Ethics at the Hinge: health-care organizations and family caregivers during discharge planning.

This essay explores ethical challenges that frequently arise during discharge planning in acute-care and post-acute settings, often involving older adults with continuing care needs, with attention to organizational duties concerning family caregivers. Drawing on bioethics scholarship, empirical data, and their personal experiences and observations, the authors analyze a common set of burdens that a health-care organization will expect to hand off to a family caregiver as part of the discharge process. These burdens are co-produced by a patient's illness, clinical decision-making processes, the limits of public and private health insurers, and collective failures of imagination concerning how the care needs of aging societies can be met more fairly. The essay aims to be of practical use to professionals involved in discharge planning, in health-care ethics, or in executive-level decisions about organizational investments benefiting communities. It includes a set of recommendations premised on caregiver support as an ethical principle for health-care organizations.