Alternate Level of Care

1
Alternate Level of Care

• Beyond Beds

2
ALC A Definition

• Complex issue extending beyond hospital
• ALC represents multitude of patient populations
  all requiring different care
• ALC patients who no longer require hospital
  care, but cannot be discharged due to lack of
  beds/resources in community
• Not receiving the right care in the right place

3
The Faces of ALC

• The majority of ALC patients require long-term
  care beds
• Other placement/services for ALC patients
• Convalescent Care
• Rehabilitation centre/beds
• Palliative care
• Mental Health bed/services/facility
• Home care/supportive housing
• Acquired Brain Injury support/services

4
ALC Community Based Services

• Community support services expected and required
  for seamless system of care
• Long-term care facilities
• Convalescent care beds
• Rehabilitation facilities/support services
• Palliative care services
• Mental Health facilities/community-based services
• Supportive care/supportive housing
• Independent living services
• Complex continuing care beds/services

5
Community-Based Support City of Greater Sudbury

• City of Greater Sudburys community-based health
  support services
• Insufficient long-term care capacity
• Insufficient convalescent care capacity
• Significant lack of home care services
• Significant lack of rehabilitation services
• Significant lack of supportive housing
• Lack of mental health community-based services

6
Regional Challenges

• ALC a provincial and national health care issue
• Unique regional challenges that compound ALC
  issue for the north
• Older, less healthy population
• Youth migration
• Vast geographic dispersion
• Economically depressed area

7
Population Health in the North

• Northeastern Ontario residents less healthy on
  almost all indicators
• Advances in care mean people live longer, but
  with higher number of dependant years
• Challenges of providing care to elderly
  exacerbated by poorer health
• Impact of an aging and less healthy population
  felt more acutely

8
Economic Factors in the North

• Lower socio-economic status leads to poorer
  health
• Northeastern Ontario economically depressed area
  creates two-fold problem
• Lack of resources to pay for retirement home,
  government-subsidized LTC facility only option
• With youth migration, many unable to return to
  provide care when parents become elderly or infirm

9
ALC and Long Term Care

• Majority of ALC patients waiting for
  long-term-care
• Ministry guidelines allow for ALC patients to
  wait in hospital until a LTC bed of their choice
  becomes available
• Can be a lengthy wait, impacting hospital
  operations
• When hospital acute and surgical care affected by
  ALC, Ministry can invoke Crisis 1-A designation

10
Crisis 1-A Designation

• Category 1-A Crisis ALC patients awaiting LTC
  placement in hospital are required to accept the
  first appropriate level of care bed available,
  while they wait for their bed of choice.
• In April 2004, the Ministry of Health and
  Long-Term Care granted a Category 1-A Crisis
  Designation for all ALC patients at HRSRH

11
Impact of ALC at HRSRH

• ALC has domino effect on hospital system
• Hospital needs regular flow of patients moving
  out
• When outflow does not occur
• Emergency Department overcrowding
• Surgical Cancellations
• Impact on resources (human, financial,
  utilization)

12
Impact of ALC at HRSRH

• Emergency Department Overcrowding
• Most acute symptom of the problem
• Patients must wait in the ED until a bed becomes
  available
• Twelve or more admitted patients waiting in ED
  triggers Level Three Status
• When capacity is reached, physicians do not have
  beds in which to examine or treat patients
• Creates long wait times in the ED
• Very stressful for both staff and patients

13
Impact of ALC at HRSRH

• Surgical Cancellations
• When system capacity is reached and no other
  options are available, hospital is forced to
  cancel elective surgery
• To minimize impact on patients
• surgeries rescheduled within two week timeframe
• Fewer procedures scheduled during peak times
• Results in increased waits for surgical
  procedures

14
Impact of ALC at HRSRH

• Impact on resources
• Human Resources Expending valuable resources
  reacting to and planning for bed crisis, creating
  stressful working environment for physicians and
  staff
• Utilization ALC leads to increase in expected
  length-of-stay, impacting hospital efficiency
• Financial HRSRH has borne the cost of keeping
  extra beds open and staffed, and has not been
  able to make full use of targetted wait time and
  priority program funding.

15
Potential ALC Solutions

• Create capacity for long-term and convalescent
  care
• Create capacity for full spectrum of community
  supports (home care, supportive care ,supportive
  housing, improved addictions and mental health
  services)
• Improved respite care and supports for family
  members who choose to care for elderly or infirm
  people in their homes
• Implement strategies to make more efficient use
  of resources i.e. Nursing Outreach Strategy to
  re-direct patients from ED
• Reduce financial barriers to accessing retirement
  homes

16
ALC Future Outlook

• As Baby Boomers age ALC problem will grow
• Need to take control of our own health
• Must improve preventative and wellness strategies
• Education and personal and community planning is
  key