Much attention has been given in recent years to changing reimbursement for hospital care, shortened lengths of stay, and changes in the delivery of health care. The corollaries to these changes are more restrictive admission criteria, increased severity of patient illness, and changes in patient care. The purpose of the present paper is to describe the inpatients who remain in the acute care hospital, and to examine both how the patients and families in need of social work consultation are identified and the implications of these methods of identification for social work practice.