Changes to the health care system have increased pressure on patients and their families as well as hospital staff. The changes in medical technology and service delivery systems have heightened the importance of quality of life and the social circumstances of patients who live independently in the community in spite of chronic illness and disability. Patients are in the hospital for very short periods of time at a point in their lives when their physical problems place them under considerable stress. The inevitable crisis associated with hospital treatment is exacerbated by the time pressure and the need for decisions about treatment and post discharge arrangements to be made promptly. Some social work research has focused on the impact of discharge planning on patients and families and the degree to which patients have maintained control in decision making.