![]() There is thus considerable pressure on hospitals to discharge ALC patients. If fewer hospital beds were occupied by ALC patients, those beds could be used to immediately admit patients from the emergency department, thus potentially decreasing emergency department overcrowding. ALC and emergency departmentsĪLC has gained prominence in Ontario as an issue that affects the whole health care system, including the emergency department. Interestingly, a study from Montreal found that elderly patients who do not have children stayed in hospital twice as long as those who do have children. The shortage of diverse options that meet the needs of ALC patients outside the hospital (ranging from enhanced home care to supportive housing to rehabilitation to a nursing home) is the main reason ALC patients are not discharged from hospital as soon as they no longer need acute care. ALC patients who remain in hospital do so because the supports they require outside of the hospital are not available. Why are ALC patients still in hospital?ĪLC patients tend to need help with activities of daily living, which can range from house cleaning or cooking, to people who need round the clock care. The frail elderly, people with cognitive and behavioral problems and neurology/stroke patients account for the greatest proportion of ALC patients. ALC patients are twice as likely as non-ALC patients to have multiple medical problems. Differences across regions may be related to a great concentration of community-based health care services in the urban Toronto area. For example, in Northeastern Ontario 31% of acute care beds are filled by ALC patients, while in Toronto the ALC rate is 10.5%. Across Ontario there is significant variation in ALC rates. ![]() ALC rates are influenced by the age of the population, as well as the availability and integration of health care services. Overall, about 16% of acute care beds in Ontario are occupied by ALC patients. How many acute care beds are occupied by ALC patients? An inability to discharge ALC patients is one of the root causes of long emergency department wait times. These patients are described as needing alternate level of care (ALC). One of the biggest causes of gridlock is the inability to discharge patients who no longer need hospital care – patients who cannot go home because there are insufficient supports at home, or are waiting for a bed in a rehabilitation hospital, nursing home or other assisted living facility. Gridlock occurs when patients are unable to flow effectively and efficiently through the health care system. The term ‘gridlock’, used to describe heavy traffic on roads or highways, is being applied to our hospitals and health care system. These beds are called Alternate Level of Care (ALC) beds.īecause ALC beds are not available for sick patients in the emergency department, ALC beds are an important cause of emergency department overcrowding. About one in six beds in Ontario’s hospitals are occupied by patients who no longer need hospital care.
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