Factors Influencing the Discharge Plan for Terminal Patients Where Alternatives Exist--Home vs. Institution

The major objective of this research was to investigate factors involved in discharge planning for terminal patients and their families where alternatives exist--home vs. institution. This was an exploratory-descriptive survey, utilizing questionnaires and telephone interviews. The respondents were 86 trained social workers from acute care hospitals and hospice units within hospitals. Data collected were analyzed quantitatively and qualitatively. The social workers who responded came from hospitals within one state, and from hospices across the country. Sampling was a two-stage process, with hospitals and hospices selected in the first stage, and social workers in the second. The major research aims were: (1) Identify the parameters of discharge plans for terminal patients, including those factors already suggested in the literature as being involved in discharge planning. (2) Specify the relative importance among factors that social workers consider in their formulation of discharge plans for terminal patients. (3) Compare differences in worker reactions to discharge planning as between the hospital and hospice settings. Most social workers felt terminal patients needed nursing services upon discharge, and doctors and nurses were important team members in discharge planning. Hospice workers were more likely than hospital workers to take patients' needs and home conditions into account. Hospice workers recognized patients' spiritual needs and considered religious personnel to be significant team members. Hospital workers saw their patients as more helpful, while hospice workers perceived their patients to be more accepting of prognosis. Although most social workers felt patients and families needed counseling around death and dying, hospice workers especially noted the need for bereavement counseling. They were more likely than hospital workers to consider the family attitude of leaving the decision of disposition to the patient. All hospice workers and many hospital workers had personal experience with family and terminal illness. Most workers preferred sending patients home to die, rather than to an institution. Plans to send patients home generated workers' feelings of competence and empathy toward their work, while plans to send patients to institutions provoked feelings of sadness, guilt, and frustration. Generally, workers believed patients were aware of their prognosis, despite their feelings that the patients were not formally told by their physicians. Principal factors influencing discharge planning were found to be the family's desire to have the patient home, financial conditions, and the patient's desire to go home.