Confronting the Alternate Level of Care (ALC) Crisis with a Multifaceted Policy Lens

It is not an issue of strictly optimizing hospital stays and discharges, but rather differentiating and articulating the role of acute care while simultaneously improving integration with and the resourcing of complementary parts of the health-care system. [...] Introducing accurate and standardized coding procedures for ALC designations is critical for guiding policy development and directing operational management (Cancer Care Ontario 2017).3 Comparing ALC management within and between provincial health systems must be done in the context of the stringency of which ALC is identified and designated as much as the underlying ALC rates themselves. [...] For example, in comparing Alberta and Saskatchewan with Ontario between 2014 and 2018 (using data available before the disruption of the COVID-19 pandemic), it is striking to note the relative stability of overall ALC hospitalizations in Ontario compared with the dramatic increases noted in the other provinces. [...] Streamlined pathways to institutional care for frail patients that are accessible and communicated to patients and families in advance can aid in appropriate decision-making and accessing required services in a timely and effective manner. [...] Use of any such paradigm must consider the diversity and complexity of the ALC population and the data and coding that measure service use.