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 Sudbury’s 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 aCategory 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 Impacton 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