not the, central function of social workers in most hospitals (Cowles, 1999: 163). In 1986, federal legislation in the form of the Omnibus Budget Reconciliation Act mandated that every hospital have a process for planning patient discharges. According to the Omnibus Budget Reconciliation Act, a discharge plan must be included in the patient’s medical record and discussed with the patient or patient representative.
The underlying purpose of this law was to facilitate speedy discharge of patients (Sharpe, 1991). As a result, the role of the discharge planner is now firmly established and integrated into the structure of the contemporary hospital (Iglehart, 1990). It is necessary to emphasis here that the role of the hospital social worker in planning patients for discharge is indispensable.
The role of the hospital social worker in planning for discharge is important to ensure that patients are able to adequately adapt to their former environment. This case is an important concern to practitioners working with patients recovering from or managing acute health conditions such as cancer or a disability. The American Hospital Association (1984) defines discharge planning as an interdisciplinary process guided by the following essential elements:
- Early identification of patients likely to need complex post hospital
- Indication of patient preferences for post hospital care
- Patient and family education
- Patient and family assessment and counseling
- Planning, development, and coordination of community resources
needed to ensure continuity of care after discharge
- Post discharge follow-up to ensure services and plan outcome
In most hospitals, these activities fall within the realm of the social work department although nursing departments are also involved. From the viewpoint of social work, discharge planning is an aspect of professional activity that helps patients cope with their illness and its effects, move through the hospital system, and eventually return to their home with all the necessary supports to sustain their health (Beder, 2006). This service encompasses assessment of individual needs, formulation of an adequate and safe discharge plan, and implementation of the plan that ensures the safety and well-being of the patient in a timely manner (Davidson, 1990).
Discharge planning is viewed as the main method for ensuring patients’ needs post discharge will be met to enable optimal functioning once they return home (American Hospital Association 1984). It is important to note that after-hospital care is exhaustively linked to discharge planning.
The Phases of Discharge Planning
In an article written by Oktay et al. (1992) on the “Impact of Hospital Discharge Planning on Meeting Patient Needs after Returning Home,” discharge planning was conceptualised as having four phases (1) patient assessment; (2) development of a discharge plan; (3) provision of services, including patient/family education and service referrals; and (4) follow-up/evaluation. Although hospitals employ different types of discharge planning strategies in each of these phases, it is generally agreed that two factors in particular are important for meeting patient needs.
First, discharge planning is expected to be more effective if there is interdisciplinary input in planning the patient’s home care (Hartigan and Brown 1985). The advantage of involving multiple disciplines in a team effort is that the expertise of each discipline is brought to bear on identifying and meeting the patient’s home care needs. Through such professional interaction, the patient’s needs can be identified more readily, and appropriate referrals for services can be coordinated and executed in a timely manner.
Second, the usefulness of a designated professional like the case manager, who assumes primary responsibility for coordinating the discharge plan with other providers, has also been emphasized as essential (Hartigan and Brown, 1985). It is viewed that case managers with established community linkages to various services and specific knowledge of the complicated reimbursement requirements can act more efficiently to implement aftercare services (Oktay et al., 1992).
The phases of discharge planning introduced by Oktay et al. (1992) shares a platform with the discharge planning process of the Komfo Anokye Teaching Hospital (KATH) per the information we received from the hospital social work department. KATH’s discharge planning process includes an evaluation of the outcome of the patient’s treatment, a discussion between the social worker and the patient or a representative of the patient (a relative, friend or any other significant others) about the outcomes of the evaluation, planning, determination (how to execute the plan) and a referral (for when the patient is to be transferred to another facility).
The Significance of Discharge Planning in a Hospital Setting
The significance of quality discharge planning to cost savings is indicated by study findings to support early hospital social worker intervention with a patient correlates with shorter patient’s stays. “Implementing discharge planning activities, and their coordination, are central functions of the hospital-based social worker. Today’s social workers monitor comprehensive discharge planning services in a case management context” (Blumenfield, Bennett, & Rehr, 1998, p. 83). Beder (2006) contends that discharge planning must be done to enable the purpose and survival of the hospital as a financially stable institution.
