Clinical Characteristics and Service Needs of Alternate-Level-of-Care Patients Waiting for Long-Term Care in Ontario Hospitals

Abstract

Background: Alternate-level-of-care (ALC) patients waiting for admission to longterm care (LTC) in Ontario hospitals are an important subgroup of ALC patients. understanding the characteristics of ALC patients waiting for LTC can identify opportunities for alternative discharge options. Methods: Characteristics from a sample of 13,915 ALC patients waiting for LTC in acute and complex hospitals were analyzed and compared to those from a sample of 113,046 long-stay home care clients in Ontario. Population-level data were obtained using Ontario' s RAI-HC database for the period January 2007 to september 2008. Findings: Relative to older long-stay home care clients, ALC patients waiting for LTC admission have more functional impairment and complex health needs. A combination of targeted transitional care and more resource-intensive home care services are needed to successfully address ALC patients' care needs in the community. Conclusions: A substantial portion of ALC patients waiting for LTC placement in acute and complex care hospitals may be more appropriately cared for in community settings if adequate community-centred resources are put in place.

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

“…It is noteworthy that lengthy waits for long-term care for both patients and families have become normalized -they were largely unquestioned by participants. This finding is consistent with that of others who assert that limited access to long-term care is a key factor in the ALC issue (Costa and Hirdes 2010;Zhang et al 2012). Although wait times within the Canadian healthcare system are frequently discussed and monitored, these discussions are generally limited to acute care services (Shamian et al 2006).…”

“…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). 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).…”

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

“…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]. As most people with dementia want to stay at home for as long as possible [50], this would require a greater integration of care between the acute and post-acute care providers [51].…”

Gender differences in home care clients and admission to long-term care in Ontario, Canada: a population-based retrospective cohort study

“…ALC designations are given to patients who no longer require hospital-level services but cannot be discharged because appropriate care is not available elsewhere (for example, when a LTC bed is not available for a patient who requires one). ALC patients have been identified as a major contributor to hospital bed shortages and ED backlogs [34,41]. …”