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Appropriateness of Care

Alternate Level of Care (ALC)

When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (acute, complex continuing care, mental health and addictions or rehabilitation), the patient is designated alternate level of care (ALC) at that time by the physician or her/his delegate.
The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination (or when the patient’s needs or condition changes and the designation of ALC no longer applies).
Below are Grand River Hospital results, broken down by service area, for ALC days as a percent of total patient days.
GRH's alternate level of care indicator

(This chart shows the percentage of GRH's beds used for alternate level of care patients. The chart is from April 2009 to August 2012. The chart shows the percentage dropping from a high of 21 per cent in August 2009 to a low of 10 per cent in August 2012.)

Example interpretation: In August 2009, approximately 22% of total patient days, at GRH, were classified as ALC days.


1) ALC can be determined when the patient’s care goals have been met or progress has reached a plateau or the patient has reached her/his potential in that program/level of care or an admission occurs for supportive care because the services are not accessible in the community (e.g. “social admission”). This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

2) Discharge/transfer destinations may include, but are not limited to:

  • Home (with/without services/programs)
  • Rehabilitation (facility/bed, internal or external)
  • Complex continuing care (facility/bed, internal or external)
  • Transitional care bed (internal or external)
  • Long term care home
  • Group home
  • Convalescent care beds
  • Palliative care beds
  • Retirement home
  • Shelter
  • Supportive housing

The patients discharge destination will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

3) The term ALC does not apply to patients waiting at home, or waiting in an acute care bed/service for another acute care bed/service (e.g., surgical bed to a medical bed), or waiting in a tertiary acute care hospital bed for transfer to a non tertiary acute care hospital bed (e.g., repatriation to community hospital).


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