Healthcare Quarterly

Healthcare Quarterly 12(Sp) May 2009 : 51-54.doi:10.12927/hcq.2009.20765

Alternate Level of Care Definition for Ontario

The healthcare system aspires to deliver care in a setting that is congruent with the clinical needs of a patient as defined by the patient's health status, treatment plan and goals. The definition applies to all patient populations waiting in all patient care beds in an acute or post acute care hospital in Ontario.

ALC (eh el see) n. When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate Level of Care (ALC)1 at that time by the physician or her/his delegate. The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination2 (or when the patient's needs or condition changes and the designation of ALC no longer applies).

ALC: some fine print you need to know

Note 1

  • The patient's care goals have been met or
  • Progress has reached a plateau or
  • The patient has reached her/his potential in that program/level of care or
  • An admission occurs for supportive care because the services are not accessible in the community (e.g. "social admission").

This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Note 2

Discharge/transfer destinations may include, but are not limited to

  • home (with/without services/programs),
  • rehabilitation (facility/bed, internal or external),
  • complex continuing care (facility/bed, internal or external),
  • transitional care bed (internal or external),
  • long-term care home,
  • group home,
  • convalescent care beds,
  • palliative care beds,
  • retirement home,
  • shelter,
  • supportive housing.

This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Final Note:

The definition does not apply to patients:

  • waiting at home,
  • waiting in an acute care bed/service for another acute care bed/service (e.g., surgical bed to a medical bed),
  • waiting in a tertiary acute care hospital bed for transfer to a non tertiary acute care hospital bed (e.g., repatriation to community hospital).

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