An Environmental Scan of Alternate Level of Care (ALC) Policies in Ontario, Canada.

Background: Alternate level of care (ALC) patients occupy hospital beds despite no longer requiring acute services, impacting patient flow and contributing to overcrowding. Ontario hospitals have updated legislation and policies to address this issue, yet protocols vary across centres. This study conducted an environmental scan of ALC policies to examine differences in patient identification, management, and support. Methods: The research employed a multi-phase approach, beginning with a review of ALC policies obtained through direct inquiry from relevant institutions and publicly available documents. Policies were analyzed using content analysis to systematically identify common practices and differences across key areas, including risk identification, clinical criteria, leadership roles, early discharge planning, and patient engagement. A coding framework was developed based on Ontario Health guidelines and used as a comprehensive guiding document for comparison. Two researchers independently coded the documents to ensure consistency, and discrepancies were resolved through discussion to reach consensus. Key patterns and themes were then synthesized to highlight areas of convergence and divergence across the policies. Results: Qualitative content analysis of 10 policy documents revealed consistency in the core definition of ALC patients but variability among clinical criteria, substitute decision-maker roles, caregiver supports, discharge-planning protocols, and language. Variability existed in the application of senior- friendly care principles, with emphasis on discharge rather than successful transitions, suggesting opportunities for improvement in person-centred care. Conclusions: ALC policies vary greatly and exhibit both strengths and gaps in addressing patient flow and care coordination. Comprehensive discharge-planning models, which maintain a person-centred approach, could help mitigate patient flow challenges without loss of senior-friendly care principles by strengthening caregiver engagement and standardizing ALC patient identification and management practices. These findings identify the need for a more cohesive and formalized ALC management strategy in Ontario, with implications for the development of national policies and protocols worldwide.