Alternate Level of Care Patients in Hospitals: What Does Dementia Have To Do With This?

Abstract

BackgroundPatients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem.MethodsA chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed.ResultsThirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room.ConclusionsThe majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients.

Patterns of health service use in community living older adults with dementia and comorbid conditions: a population-based retrospective cohort study in Ontario, Canada

“…The estimates of the percent of ALC patients with dementia range between 25 % [46] to over 60 % [37]. The use of hospital beds for ALC patients can contribute to a decrease in acute care capacity, emergency department overcrowding, and patient flow inefficiencies throughout the entire healthcare system [47].…”

“…This suggests that the impact of dementia on ALC days may be under-estimated in administrative-data based studies and underscores the complexity of these patients. Most ALC patients are waiting for placement in long-term care facilities [37, 48]. A study exploring ALC patients waiting for nursing home admission, however, found that some of these patients could be discharged to a community setting with the support of transitional programs and increased community care [49].…”

“…ALC refers to periods of time when a patient is considered to no longer require hospital-level care but cannot be discharged due to a lack of alternative services (for example, when a long-term care bed is required but not available). This is particularly relevant in dementia patients since it is the most frequent diagnosis associated with ALC designation [37]. We distinguished physician visits, emergency department visits, and hospitalizations for dementia (index condition) from those for all other reasons (non-index conditions).…”

The Untold Story of Being Designated an Alternate Level of Care Patient

“…The inclusion of only English-speaking patients who could provide informed consent precluded those with cognitive impairment or non-Anglophone from participating. A recent study conducted in the province where this study took place reported that 63.6% of people designated as ALC had a diagnosis of dementia (McCloskey et al 2014). It is possible that patients who did not meet this study' s eligibility criteria had very different experiences that are not reflected in these findings.…”

“…Others have attempted to explore possible strategies to respond and reduce ALC within Canadian hospitals (Costa and Hirdes 2010;Ontario Hospital Association 2012;Sutherland and Crump 2011;Walker 2011). Despite these efforts, ALC continues to be of concern, with reports of as many as 25% of acute care beds being occupied by people designated as ALC (McCloskey et al 2014).…”