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Alternate Level of Care and Emergency Room

​​​​​The Alternate-Level-of-Care (ALC) and Emergency Room (ER) issue remains a critical challenge for Ontario hospitals. The OHA has been working with the Ministry of Health and Long-Term Care (MOHLTC) and its other system partners to find and develop innovative solutions that address the ER and ALC issue. These efforts are aimed at alleviating the health system pressures related to ER and ALC, and thus improve wait times and enhance overall access to care.

The following resources provide an understanding of the ALC situation in hospitals.

Performance Reports

Please note:  Important OHA member resources are available on this page.  To access these resources, members are required to sign in through the Log In at the top of the page.

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OHA Reports

Two Studies Investigating ALC Patient Days
In order to gain a deeper understanding of ALC patient needs, the OHA commissioned two research projects led by the University of Waterloo. Both studies focused on long-stay ALC patients defined as patients who have accumulated more than 30 ALC patient days within an episode of care. Focusing on this group acknowledges the fact that unavoidable ALC days may be incurred at the end of an episode of care as patients transition to a less intensive care setting, despite best efforts to discharge them in a timely manner. Long-stay ALC patients are therefore, more likely to be those individuals who are having a harder time transitioning to a more appropriate, lower intensity setting. 

2018 -  Managing Transitions: A Guidance Document, Second Edition
This Guidance document aims to be a resource and promote a consistent approach and understanding of the information necessary to support and manage the transitions to care ensuring compliance with the legislative and regulatory requirements while recognizing both the patient’s rights and responsibilities. The document is written by legal counsel who regularly assists health care providers with difficult discharge issues.

2014 - Roundtable Discussion: Alternate Level of Care (ALC) Capacity Challenges - Long-Term Placement
Using Data to Drive Patient-Centred Care for Alternate Level of Care (ALC) Patients with Mental Health, Addiction and Behavioural Requirements in Ontario: This report is a Summary of Proceedings from the January 24, 2014 Roundtable that was hosted by the OHA’s Mental Health and Addiction Provincial Leadership Council and attended by over 35 participants from across the care continuum. It provides a snapshot of the key issues and solutions identified at the Roundtable which will inform future OHA advocacy efforts on this important issue.

2012 - Alternate Level of Care (ALC) Capacity challenges and Long-Term Care Placement
 A Roundtable Discussion: Key Messages and Suggested Actions (OHA and OACCAC paper): This report summarizes the discussions that emerged from a Roundtable, held in May 2012, to uncover the key issues impacting the interpretation of the legislation governing long-term care (LTC) placement, and offer potential systemic solutions to improve the transitioning of ALC patients waiting for LTC placement. The OACCAC and the OHA hope that the key messages and actions outlined in this report can contribute to future policy and planning discussions regarding ALC capacity challenges.

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 ALC Roundtable Summary of Proceedings
 Alternate Level of Care (ALC) Capacity Challenges A Round Table Discussion
 Long-Stay Alternate Level of Care in Ontario Complex Continuing Care Beds
 Long-Stay Alternate Level of Care in Ontario Mental Health Beds
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