Adam Preston and his family had a decision to make: let their grandmother stay in hospital, or care for her at home.
Shirley Tryon was diagnosed with dementia before her husband died in November 2018. Within a month or two of his death, she fell and broke her hip, requiring surgery and a lengthy stay in an Edmonton hospital.
The family, realizing she needed continuing care, started touring various facilities, but all had long waitlists. Eventually, doctors deemed Tryon healed from surgery.
The family faced a dilemma, because staying where she was would mean “she’s in a hospital bed with whoever knows in her room — and she’s basically stuck there until we find somewhere,” said Preston, a paramedic who lives in Sherwood Park, Alta., just east of Edmonton.
“A bunch of us are health-care workers,” he said of his family. “We knew if we took care of my grandma at home, that would free up a bed in the hospital for someone who was in much more need of it, who didn’t have the support system at home.”
Tryon was discharged from hospital and went home. Preston looked after her for three months before she moved into continuing care.
“It was, literally, 24 hours a day, for three months, either dealing with something, or the worry that something would happen,” he said.
Doctors routinely deem hospital patients well enough for a different type of care, such as continuing care or a return to their home.
Those who wait in hospital until they can be moved to a continuing care home are given the designation alternate level of care or ALC, which indicates they are in a health-care setting their needs don’t require.
Such patients are a pressing issue in Canadian health care, affecting everything from bed capacity to wait times for emergency and surgical care, said Jason Sutherland, a professor at the University of British Columbia’s Centre for Health Services and Policy Research.
“In some settings, alternative level of care patients are designated as ‘bed blockers,'” Sutherland told CBC News.
The Alberta government has cited alternate level of care patients as a key reason for the need to overhaul the health-care system.
The province, as part of its dismantling of Alberta Health Services (AHS), plans to create two separate agencies to focus on acute and continuing care, in the hopes that the system can work more cohesively.
Acute-care facilities in Alberta are working to navigate patient flow, especially as emergency room wait times in the province’s largest hospitals are still rising, according to the latest AHS annual report.
The number of hospital beds occupied by alternate level of care patients varies month to month in Alberta’s largest hospitals, publicly available data shows.
In May 2024, for example, such patients occupied about 15 per cent of beds at the Royal Alexandra Hospital in Edmonton. A month later, they filled more than a quarter of its beds.
Over the past five years, nearly 23,800 hospital patients continued to occupy their beds while waiting to move into continuing care, according to internal AHS data obtained by CBC News through a freedom of information request.
While they waited, they paid a total of nearly $32 million through a daily ALC accommodation charge.
“For many patients waiting for an alternative level of care, it’s not their choice — and many of them just, frankly, have no place to go,” Sutherland said.
The data signals a need for greater investment in community care, especially given the province’s aging population, he said.
The province and AHS are working to reduce the number of alternate level of care patients, according to a statement from the office of Health Minister Adriana LaGrange.
LaGrange was unavailable for an interview. AHS declined to answer questions.
More ALC patients waiting for continuing care
Alberta hospital patients waiting to move to continuing care have paid the ALC accommodation charge since 2015.
According to LaGrange’s office, its purpose is to offset accommodation costs such as meals and routine maintenance.
The fee, set by the health ministry but paid to AHS, applies to patients waiting for accommodation in Type A or Type B continuing-care homes, formerly known as long-term care or designated supportive living facilities. It does not apply if the move is for end-of-life care.
In 2020, the first year of the COVID-19 pandemic, about 4,100 patients paid roughly $5.5 million through the ALC accommodation charge, data shows.
Fee revenues and the number of patients paying have increased every year since. Last year, AHS collected nearly $7.7 million from more than 5,500 patients.
The daily fee increased 12 per cent between 2019 and 2023 — from $55 to $61.65.
Fees like the ALC accommodation charge cover a fraction of the actual cost for a hospital bed, said Sutherland.
The fees create an incentive for patients to leave hospital sooner, freeing up beds for people potentially waiting in the emergency room, or for surgery, Sutherland said.
The province provides income support and other benefits for patients who can’t afford to pay.
In Alberta’s 16 largest hospitals, emergency room wait times and the time it takes to discharge patients have been increasing for years.
Some rural facilities, with high numbers of alternate level of care patients, have daily bed meetings to manage capacity and demand, the latest AHS annual report says.
To improve wait times, LaGrange has tasked AHS with finding patients who no longer need acute care, the minister’s office said in its statement. But according to Sutherland, it makes financial sense for hospitals to keep those patients.
“Alternative level of care patients are the cheapest patients to have in the hospital,” he said. “They don’t need the nursing care, high-tech equipment or expensive drugs.”
‘Underinvestment’ in community care
Sutherland believes the data obtained by CBC News reflects a “significant underinvestment” in Alberta’s community-care sector.
“We’re lacking on the community side for a safe and high-quality setting to put these patients, who need some level of care and can’t be discharged to home without some level of assistance,” he said.
In its statement, LaGrange’s office acknowledged some ALC patients may need help from guardians or trustees, or “additional complex supports” at home or while in care facilities.
Some may be waiting for assessments, to learn what they need.
A cross-ministry working group, including personnel from AHS and several government ministries, meets weekly. Its goal, according to LaGrange’s office, is to identify and resolve barriers to reduce the number of ALC patients in acute-care facilities.
AHS also struck a committee to improve outcomes for ALC patients, its annual report says.
LaGrange’s office said the health ministry will keep working with continuing care operators to support the flow of patients.
Shirley Tryon, meanwhile, recently celebrated her 86th birthday. She has lived in continuing care since 2019.
She lived at Chartwell Wescott Retirement Residence, a private facility in Edmonton, for four years.
Last year, she moved to CapitalCare Strathcona, a public nursing home in Sherwood Park, because she required more care, Preston said.
“[We] couldn’t be happier where she ended up,” he said.