In Ontario, a controversial crisis has unfolded within its medical system over patients classified as Alternate Level of Care (ALC). Hospitals define these people out as discharge-ready from acute care. Yet, thousands still fill hospital beds, unable to transition to the appropriate care environments. This growing trend known as the “bed-blocking” problem is affecting patients and hospitals alike.
As of January 2023, Ontario was reporting an average of 4,740 ALC patients, with 72% of them still residing in acute care settings. Even though they are categorized ALC, most of these people are not just sitting around waiting for long-term care placements. They frequently have high acuity, multifaceted health needs and significant barriers in obtaining the required services beyond the confines of a hospital.
Then the Ford government passed Bill 7, making the problem even worse. Currently, this bill threatens to penalize ALC patients—or their families—with fines if they choose to stay in the hospital after being labeled as ALC. Advocates say that this junkyard dog approach is not only unfair, but downright harmful. Most importantly, it fails to address the systemic drivers of ALC patients backlog.
Understanding ALC Designation
ALC patients are identified by healthcare professionals as individuals whose medical needs can no longer be adequately met in a hospital environment. This designation should be done only following an in-depth clinical evaluation, including clear conversations with the patient and family.
“Designating a patient ALC is exclusively a clinical decision made by a patient’s attending physician who has determined that a patient’s care needs are no longer met in a hospital,” – Natalie Mehra, the executive director of the Ontario Health Coalition.
Yet hospitals insist that this designation is solely a clinical judgment, clínicas. A lot of ALC patients and their advocates believe it doesn’t go far enough to recognize the complexities of their circumstances. Some patients are indeed capable of leaving the hospital, but they remain there due to a lack of available services that can accommodate their needs.
Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, pointed out an essential aspect of this situation: “There’s nowhere for them to go.” She reiterated that many of her patients would like to use other alternatives but have high barriers to accessing appropriate alternative housing.
“They’re just told they have to leave as soon as they’re ALC,” – Jane Meadus.
This situation raises questions about the adequacy and accessibility of community resources to support these patients after they leave the hospital.
The Impact of Bill 7
The specific passage of Bill 7 has resulted in a controversial new framework for treating ALC patients. Since its enactment, at least five patients have faced fines for refusing to vacate hospital beds designated for those no longer in need of acute care. This legislation has been met with fierce condemnation from patient advocates who say it singles out and punishes the most vulnerable people.
“A lot of people aren’t even allowed to apply for long-term care,” – Jane Meadus.
One key goal of the bill’s sponsors is to make sure that care is delivered in the right place. Advocates assert that it fails to address the underlying issues contributing to the backlog of ALC patients in hospitals. Most patients come with intricate health burdens, including having to navigate around wheelchairs and using a feeding tube. These needs require complex, specialized, high-acuity care that hospitals are uniquely tailored to deliver.
Trillium Health Partners painted a portrait of the struggle to balance the needs of acutely ill patients. Simultaneously, they’re working to meet the needs of patients who are too wait-minded. For example, they claim that on any given day, almost 160 complex continuing care beds are fully utilized. Yet this scenario demonstrates the sobering pressure on limited funding.
“Chronic care is supposed to be a destination, but hospitals are ‘getting out of that business,’” – Jane Meadus.
Advocates argue that improving hospital capacity and enhancing services in the community should be prioritized over punitive measures aimed at ALC patients.
The Call for Solutions
Advocates for ALC patients wholeheartedly agree that we should not be kicking these patients out of hospitals. Rather, they lament a lack of more expansive healthcare services that could address these patients’ needs. A lot of folks have talked about the need to fix the systemic healthcare failures that led to ALC designations in the first place.
“If you had cancer and your doctor said, ‘Well, you’re rich, so we won’t provide the care for you here. You have to go to the United States and purchase it,’ you’d be up in arms,” – Jane Meadus.
That continued unavailability of services has posed an ongoing barrier to patients’ transitions from hospitals. From conversations with our community partners, we’ve heard a significant need for homes that are better prepared to meet the extensive needs of many ALC patients.
Priyanka Nasta, spokesperson for Trillium Health Partners, noted that long-term care and home care environments are more suitable for many ALC patients. “In these cases, long-term care and home care are much more appropriate environments to support comfort, healing and recovery,” she stated.
Meanwhile, Hannah Jensen, spokesperson for Health Minister Sylvia Jones, emphasized that Bill 7 aims to ensure individuals across Ontario receive appropriate care in suitable environments.
“Bill 7 ensures people across the province receive the care they need, in a setting that is right for them,” – Hannah Jensen.
Advocates remain cautious about the bill. They ask if it actually addresses the root systemic issues, or simply redirects the blame onto those who are most in need.
