Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 5;17(3):88-94.
doi: 10.5770/cgj.17.106. eCollection 2014 Sep.

Alternate level of care patients in hospitals: what does dementia have to do with this?

Rose McCloskey  1 , Pamela Jarrett  2 , Connie Stewart  3 , Patricia Nicholson  2
Affiliations

Alternate level of care patients in hospitals: what does dementia have to do with this?

Rose McCloskey et al. Can Geriatr J. .

Abstract

Background: Patients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem.

Methods: A chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed.

Results: Thirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room.

Conclusions: The majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients.

Keywords: alternate level of care; delayed discharge; dementia; hospitalization of older adults; long-term care.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Reasons for admission to hospital * Includes diagnoses such as pneumonia, infections, pain, syncope, weakness. † Includes diagnoses such as parkinson’s, huntington’s, multiple sclerosis. ‡ Includes diagnoses such as myocardial infarction, GI bleed, subdural, head injury.
FIGURE 2.
FIGURE 2.
Length of stay Mean length of stay = 379.6 days (SD 687.7); median length of stay = 182 days (range 5 to 6856 days).
FIGURE 3.
FIGURE 3.
Mobility and activities of daily living
FIGURE 4.
FIGURE 4.
Hospitalizations one year prior to ALC admission (n = 179)
FIGURE 5.
FIGURE 5.
Emergency room visits one year prior to ALC admission (n = 174)
See this image and copyright information in PMC

References

    1. Canadian Institute of Health Information . Seniors and alternate level of care: building on our knowledge. Ottawa, ON: CIHI; 2012. Retrieved 2008 July 8 from https://secure.cihi.ca/free_products/ALC_AIB_EN.pdf.
    1. Walker J, Morris K, Frood J. CIHI survey: alternate level of care in canada: a summary. Healthc Q. 2009;12(2):21–23. doi: 10.12927/hcq.2009.20674. - DOI - PubMed
    1. Canadian Health Services Research Foundation . Exploring the alternate level of care (ALC) and the role of funding policies: an evolving evidence base in Canada. Ottawa, ON: Canadian Health Services Research Foundation; 2011.
    1. Canadian Institute of Health Information . Alternate level of care in canada. Analysis in brief. Ottawa, ON: CIHI; 2009.
    1. Canadian Institute of Health Information . Alternate level of care in Atlantic Canada 2009–2010. Ottawa, ON: CIHI; 2011.

LinkOut - more resources