alternate level of care beyond beds. alc – a definition complex issue extending beyond hospital...
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Alternate Level of CareBeyond Beds
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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.
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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
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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