Between the Cracks
The problem with discharge planning in many hospitals is that management handed over the discharge planning function to social services. This was a huge mistake because the primary skill of social workers is to identify community resources and deal with Medicaid and Medicare eligibility issues. They are not competent to diagnose potential complications arising out of a lack of services, supplies, or equipment. Their primary focus is to move the patient through the door. When corporate executives try to solve their budget problems by assigning duties outside the scope of a particular profession, the result is incompetent performance. And patients are the ones who suffer.
Moreover, many potential problems could result in catastrophic complications when sick, dependent people leave the hospital. While doctors can prescribe the equipment, supplies, and drugs, and social workers can find vendors and identify sources of payment, it is only the nurses who can diagnose potential health problems arising out of unmet needs. Accordingly, the nurses who are best qualified to provide discharge planning services are those with experience in home care. Such nurses would be more familiar with what the patient requires in order to deal with any particular health problem in the home environment.