Discharge planning enables the patient to have a smooth transmission from hospital to home and to ensure the patient will function to the optimal level. In this, the hospital social worker helps in the patient recovery process from the time the patient prepares to leave the hospital. The worker informs the patient and any other relatives or significant others about the effects of the patient’s condition with regards to his relationship with the community. For example, one effect of a paralysed patient on family members would be the need for constant attention on the patient. Family members would need to understand the condition of their family member and how they could successfully relate to him or her.
Hospital social workers planning for discharge help inform patients when they will be going home and what they have to go through on the day of discharge. Kadushin and Kulys (1993) state that the provision of concrete services after discharge was the most basic, essential component and primary focus of discharge planning. These service arrangements may include home health care, medical equipment, transportation, or delivery of medical supplies and medication.
Discharge planning also enables patients to acquire resources to assist with functioning. In helping the patient get access to resource,s the social worker does an assessment of financial, social, and psychological resources available for the patient and family. Social works can coordination with other medical staff to facilitate the discharge plan, produce a written record of what has been and needs to be done for the patient, and link services for patients and families after discharge (Kadushin & Kulys, 1993). For instance, using Tracy’s (1990) Social Support the social worker will be able to provide information, encouragement and tangible assistance that is perceived by the patient as being beneficial to his or her functioning.
Finally, it is important to note that the central goal of discharge planning is for the social worker
to fully address the highly individualised needs of each patient and provide safeguards at home for his or her care. In general, it requires the social worker to apply a biopsychosocial approach to care that addresses a wide range of patient and family needs while incorporating the skills and orientation of medical and other health care professionals. The social worker must also have knowledge of community-based services and an understanding of how these services can best be accessed in order to serve the patient upon discharge (Blumenfield et al., 1998).
The Challenge of Discharge Planning
Many patients ready for discharge are accordingly referred to hospital social workers and other discharge planners. The challenges faced by hospital social workers at KATH is summed up in Cowles’ (1999) presentation of the constraints workers face in discharge planning. One or more of the following conditions exist as barriers to discharge planning (the list is not exhaustive):
- The patient may be insufficiently recovered from the acute health condition to take care of himself or herself.
- The patient may be mentally confused, emotionally depressed, or otherwise mentally impaired permanently or temporarily.
- The patient may have a new baby with special problems but has never cared for an infant before.
- The patient has been advised not to climb stairs and he or she is disabled from waist down and he stays in an upstairs building
- The patient has to be reporting to the hospital regularly for treatment, and he or she has no personal transportation and the financially incapable (Cowles, 1999: 167).
- Other challenges noted by the hospital social work department of KATH was the problem working with the elderly (65+), the developmental disabled, the unemployed, persons without health insurance and patients who attempt suicide
In conclusion, Beder (2006) notes the primary role of the social worker is to facilitate discharge and engage the patient and family. However, beyond this mandate, social workers have numerous opportunities to interact with and influence the patient and family to enhance fulfillment during the healing process.
American Hospital Association. (1984). Discharge planning guidelines.Chicago: Author.
Beder, J. (2006). Hospital Social Work: The Interface of Medicine and Caring.New York: Routledge, Taylor and Francis.
Blumenfield, S., Bennett, C., & Rehr, H. (1 998). Discharge planning: A key function. In H. Rehr, G. Rosenberg, & S. Blumenfield (Eds.), Creative social work in health care (pp. 83–91). New York: Springer.
Cowles, L. A. (1999). Social Work in thr Health Field: A Care Perspective.New York: Haworth Press, Inc.
Davidson, K. (1990). Evolving Social Work roles in Health Care: The case of Discharge Planning. Social Work in Health Care, 181-194.
Hartigan, E. G. (1985). Discharge Planning for Continuity of Care. New York: National League for Nursing.
Iglehart, A. (1990). Discharge Planning: Professional Perspectives Versus Organisational Effects. Health and Social Work, 15(4), 301-309.
Kadushin, G. and Kulys, R. (1993). Discharge Planning Revisited: What do Social Workers Actually do? Social Work, 38(6), 713-726.
Oktay et. al, (1992). Impact of Hospital Discharge Planning on Meeting Patient Needs after Returning Home. Health Services Research, 156-170
Sharpe, L. (1991). Discharge Planning: Before the fact. Discharge Planning Update. 11(4), 3-5.