This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings showed 40 percent of patients were referred to institutional care and 60 percent were sent home with plans to receive community services. At follow-up, the rates of implementation varied by planned services. Among patients referred to institutional care, 46 percent of those referred to nursing homes and 70 percent of those referred to rehabilitation facilities received the planned care. Of those discharged home, 65 percent received planned home attendant services and 59 percent received planned home health care. Implementation of institutional care was related to the patient's functional status and population group. Implementation of community and home services was related to age, gender, population group, and hospital department. These gaps in implementation of planned services have important policy implications. Discussion of the findings with the participating hospitals and national authorities resulted in plans to improve continuum of care.