Transition of appropriate alternative level of care seniors to special care home

With an overworked and overburdened healthcare system, long hours spent waiting in hospital Emergency Departments, and difficulties scheduling appointments with a general practitioner, the need to free up hospital beds and staff is more pressing than ever. This is particularly true for New Brunswick, where an estimated 21.2% of patients in hospital beds don't necessarily need to be there. These patients are called Alternate Level of Care (ALC) patients. They no longer require the acute care services that hospitals provide, but they cannot be medically discharged because they need extra services in place before they can safely return home or to a community setting. Often, ALC patients are seniors who are waiting for a suitable placement in long-term care, and their lengthened hospital stays result in fewer available beds and higher hospital costs while requiring extra staff time and resources. Finding ways to manage ALC hospital cases and decrease the burden on the health system is important. New Brunswick has one of the highest ALC rates in Canada (21.2% provincially compared to 16.3% nationally), making this a priority for the provincial government. This pilot program provided extra resources to special care homes in the Moncton region to support the transition of ALC patients from Moncton-area hospitals to these homes, where they awaited placement in long-term care. In the first two seasons of operation - between October 2018 and March 2020 - 54 ALC patients were transferred from hospital beds at the Moncton and Georges-L.-Dumont Hospitals to vacant special care home beds, where they awaited transfer to long-term care. This study examined the impact of this program in terms of hospital bed availability and cost savings, using an economic analysis, to see how this program might address the problem of ALC hospital care if it was rolled out across the whole province.

• Overall, this study showed that the implementation of a pilot program facilitating the transfer of ALC patients from two hospitals in the Moncton region to special care homes had positive outcomes in terms of freeing up hospital beds for other patients while lowering unnecessary hospital costs.
• Beyond the cost savings involved, transferring ALC patients to special care homes is also likely to result in them receiving more appropriate care - whereas long hospital stays can lead to a deterioration in their health.
• These outcomes suggest the earlier ALC patients can be transferred out of hospital, the higher the return on investment will be. If some special care homes don't have available resources, a lower number of ALC patients may be eligible for transfer, or the speed at which patients are transferred might be slower than in the pilot program.

Further studies should look at other types of impacts the program may be having to better understand the ways the pilot program is affecting healthcare delivery and patient outcomes. For instance,

• how does the transfer to special care homes affect ALC patients' health outcomes?
• do the transferred patients experience different rates of hospital readmission to acute care than those who remained in hospital?
• what kind of impacts do these freed-up hospital beds have on other forms of health care delivery?

To learn more read the complete project findings (PDF 166 KB)