Exploring the life of a typical ALC patient - Dr. Peter Zalan

So, what exactly is an alternate level of care (ALC) patient?

John is 82 years old. He lives alone in his home. His son lives in southern Ontario. Most of his friends have died. His eyesight is failing, and he can no longer drive.

It is getting hard for him to get out of the house. He has difficulty opening jars, opening medication containers and making nutritious meals. He is losing weight. He is lonely and depressed.

John is eventually admitted to hospital when his neighbor notices that he has not been out for two days, and finds him on the floor. He is treated for dehydration and a urinary tract infection.

Where should John go from the hospital when his treatment is finished? He could return home if he had sufficient help with meals, transportation and household tasks to meet his needs.

He could move to a retirement home, but he cannot afford the rent.

He could move into affordable supportive housing. This would provide him with a one-bedroom apartment in a housing complex. The rent would be subsidized and affordable on his Canada Pension Plan.

The opportunity for increased social interaction would be available. Signs of deterioration would be picked up early by staff before permanent damage occurred. But in the absence of alternatives, John would have no choice but to stay in hospital and wait for admission to a long-term care facility. However, this would only be the right facility for him if he required 24-hour nursing or personal care.

It all comes down to whether John has the ability to perform the daily tasks we all take for granted while we are strong and healthy. It’s about caring for people in the right place, at the right time.

If this is the goal, how does Sudbury measure up?

Sudbury Regional Hospital is perhaps the most visible symptom of what ails our health care system today. The hospital has 60 ALC patients (plus 130 ALC patients at the Memorial site) because the wait time for affordable supportive housing is five years.

The sad fact is that one-sixth of acute hospital beds in Ontario are filled with patients who do not need to be there. The wait time for a long-term care facility in Sudbury has tripled since 2005, and the waiting list is over 500 clients.

But we know that one in four people in Ontario placed in long-term care facilities could be cared for in non-institutional settings such as affordable supportive housing.

Also consider that Ontario has stopped building group homes. These homes serve the needs of clients with mental illness and physical handicaps. In the absence of group homes, these individuals are applying for long-term care. Many are under the age of 50.

The estimated cost of an ALC patient in hospital is $450 per day. A long-term care facility cost is $150 per day. Caring for that same patient in their home with nursing care support costs $100 per day. Care in supportive housing costs even less.

So what we have in Ontario are many patients in the wrong place, at the wrong time, leading to higher costs for the taxpayer and disruptions to care in our hospitals. In my next column, I will explore the impact that ALC patients have on our hospital system.

Dr. Peter Zalan is the president of Sudbury Regional Hospital’s medical staff. This is the second in a series of six columns about the issues surrounding ALC patients.