Research Article| Volume 53, ISSUE 2, P95-103, March 2005

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Discharge planning, nursing home placement, and the Internet


      Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals.


      (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs).


      Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals.


      This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities.


      Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.
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        • Castle N.
        Searching for and selecting a nursing facility.
        Med Care Research Review. 2003; 60: 223-247
        • Holliman D.
        • Dziegielewski S.
        • Datta P.
        Discharge planning and social work practice.
        Social Work Hlth Care. 2000; 32: 1-19
        • Levit K.
        • Smith C.
        • Cowan C.
        • Sensenig A.
        • Catlin A.
        Health spending rebound continues in 2002.
        Hlth Affairs. 2004; 23: 147-159
        • Lyon J.C.
        Descriptive study of models of discharge planning and case management in California. University of California, San Francisco1992 (PhD Dissertation)
        • Lyon J.C.
        Models of nursing care delivery and case management.
        Nurs Eon. 1993; 11: 163-178
      1. Joint Commission on Accreditation of Healthcare Organizations [JCAHO]. (2004). 2004 Hospital Accreditation Standards.

        • Miller N.
        Patient centered long-term care.
        Hlth Care Financing Review. 1997; 19: 1-10
        • Pottoff S.
        • Kane R.
        • Franco S.
        Improving hospital discharge planning for elderly patients.
        Hlth Care Financing Review. 1997; 19: 47-72
      2. Wunderlich G.S. Kohler P. Improving the quality of long-term care. National Academy of Sciences, Washington, DC2001
        • US General Accounting Office
        Nursing homes: additional steps needed to strengthen enforcement of Federal Quality Standards. Report to the Special Committee on Aging, US Senate. GAO/HEHS-99-46. US General Accounting Office, Washington, DC1999
        • Harrington C.
        • O’Meara J.
        • Kitchener M.
        • Simon L.P.
        • Schnelle J.F.
        Designing a report card for nursing homes.
        Gerontologist. 2003; 43 (Special Issue II): 47-57
        • Travis S.
        • McAuley W.
        Searches for a nursing home.
        J Applied Gerontol. 1998; 17: 352-371
        • Pew Internet and America Life Project
        America’s online pursuits. 2003 (Available at: Accessed December 29)
        • Harrington C.
        • Collier E.
        • O’Meara J.
        • Kitchener M.
        • Simon L.P.
        • Schnelle J.F.
        Federal and state nursing facility websites.
        Am J Med Quality. 2003; 18: 21-37
      3. Wunderlich G.S. Sloan F.A. Davis C.K. Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes. Nursing staff in hospitals and nursing homes: is it adequate? National Academy Press, Washington, DC1996
        • US Office of the Inspector General, Department of Health and Human Services (USOIG)
        Nursing home survey and certification: deficiency trends. OEI-02-98-00331. Inspector General, Washington, DC1999
      4. US Centers for Medicare and Medicaid Services (CMS), Prepared by Abt Associates Inc. Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes. Report to Congress: Phase II Final. Volumes I-III. Baltimore, MD: CMS, 2001.

        • US Department of Health and Human Services
        • Centers for Disease Control and Prevention
        • National Center for Health Statistics (NCHS)
        The National Nursing Home Survey.
        Vital Hlth Statistics. 2002; 13: 1-117
        • Sahyoun N.
        • Pratt L.
        • Lentzner H.
        • Dey A.
        • Robinson K.
        The changing profile of nursing home residents: 1985–1997. National Center for Health Statistics, aging trends No. 4. 2001 (Available at:
        • Mukamel D.B.
        • Spector W.D.
        Quality report cards and nursing home quality.
        Gerontologist. 2003; 43 (Special Issue II): 58-66
        • US Department of Health and Human Services (USDHHS)
        HHS fact sheet. HCFA press Office, Washington, DC1998
        • Morris J.N.
        • Moore T.
        • Jones R.
        • Mor V.
        • Angelelli J.
        • Berg K.
        • et al.
        Validation of long-term and post-acute-care quality indicators. 2002 (CMS Contract No 500-95-0062/T.O. #4)
      5. U.S. House of Representatives, Committee on Government Reform. HHS ‘Nursing Home Compare’ has major flaws. Report Prepared for Rep. Henry A. Waxman and Sen. Charles E. Grassley. Washington, DC: US House, 2002.

        • Harrington C.
        • O’Meara J.
        • Collier E.
        • Schnelle J.F.
        J Gerontol Nurs. 2003; 29: 5-11
        • California HealthCare Foundation
        Website Statistical Report for Oakland, CA. 2003
        • Bull M.
        • Roberts J.
        Components of a proper hospital discharge for elders.
        J Adv Nurs. 2001; 35: 571-581
        • Huber D.
        The diversity of case management models.
        Lippincott’s Case Management. 2002; 7: 212-220
        • Tennier L.
        Discharge planning.
        Social Work Hlth Care. 1997; 26: 41-60
        • Hedges G.
        • Grimmer K.
        • Moss J.
        • Falco J.
        Performance indicators for discharge planning.
        Australian J Adv Nurs. 1999; 16: 20-28
      6. Parkes J, Sheppard S. Discharge planning from hospital to home (Cochrane Review). In: the Cochrane Library, Issue 2. On-Line Available at: Accessed July 18, 2003.

        • Clemens E.
        Multiple perceptions of discharge planning in one urban hospital.
        Hlth Social Work. 1995; 20: 254-261
      7. California Office of Statewide Health Planning and Development (COSHPD). Hospital Cost Report Data, 2001–2002. Sacramento, CA: OSHPD33, 2003.

        • Congdon J.
        Managing the incongruities.
        Applied Nurs Research. 1994; 7: 125-131
        • McAuley W.
        • Travis S.
        Positions of influence in the nursing home admission decision.
        Research Aging. 1997; 19: 26-45
        • Matthews P.
        Case management information systems.
        Lippincott’s Case Management. 2002; 7: 255-260
        • McKenna H.
        • Sinead K.
        • Glenn A.
        • Gordon P.
        Discharge planning.
        J Clin Nurs. 2000; 9: 594-601


      Eric Collier is a Doctoral Student at The Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA.


      Charlene Harrington is a Professor of Nursing and Sociology at the Department of Social and Behavioral Sciences, School of Nursing, San Francisco, San Francisco, CA.