Finding appropriate care for ALC patients in hospital

Today, in the Ottawa Citizen, the Queensway Carleton Hospital reports a big decline in the number of "ALC" patients, down from 50 patients a day to 20 or 25. That is a 50% to 60% decline.

Queensway Carleton Hospital

The story highlights the home first program (where seniors get intensive home care for up to two months) and a decision not to discuss LTC options with patients, or fill in LTC applications.

It sounds like a more important explanation of the ALC decline was the creation of 24 "restorative" beds at the hospital. The patients in those beds are the same sort of patients who were formerly ALC (i.e. not requiring acute care but still not ready to go home). With the creation of the restorative beds program there are now special programs to help these patients become fit and active while they fully recover in hospital.

With this program, these patients are no longer in acute care beds and are no longer waiting for another form or care. As a result they are no longer "ALC". They have found their appropriate level of care -- in the hospital.

With 24 restorative beds, 24 patients are no longer waiting to go elsewhere. Restorative hospital care would appear to account for almost the entire reduction reported (i.e. 24 of the 25 to 30 bed reduction).

Note, however, this program did not increase the number of beds very much. It appears the program was started in December 2010 – and at that time the number of acute care beds decreased 11 from 211 to 200. At the same time “Rehabilitation” beds increase from 25 to 38, an increase of 13. So apparently some acute care beds and rehabilitation beds were changed to “restorative” rehabilitation beds. The occupancy of the rehabilitation beds also increased sharply. In total, bed numbers increased by two.

Oddly, the current Queensway Carleton target is to have 20% of patients designated ALC. With 262 beds, that would mean an average of 52 ALC patients, far higher than what they have suggested to the Citizen. What accounts for this discrepancy remains unclear to me.

The Citizen also reports a smaller decline in the number of people waiting for a long-term care beds. That is down 12.4% since September 2011, from 2,672 to 2,341. This, however, sounds directly related to the decision of the hospital not to discuss LTC options with patients or fill in LTC applications.

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