title: Alternate level of care patients in hospitals: what does dementia have to do with this?
abstract: BACKGROUND
  Patients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem.
  
  
  METHODS
  A chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed.
  
  
  RESULTS
  Thirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room.
  
  
  CONCLUSIONS
  The majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients.
authors.affiliation: Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB;
authors.forename: Rose
authors.initials: R
authors.lastname: McCloskey
authors.affiliation: Health & Aging Program, Horizon Health Network NB;
authors.forename: Pamela
authors.initials: P
authors.lastname: Jarrett
authors.affiliation: Department of Computer Science & Applied Statistics, University of New Brunswick, Saint John, NB.
authors.forename: Connie
authors.initials: C
authors.lastname: Stewart
authors.affiliation: Health & Aging Program, Horizon Health Network NB;
authors.forename: Patricia
authors.initials: P
authors.lastname: Nicholson
keywords: alternate level of care; delayed discharge; dementia; hospitalization of older adults; long-term care