Alternate level of care (ALC) designates a patient occupying a bed at a higher level of care than is required. ALC has significant negative implications for patients and the health system. ALC is more prevalent among older adults, specifically among those with functional limitational that require supportive services to maintain independence, such as those needing home care, or living in supportive community housing. To describe period prevalence of ALC among a high-risk population of older adults in NB. A population-based prevalence study was conducted at the NB Institute for Research, Data and Training (NB-IRDT) using linked individual-level administrative data. Records from the Social Development Long-Term Care (SD LTC) program over 5-years (2013-2018) for adults over 65 years, were linked to Department of Health (DH) hospital data to profile ALC hospitalizations. Various demographic, geographic and program characteristics were stratified by hospitalization status to examine differences in ALC prevalence. In 21,635 older adults identified, 70% were hospitalized and 25% included ALC. In those hospitalized requiring ALC, acute length of hospital stay was longer (median: 10 vs 6 days). Median duration in ALC was 2 weeks, and 25% stayed longer than 33 days. Differences were noted for certain geographic and program, but not demographic characteristics when examining likelihood of ALC. These results provide policy-relevant insights into ALC experience among high-risk older adults in NB. Inconsistent with previous research, no inequalities across demographic characteristics were found. Additional research is required to better understand predictors of ALC in NB.

1. Alternate Level of Care
Experience in High-Risk
Older Adults in New
Brunswick:
An Administrative Data Study
Jan 25 | NB-IRDT DH Knowledge Transfer Event
Sandra Magalhaes1, Kyle Rogers1, Chris Folkins1, Sunil Ghimire2, Blake
McNeil2
1. New Brunswick Institute for Research Data and Training. 2. Department of Social
Development

2. Background
• Alternate level of care (ALC)
• designates a patient occupying a bed at a higher level of care than is
required
• ALC has significant negative implications for patients and the health
system
• Deconditioning in patients and high-cost/inappropriate use of
resources
• ALC is most common among older adults
• 85% of patients in ALC are older adults
• Especially in those with functional limitational requiring supportive
services to maintain independence
• Research on ALC in Canada in limited
• Better understanding ALC can help to alleviate strain on health
system 2

3. Methods

4. Objectives
4
Demonstrate the feasibility of Social Development data linkage with
other departmental data within NB-IRDT secure environment
Explore the extent and length of alternate level of care (ALC)
hospitalization status among Long Term Care (LTC) Clients between
January 1st, 2013, and December 31st, 2018
Examine how ALC among LTC clients differs depending on
demographic, geographic and Long-Term Care (LTC) program
characteristics

5. 5
WHAT NB-IRDT DOES
NB-IRDT works with partners to turn data and information into policy
and action
Federal, Provincial and Municipal Government, NGOs, Private Sector, Academic, Clinical

6. 6
Data Sources and Uses
• Define LTC
client status and
target group
1. SD Long Term
Care database
• Generate
demographic
and geographic
information
2. DH Citizen Data
• Identify acute
hospitalizations
and ALC status
3. DH Discharge
Abstract Database

7. Sample Selection
Inclusion criteria
All long-term care client records between January 1st, 2013, and December
31st, 2018
Exclusion criteria
LTC records associated with -65 target programs (e.g., “In Home -65”)
Individuals under the age of 65 at time of first LTC case open
Individuals who became LTC clients after a hospitalization
7

8. Defining Hospitalization Status
• Each LTC Client was categorized into one of three categories
• No hospitalization
• Hospitalized, no ALC
• Hospitalized, ALC
• ALC hospitalizations were identified in DAD using a CIHI derived
variable for length of stay (LOS)
• Acute LOS and ALC LOS
• Any hospitalization that had an ALC LOS component resulted in that
individual being placed in the ‘Hospitalized, ALC’ category
8

9. Statistical Analyses
 Descriptive statistics
 Mean and standard deviations, median and interquartile range,
percentages corresponding counts
 Bivariate cross tabs
 Comparing hospitalization status with sociodemographic, geographic
and program characteristics
9

10. Results

11. Hospitalization Status
11
25.4%
44.2%
30.4%
0%
20%
40%
60%
80%
100%
Hospitalized, ALC Hospitalized, No ALC Not Hospitalized
15,055
6,580
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Hospitalized Not Hospitalized
n=21,635
A greater number of LTC clients were
hospitalized than were not hospitalized
A higher percentage of LTC clients were
hospitalized than were not hospitalized

12. Age at Time of LTC Case Opened
12
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
[CELLRANGE]%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
90+
85-89
80-84
75-79
70-74
65-69
Hospitalized, ALC Hospitalized, No ALC Not Hospitalized

