Fair enough.
Certainly, the costs of ALC are not well recognized. A lot of the costs are essentially the suffering of patients who are not able to access the beds that are occupied.
Just for clarification, ALC patients are hospital patients who are ready to be discharged but can't be placed in the community. They're clogging up hospitals and resulting in indirect clogging in emergency departments. I'm not aware of the costs, although I am indirectly aware that hospitals use ALC as a cost-minimization technique to keep under the global budget. This means they don't have their foot fully on the pedal of ALC. Those are the cheapest kinds of patients in the hospital. They require minimal nursing care, minimal drugs, and they're going to be replaced by a high-cost patient.
Second, with respect to the structural factors of ALC, the lack of robustness in many communities has to do with community-based providers. For example, behavioural or geriatric patients with behavioural conditions are fairly rare but difficult to place. The post-acute-care community doesn't have the robustness to accept patients with high or different intensities, or receive the funding associated with them, because they receive a global budget. Those expensive patients are viewed as cost drivers rather than revenue drivers.
That leads to the third question of how to align the policy incentives or create policy incentives to reduce ALC. It follows from the first point that if you want a robust post-acute-care sector you have to pay for it and align the funding with the kind of care you want to provide. If it's expensive and difficult to place patients, you make them almost like revenue-type patients for post-acute-care providers. They'll attract more revenue so they can build specialized facilities and hire or train new staff to deal with those patients.
Lastly, we come to the best practices that reduce ALC. I'm not aware of best practices to reduce ALC, because it seems to be a made-in-Canada problem. In fact, it exists across Canada in every single province from coast to coast. The rates vary in some provinces. Internationally, they get around this by adding capacity and driving up the costs in community care. If we were to do the same and add community-based care to reduce ALC, this would induce higher utilization of hospitals, which might be something we want.
There are no best practices. But there's certainly the opportunity to improve the robustness of the community care setting and take those patients out. As you pointed out, reading from my research, this is really good for a lot of these hospitalized ALC patients, it's good for the staff of the hospitals, and it can also improve the patients waiting for hospital-based care.
