My hospital is experiencing a significant problem related to admitted patients who have completed treatment but have no resources and no post-discharge plan. We now have patients that have been inpatients for 3-4 years without any discharge disposition! Most are not capable of living independently and require either nursing home or other custodial care. But for a variety of reasons, they either don't qualify or are not accepted. As the academic medical center for our region we take all patients but we find we're often left with no alternatives for patient discharge. We are considering the use of an "Administrative Discharge" proceeding to remove patients from the hospital who no longer meet clinical criteria for hospitalization. Does anyone else have any experience in this area? How do you handle the patient safety/risk aspects, not to mention the possible bad PR? Any assistance would be greatly appreciated.