CIHI Survey: Alternative Level of Care in Canada: A Summary

Walker, Jennifer; Morris, Kathleen; Frood, Jennifer

doi:10.12927/hcq.2009.20674

Cited by 20 publications

(31 citation statements)

References 3 publications

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“…The designation of Alternate Level of Care (ALC) applies to people who occupy an acute care hospital bed and who can be cared for elsewhere (1,2) but who, for some reason, remain in hospital. The utilization of hospital beds by ALC patients can contribute to a decrease in acute care capacity, emergency department overcrowding, increase wait times for elective surgical procedures, surgical cancellations, and patient flow inefficiencies throughout the entire health-care system.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…In Canadian hospitals, an authorized physician or physician delegate designates ALC status when acute care services are no longer medically necessary for the patient [23,24]. A patient that occupies an acute care bed for over a day whilst designated ALC is referred to as an ‘ALC patient’ [25-28]. …”

Section: Introductionmentioning

confidence: 99%

“…ALC patients have been the targets of many Canadian provincial health care strategies, and progress has been made to characterize ALC patients using administrative and clinical data [23,26,28-30]. In Canada, the distribution of bed days among ALC patients is positively skewed [28].…”

Section: Introductionmentioning

confidence: 99%

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

Costa

Poss

Peirce

et al. 2012

BMC Health Serv Res

105

100

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BackgroundAcute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.MethodsPopulation-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.ResultsALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.ConclusionsA small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.

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“…CIHI has produced several reports on ALC over the years with the hope of "understanding the extent of the ALC challenge in hospitals" (CIHI 2009(CIHI , 2012Walker et al 2009). 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).…”

Section: Résumémentioning

confidence: 99%

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

Jarrett

Stewart

2015

hcpol

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Introduction: Much of the research and policy reports on Alternate Level of Care (ALC) in Canada have focused on the impact ALC has on acute care services. To date, the experiences and opinions of those who must wait in hospital for alternate services have been largely absent from discussions. Method: A qualitative study was conducted with patients and families designated as ALC in one urban and two rural hospitals in Atlantic Canada. Data were analyzed using content analysis. Results: Three themes emerged from the data: a perception of normalcy, being old but not sick and anticipating relocation to another facility.

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CIHI Survey: Alternative Level of Care in Canada: A Summary

Cited by 20 publications

References 3 publications

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

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

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

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

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