13. Area-Level Income Quintiles
13
25.5% 26.3% 24.1% 25.7% 24.7%
44.2% 43.5
46.7%
43.6% 43.1%
30.3% 30.2% 29.2% 30.7% 32.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1st lowest 2nd 3rd 4th 5th highest
Hospitalized, ALC Hospitalized, No ALC Not Hospitalized

14. 14
26% 25%
45% 44%
29% 31%
0%
20%
40%
60%
80%
100%
Male Female
23.3% 25.7% 26.1%
43.1% 44.2% 44.7%
33.7% 30% 29.2%
0%
20%
40%
60%
80%
100%
Married Single Other
24.1%
27.6%
44.8% 43.2%
31.1% 29.2%
0%
20%
40%
60%
80%
100%
English French
32.7%
19.8%
43.9% 44.5%
23.4%
35.7%
Adult Res. Facility In Home
(ARF)
Sex Preferred Language
Martial Status Long-Term Care Program type

15. Long-Term Care Target Groups (Program Types)
15
30.2%
25.4%
17.7%
10.5%
33.3%
32.7%
32.6%
12.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
In Home
Enhanced
In Home High
In Home
Medium
In Home Low
ARF 3 & 4
ARF 3B
ARF* 1 & 2
Alt family living
Not Hospitalized Hospitalized, No ALC Hospitalized, ALC
Approved
Facility
In
Home
Support

16. Health Regions
16
24.4% 25.8%
18.4%
22.6%
34.2% 32.5%
29.1%
46.7%
41.3%
51% 51.1%
39.2%
34.6%
40.6%
28.9%
33%
30.6%
26.3% 26.7%
33%
30.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Moncton Saint John Fredericton Edmundston Campbellton Bathurst Miramichi
Hospitalized, ALC Hospitalized, No ALC Not Hospitalized

17. Regional Health Authorities
17
52%
52%
49%
47%
38%
35%
33%
31%
31%
30%
25%
0% 10% 20% 30% 40% 50% 60%
Hôpital de Lamèque
Hôpital de Tracadie-Sheila
Hôpital de l'Enfant-Jésus RHSJ
Hôpital régional Chaleur
Hôpital Régional de Campbellton
Hôpital Stella-Maris-de-Kent
Hotel-Dieu Saint-Joseph de Saint-Quentin
Hôpital général de Grand-Sault
Vitalité Health Network
Hôpital régional d'Edmundston
Centre hospitalier universitaire Dr-Georges-L.-…
Hotel-Dieu of St. Joseph
52%
49%
45%
42%
40%
36%
34%
31%
20%
19%
13%
0% 10% 20% 30% 40% 50% 60%
Sackville Memorial Hospital
Sussex Health Centre
Charlotte County Hospital
Miramichi Regional Hospital
Saint John Regional Hospital
The Moncton Hospital
Horizon Health Network
Dr. Everett Chalmers Regional Hospital
Upper River Valley Hospital
Oromocto Public Hospital
Grand Manan Hospital

18. Length of Hospital Stay

19. Average Length of Hospital Stay for LTC Target Groups
19
0 10 20 30 40 50 60
ARF - Level 1
ARF - Level 2
ARF - Level 3
ARF - Level 3B
ARF - Level 4
Alt Family Living
In Home Low
In Home Medium
In Home High
In Home Enhanced
Length of Stay (days)
Total LOS
Acute LOS
ALC LOS
Approved
Facility
In
Home
Support

20. Discussion

21. Summary
• Ability to link data across departments allowed examination of ALC
experience (Department of Health data) among Social Development Long-
Term Care clients
• Data are accessible to the community through approval at NB-IRDT
• A quarter of individuals with functional limitational requiring supportive
services to maintain independence are acutely hospitalized, followed by
ALC
• Median length of stay nearly 1-month in hospital, half of which is in ALC
• No striking differences were observed across sociodemographic and
geographic characteristics
• Differences were observed for program related characteristics
• Individuals living in supportive community housing had the highest rates of
ALC
• This is likely representative of increasing health burden in clients needing
21

22. Discussion
• Research of ALC is very limited
• Robust estimates are not readily available
• Among general population of older adults sociodemographic factors are
suggested to predict ALC
• Lower income, female, living alone, single martial status are found to have
greater chances of ALC
• Community-based support programs appear to mitigate disparities in ALC
across disadvantaged sociodemographic groups among higher risk older
adults
• Older adults with different characteristics enrolled in the Social
Development Long-Term Care program had similar likelihood of ALC
22

23. Thank you!
Study supported by