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Alternate Level of Care

The following information is for healthcare professionals and administrators.

On July 1, 2009, all acute and post-acute hospitals in Ontario began using a standardized Provincial Alternate Level of Care (ALC) Definition to designate patients ALC.

Why we need a standardized definition

Having a standardized ALC definition will help achieve the goals of the Provincial ER/ALC Information Strategy. It is an important step toward capturing high-quality and near real-time data on all patients waiting in acute and post-acute hospitals for alternate levels of care. This data will help understand the challenges, barriers, and opportunities to improve timely and appropriate care.

Who contributed to the definition

This definition was approved by the Ministry of Health and Long-Term Care in March 2009. It was developed in consultation with stakeholders from across the continuum of care, including:

  • Acute and post-acute hospitals (i.e., complex continuing care, mental health and rehabilitation)
  • Community Care Access Centres (CCACs)
  • Ministry of Health and Long-Term Care (MOHLTC)
  • Local Health Integration Networks (LHINs)
  • Canadian Institute for Health Information (CIHI)
  • Ontario Hospital Association (OHA)
  • Ontario Health Quality Council (OHQC)

Cancer Care Ontario’s role:

The Wait Time Information System Program (WTISP) at Cancer Care Ontario captures data electronically through a single provincial system. Hospitals submit information in near-real time data for ALC patients in Acute Care, Complex Continuing Care, Rehabilitation, and Mental Health Beds. Information assists healthcare planners and decision-makers to identify gaps in services.

Provincial ALC Definition

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 [CCC], Mental Health or Rehabilitation), the patient must be designated ALC1 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 destination2 (or when the patient’s needs or condition changes and the designation of ALC no longer applies).

Note 1Note 2

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.

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

  • Home (with/without services/programs),
  • Rehabilitation (facility/bed, internal or external),
  • CCC (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

This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Final Note

The definition does not apply to patients:

  • Waiting at home,
  • Waiting in an Acute Care bed/service for another Acute Care bed/service (e.g. surgical bed to a medical bed),
  • Waiting in a tertiary Acute Care hospital bed for transfer to a non-tertiary Acute Care hospital bed (e.g. repatriation to community hospital).

For questions, please contact Access to Care at Cancer Care Ontario at

Last modified: Wed, Sep 21, 2016
cancer care ontario | action cancer ontario   620 University Avenue Toronto Ontario, Canada M5G 2L7   Phone: 416.971.9800 Fax: 416.971.6888

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