This paper examines the hospital discharge decision making process for elderly patients, based on observations of the operations of a long term care agency, the California Multipurpose Senior Services Project. The analysis is divided into four components: actors, factors, processes, and strategy critique. The first section discusses the major actors in the discharge and placement decision making process, i.e., the treaters (physicians, nurses, social workers, and discharge planners), the timekeepers (utilization reviewers and medical reviewers), and the supporters (patient, family and friends, and outside agencies). Each actor's role and impact on the decision making process is discussed. Next, three factors, treatment purpose, treatment cost, and patient resource structure, which influence both length of placement and decision making behavior, are analyzed. The decision making process is examined in terms of the relationship between these three factors and the behavior of the actors. Based on this interaction, a discharge and placement model is offered and illustrated in a series of charts. Implications of the decision making process for community-based long term care agencies are discussed and suggestions are offered to facilitate identification of hospitalized clients who will benefit from placement in a long term care facility. A critique of the model, with an eye toward the realities of the social world and the medical actors, completes the paper. (BL)