Alternate Level of Care Leading Practices Guide

The COVID-19 pandemic has brought the issues of alternate level of care (ALC), patient flow, and the care provided to older adults in the acute care sector and other settings to the forefront. Focus has shifted from decreasing ALC days to preventing the phenomenon of ALC altogether. With 80% of Ontario’s ALC designations being attributed to older adults (65+), ensuring that older adults receive evidence-based care that meets their needs is a key factor in improving health outcomes and, in turn, improving flow by reducing length of stay (LOS) and ALC. These efforts are viewed as part of an approach to integrated patient care across the continuum where the right care is provided in the right place at the right time.

This guide was developed by the Ontario ALC Leading Practices Working Group and identifies evidence-based leading practices for the care and proactive management of hospitalized older adults at risk of delayed transition to an appropriate setting that can be implemented in the emergency department, acute care and post-acute care settings. While the focus of this guide is on ALC prevention and management in hospitalized older adults, many of these leading practices can be applied to other patient populations.

We gratefully acknowledge the valuable contributions to this guide from older adults, caregivers and frontline clinicians.