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The provincial Alternate Level of Care (ALC) designation project provides resources to support healthcare staff and physicians with the implementation of a standardized ALC designation process for all acute care settings within Nova Scotia Health (NSH).
The ALC Designation Project includes the following key components:
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To standardize the ALC designation process in all acute care settings within Nova Scotia Health.
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Alternate level of care (ALC) is used to identify patients who no longer require inpatient acute care services provided at their current facility.
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Once the patient fulfills above criteria, the patient must be designated as ALC by their care team within 24 hours.
The ALC designation process is described in the NS Health ALC Status Policy. The following flow chart provides a high-level overview of the process:
| Role | Action(s) |
|---|---|
| MRHCP |
|
How does the new ALC designation process change the way we work?
The new process clarifies the classification of ALC patients and recommended supports for discharge from the acute care setting.
All ALC designation information will be documented on the ALC Status Form and your signature will make the designation official.
Does Long-Term Care mean ALC?
The terms ALC and Long-Term Care (LTC) are often and mistakenly used interchangeably throughout Nova Scotia Health. Not all ALC patients are LTC and not all LTC patients are ALC.
LTC is only one of the supports that may be required to discharge an ALC patient.
Should my patient be designated as ALC if they no longer require the level of care provided by my unit/service but still need acute care services?
A patient who still requires acute care services but whose need are less complex than the services provided in their current unit should NOT be designated as ALC.
For example, a patient in an Intensive Care Unit awaiting transfer to a medical/Surgical inpatient bed for further acute care.
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Mr. Singh, a 67-year-old male, was admitted to the Valley Regional Hospital, to have an endovascular ruptured aortic aneurysm repair. Upon completion of surgery, he was transferred from PACU to IMCU. The team assessed Mr. Singh the next day and identified that he is healing well and is medically stable. He no longer needs to be in IMCU and can be transferred to a medical nursing unit within the same hospital; however, there is no bed available to accommodate Mr. Singh. He must remain in IMCU until a medical bed becomes available.
No. The clinical team and Most Responsible Healthcare Provider (MRHCP) should not designate this patient as ALC, because Mr. Singh still needs acute care services within the hospital/facility.
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Mrs. Lorenz, a 70-year-old female, was admitted to the Halifax Infirmary, with a diagnosis of congestive heart failure exacerbation. She presented with shortness of breath, fluid retention and increased fatigue. The clinical team stabilized her condition, managed her symptoms, and initiated appropriate treatment.
Mrs. Lorenz responded well to the initial treatment with stable vital signs. However, during her hospital stay, it became evident that she has a new baseline. While she no longer required the high level of acute care services provided in the cardiology unit, her overall needs were less complex. During the Rapid Rounds using elements of SAFER-f, it was identified that she can be discharged home with the Support Required from Victoria Order of Nurses (VON) to provide nursing care once a day.
Yes. If Mrs. Lorenz no longer needs the intensity of the acute care resources, she would be considered ALC even though community services that match her needs are not available. Therefore, if Mrs. Lorenz meets the ALC definition and criteria, a regulated healthcare provider within that interdisciplinary team (charge nurse, continuing care, physiotherapist, and MRHCP) can initiate the ALC Designation process by starting to fill out the NSH ALC Status Form. A collaborative conversation must occur, including necessary care team members, to collectively determine the most appropriate support required for Mrs. Lorenz.
What is the Support Required?
Mrs. Lorenz could benefit from transitioning home with VON support from Continuing Care. Therefore, the selection of the Support Required is based on a comprehensive assessment of the patient’s situation. Given the information provided, the Support Required would either be access to Home/Community Care - NSH Continuing Care or access to Home/Community Care - Private Home Care Required.
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Gladis, an 80-year-old woman living independently, is admitted to Dartmouth General Hospital for hip fracture repair. After surgery, she is put on the list to be transferred to the Nova Scotia Rehabilitation Hospital.
No. She is not an ALC patient because she is awaiting to be transferred to the Nova Scotia Rehabilitation Hospital because the care required can only be provided in an inpatient rehabilitation setting and not in the community.
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Gladis, from scenario above has completed her inpatient rehabilitation. The interdisciplinary team has confirmed that all ALC criteria have been met. Despite her family's wishes for her admission to a Long-Term Care (LTC) facility, Gladis, who is alert, cognitively sound, and capable of making her own decisions, expresses her desire to continue living at home with appropriate community support. She requests that her clinical team and family respect this decision. Although her rehab therapy is complete, she must stay in the facility until home care arrangements are finalized.
Yes. This situation is indicative of an ALC scenario, emphasizing the importance of including ALC considerations in Rapid Rounds. An interdisciplinary team, including a social worker and/or continuing care coordinator, should be involved. A regulated healthcare provider initiates the ALC Status form, with the MRHCP joining the discussion and signing the form to confirm Gladis' ALC status.
What is the Support Required?
The selection of the Support Required is based on a comprehensive assessment of the patient’s
situation. Given the information provided, the Support Required would either be access to Home/Community Care - NSH Continuing Care or access to Home/Community Care - Private Home Care Required. Access to LTC - NSH Continuing Care is not appropriate in this case because the patient is of sound mind and has expressed her wish to return home with support. This aligns with NSH philosophy where ‘home’ is the best place to make long-term decisions.
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Kim, a 45-year-old man, was admitted to the Halifax Infirmary due to a third-degree burn. After receiving intensive treatment from multiple inpatient care services over two months, his condition has stabilized. He now has a new baseline. During the unit’s Rapid Rounds, the team learned that Kim was unhoused. Compounding this challenge, Kim needs home therapy services and wound management that can be provided in the community.
Yes. Due to homelessness, the team explored that he can be discharged to The Bridge Transitional Care Unit. He is awaiting placement.
What is the Support Required?
The selection of the Support Required is based on a comprehensive assessment of the patient’s situation. Given the information provided, the Support Required would be access to Housing – Homelessness.
Integrated Access and Flow Network, 2024