Acute hospital discharge of older patients and external control

This article examines acute hospital discharge planning processes and the constraints imposed by external control, including third party payors and PSRO. Analysis suggests that availability of third party payment for services dominates the discharge plan. From the professional perspective, in-home services are often planned and provided only to the extent they meet the requirements of medical necessity; from the lay perspective, the services most required are those which preserve the social context. As a consequence, care providers, patients, and significant others become "caught" in regulations often unrelated to a reasonable plan of care designed to meet patient and family needs.