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Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region
Open accessAbstract
BACKGROUND: Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission. METHODS: Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days. RESULTS: ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles. CONCLUSIONS: A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
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“This counterintuitive finding can be explained by the tendency of ALC length-of-stay to increase with age.”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Costa et al. 2012
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“ALC patients frequently occupy a substantially higher proportion of hospital bed-days (Victor et al. 2000;Costa et al. 2012).”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Costa et al. 2012
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“In a cohort of 17,111 inpatients, 65% of those awaiting nursing home admission were prescribed psychotropic medications, with dementia prevalent but other neurological conditions rare (Costa et al. 2012).”
From Dementia and Delayed Hospital Discharges: Assessing the Post-Discharge Care Gap for Older Adults in Canada. (2026) · cites this paper as Costa et al. 2012
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“The ALC reflects the fundamental mismatch between patients' needs and the availability of necessary post-discharge care services (Costa et al. 2012).”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Costa et al. 2012
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“Consequently, older ALC patients spend a larger portion of their hospital stay in ALC compared to younger patients (Costa et al. 2012;CADTH 2024).”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Costa et al. 2012
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Metadata
- Authors
- Costa, A. P., Poss, J. W., Peirce, T., & Hirdes, J. P.
- Affiliations
- University of Waterloo (CA)
- Corresponding author
- Costa, Andrew P
- Venue
- BMC Health Services Research
- Published
- 2012-06-22
- Volume
- 12
- Issue
- 1
- Pages
- 172-172
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3424132
- OpenAlex
- W2026306668
- Cited by
- 132
- References
- 53
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 9 · 2023: 13 · 2022: 13 · 2021: 18 · 2020: 11 · 2019: 16 · 2018: 7 · 2017: 8 · 2016: 8 · 2015: 6 · 2014: 4 · 2013: 3
- FWCI
- 7.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Public Health Agency of Canada
- Ontario Ministry of Health and Long-Term Care
- Public Health Agency
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- alternate level of care, delayed hospital discharge, nursing home admission, length of hospital stay, morbid obesity, psychiatric diagnosis, abusive behavior, stroke, home care, nursing home capacity, care transitions, community-based care
- MeSH terms
- Activities of Daily Living, Acute Disease, Aged, Aged, 80 and over, Bed Occupancy, Catchment Area, Health, Female, Health Services for the Aged, Home Care Services, Hospitalization, Humans, Inpatients, Length of Stay, Long-Term Care, Male, Middle Aged, Nursing Homes, Ontario, Patient Discharge, Retrospective Studies, Time Factors, Waiting Lists, Evidence-Based Medicine
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