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Guidelines to Support ALC Designation

Alternate level of care (ALC) is used in hospitals to describe patients who occupy a bed but do not require the intensity of services provided in that care setting. Clinical and physician leaders can use the following information to support ALC designation of patients in acute inpatient care. It is intended to prompt questions for clinicians to consider for ALC designation.

Clinical Status

Acute Inpatient Care
If any one of the following criteria is met:

  • Unstable and/or deteriorating
  • Anticipated risk for rapid decline
  • Actively under investigation and diagnoses under revision

Alternate Level of Care

  • Stable and/or patient's status has plateaued
  • Low risk for rapid decline
  • No longer searching for new additional diagnoses

Safety Risk: Self and others

Acute Inpatient Care
If any one of the following criteria is met:

  • Progressive acute behavioral or neurological difficulties requiring acute inpatient care
  • Evidence of actual or potential danger to self or others
  • Requires protection for self and/or others from aggression/self-injurious behaviour
  • Requires 1:1 observation

Alternate Level of Care

  • Cognitive impairment including dementia, with stable treatment plan, not requiring acute care services
  • Behavioral or neurological difficulties that can be managed with interventions in the community specified in the care plan

Activity Tolerance

Acute Inpatient Care
If any one of the following criteria is met:

  • Activity level markedly below baseline or new baseline; requires assistance
  • Anticipated to require access to the full range of professional therapies to achieve client goal
  • Alterated cognition or physical symptoms impair rehabilitation services
  • If dominant treatment plan is rehabilitation, can tolerate intensity of 2 professional therapeutic services (e.g., nursing, occupational therapy, physical therapy)

Alternate Level of Care

  • Baseline independence recovered or new baseline established.
  • Can receive activity support in a different setting
  • Assisting patients in returning home or moving to another level of care (e.g. waiting for specialized rehabilitation care beds)

Clinical Practice & Process

Acute Inpatient Care
If any one of the following criteria is met:

  • >/= 2 professional therapeutic services are required daily (e.g. any combination of Nursing, OT, PT, etc.)
  • Close monitoring at least 3 times daily (e.g. vital signs)
  • Plan actively changing
  • Clinical status or need requires >/= 1 daily doctor visit

Alternate Level of Care

  • Required professional therapeutic services and monitoring can be provided in a different setting (e.g. in specialized rehabilitation care beds/facilities)
  • Stable treatment plan
  • Requires < 1 daily doctor visit

Medication and Fluid Administration

Acute Inpatient Care
If any one of the following criteria is met:

  • Requires multiple assessments and/or titrations
  • Requires special routes of administration that must be performed in hospital (e.g., IV, epidural, intrathecal)

Alternate Level of Care

  • Frequency of assessment and/or titration per administration can be accomplished in another setting
  • Route of administration could be done on an outpatient basis (e.g. IV medication) regardless of service availability in the community

Diagnostics and Therapeutics

Acute Inpatient Care
If any one of the following criteria is met:

  • Requires access to diagnostics / procedures and results or pre-/post-testing care

Alternate Level of Care

  • Service as well as pre/post care available other than in hospital
  • No immediate results requirement

Palliative Care

Acute Inpatient Care
If any one of the following criteria is met:

  • Medically unstable with potentially reversible conditions requiring diagnostics and treatments not available outside the hospital setting. The goal is life prolongation.
  • Complex symptom control issues and required support for imminent death within the acute care environment (e.g. a patient on a medical ward, palliating without a plan to move to another level of service.)
  • End of life care focused on comfort only; with unstable complex symptoms that require the support of the interdisciplinary team and specialist palliative care services

Alternate Level of Care

  • Medically stable with gradual progression of non-reversible illness; stable treatment plan may be supported outside of acute inpatient care
  • Care requirements may be delivered in another setting (e.g. chronic or complex continuing care, home with home care, hospice care)
  • Comfort care can be supported within the community setting
  • Patient centered care can be creatively planned to support dying at home

Mental Health

Acute Inpatient Care
If any one of the following criteria is met:

  • Suffers from sudden and severe psychiatric symptoms; can include patients who are suicidal, have hallucinations, extreme feelings of anxiety, paranoia or depression
  • Progressive acute behavioural or neurological difficulties requiring acute clinical or psychiatric care
  • Therapeutic pass to inform clinical readiness for discharge

Alternate Level of Care

  • Can be managed with individual or group therapy, or relapse prevention services
  • Clinically stable or has plateaued and able to participate in recovery plan in the community, including in non-acute designated mental health treatment facilities
  • Overnight or >24 hr trial discharge where treatment plan supports care at an alternate setting

Respiratory Care

Acute Inpatient Care
If any one of the following criteria is met:

  • On a ventilator with a new tracheostomy (cuffed), requiring >= 3 assessments/day

Alternate Level of Care

  • On a ventilator, chronic respiratory care

Companion

Alternate Level of Care

  • Companion - well baby/adult (if registered)

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