In Dr. David Walker’s summer ALC (alternate level of care) report he gives the example of the Toronto Central LHIN’s efforts to reduce their ALC roster.
Alternate level of care patients are said to be indivdiuals who have completed their acute care but are unable to go home or secure a long term care bed. There used to be an ugly word for them — bed blockers — which appeared to put the blame on the patient for a failure of the system to provide a continuum of care.
The Toronto Central LHIN identified 148 long-stay ALC patients for review. While the LHIN was able to transition 28 of these ALC patients to alternate destinations, 22 were deemed medically unstable and not ALC at all. That’s nearly 15 per cent.
This would indicate that measuring the ALC problem is not as simple as it appears. Nor does it give us confidence that this is the significant problem government has made it out to be.
Walker also indicates how easy it is to get rid of the problem – by deeming wards with ALC patients to be appropriate. Apparently by simply doing this it no longer makes these patients ALC and clears up the embarrassing statistical problem. Walker recommends small rural hospitals retain their ALC patients, most of whom would not have access to the kind of community resources available in southern urban areas.
This is not the first time we have seen this. Northumberland Hills Hospital had similarly gotten rid of its ALC problem by creating an ALC unit. A stroke of a pen and the problem goes away.
It seems government has hit upon an inexpensive method of solving the ALC problem – stop labelling patients “ALC.”
Maybe we need a new term — “patients formerly known as ALC.”
Unfortunately, some hospitals/CCACs appear to have “done away” with the designation of ALC by refusing to take long-term care home applications while the patient is in hospital. Patients and their families are told that the person must return “home”, which includes moving in with family or going to a retirement home before they will commence the paperwork. Often this is accompanied by promises of round-the-clock homecare or a designation as a “crisis” admission once a long-term care application is made. In some cases, the person is not only unsuitable for either community “option”, but is difficult to place even in long-term care due to heavy care needs. Refusal to take applications in hospital is illegal and forcing people into unsafe conditions is negligent. Families are fighting these policies where they can, but workers in these areas need to stand up to management as well and refuse to comply with these demands. Finally, the Ministry of Health and Long-Term Care must take action against hospitals and CCACs who are engaged in these practices.