When AI Gets in the Way of Human Care: A Social Worker's Perspective on Placement and Technology

There is something happening in hospital social work and discharge planning that I think we need to talk about.

Recently I became aware that many nursing facilities are utilizing artificial intelligence to process referrals and output information quickly to liaisons and admissions directors. On the surface that sounds like progress. Faster processing, quicker decisions, less back and forth. And I understand the appeal. The volume of referrals that move through these systems every single day is enormous and technology that helps manage that is not inherently a bad thing.

But here is where it starts to break down.

I had a patient who was receiving denial after denial and I could not figure out why. The patient was appropriate for placement. The clinical picture made sense. And yet every referral was coming back denied. It was not until I dug deeper that I understood what was happening. Facilities were running the referral through AI that was spitting out information quickly, and that information was being used to make placement decisions without anyone taking the time to look at the full picture.

The full picture in this case was that my patient had presented with behaviors. Significant ones. But those behaviors existed because the patient was not yet stabilized on medications, or had not been taking medications consistently, or because there were multiple layered reasons that created a perfect storm at the time of the initial referral. After non-pharmacological interventions and medication stabilization, that patient was in a completely different place clinically. The behaviors were gone or significantly reduced. The person who showed up in that AI generated output was not the person who was ready for placement.

But the AI did not know that. The AI read what was written and made a determination based on a snapshot of someone's worst moment. It had no ability to understand context. No ability to recognize progress. No ability to see that the information pertinent at admission was no longer accurate by the time placement was being sought.

And nobody at those facilities was taking the time to look past it.

So I did what I always do. I challenged it. I called the person giving the denial and I advocated for my patient. I walked them through the full clinical picture, the interventions that had worked, the progress that had been made, the person behind the behaviors that the AI had flagged. And because someone was willing to listen, the facility took the patient.

But I keep thinking about what happens when no one challenges it. What happens to the patients whose social workers are too overwhelmed to make that extra call, or whose cases move too fast for anyone to slow down and push back. What happens to the people who are the most complex, the most vulnerable, the ones with cognitive decline or severe mental illness or histories that look scary on paper but tell an incomplete story.

Those are the people who fall through the cracks. And AI that processes referrals without human oversight is going to widen those cracks significantly.

I want to be clear that I am not anti-technology. I understand why facilities are moving in this direction and I believe there is a place for AI in healthcare. But what concerns me deeply is what we lose when we remove the human touch entirely. When we take away a clinician's ability to look past what is written on a piece of paper and see that there is more than black and white words on a referral. When we let an algorithm make decisions about human beings without anyone stopping to ask who that person actually is and what they actually need right now, not six weeks ago when the referral was first generated.

A referral is a document. A patient is a person. And no algorithm is equipped to tell the difference.

The work of hospital social work and discharge planning has always been about bridging gaps, between what the system sees and what the patient needs, between what is written and what is true, between a denial and a placement that changes someone's life. That work requires human judgment. It requires someone willing to pick up the phone and say I need you to look at this differently.

And we have to keep doing it, even when it is hard, even when it is one more call at the end of an already impossible day, because the alternative is a system that makes life altering decisions about the most vulnerable people based on a snapshot that was never the whole story.

That is not progress. That is a problem.So my challenge to every hospital social worker reading this is this. Do not be afraid to push back. I know it is exhausting. I know there are days when the last thing you want to do is get on the phone and fight for one more thing. But when you know in your gut that the full picture is not being seen, you have to say something. Do it professionally, do it with your clinical knowledge, do it with the facts you have in front of you. But do it.

Your patient cannot advocate for themselves in that moment. Their family is scared and confused and counting on someone inside that system to see their loved one as more than a flagged referral on a screen.

Be that person. Advocate loudly, advocate without apology, and never let an algorithm have the final word on a human being.