Alternate Care Settings

Goal:  Improve access to hospital care by reducing the amount of time (the ALC rate) that patients wait in hospital for alternate care when their hospital care is complete.

Some patients who have completed the acute care phase of  treatment in hospital, remain in acute care beds waiting to be discharged or transferred elsewhere. They need an alternate level of care which is not always available. Close to 19% of patients currently in Ontario hospital beds are waiting for an alternate setting such as their own home with supports, alternate housing, rehabilitation, palliative or convalescent care settings, or transfer to a long-term care home. This often leads to longer wait times in the emergency department as patients wait to be admitted to an acute care hospital bed. The LHINs are working with the Ontario government on a variety of initiatives that will help patients get the care they need where they need it.

Historically, a long-term care home was often considered the most appropriate destination for frail, elderly persons after care in the hospital was complete. “Home First” is a philosophy that respects people’s choice, independence and safety. The “Home First” initiative is designed to identify and bundle linked services for the right care, at the right time, in the right place. An intentional focus on matching patients’ needs with available resources reduces wait times in hospital for discharge and frees up hospital beds for admitted patients.

ALC is not solely a hospital problem but a reflection of the challenges associated with transitioning across the system. ALC is about flow and system performance.  Reducing the number of ALC patients is critical to solving our challenges associated with emergency department overcrowding, prolonged ambulance offloading times, elective surgical cancellations and acute care bed availability.  It also about making sure we are taking care of people in the right environment.

While viewed as an important indicator of health system performance, ALC is most importantly an issue that affects patients and their families.  Many ALC patients find themselves waiting in the hospital faced with important decisions regarding their longer term care needs.  This can be a stressful time for patients and families.   While hospitals provide safe, high quality care, patients waiting for alternate level of care may be at risk of hospital acquired illness and deterioration in physical, mental and social functioning.

There is no quick fix for ALC issues, and no one solution will resolve the problem.  Building the necessary capacity in the community and prevention measures will take time to realize their potential.  ALC challenges are a complex system issue and solutions require partnership and collaboration between patients, families and providers across the health care continuum.