A doctor speaking with a female patient.

Healthcare Challenges: ALC Patients

There are a host of issues facing the healthcare industry, but today I want to focus on one in particular – patients requiring alternate levels of care, and the impact on our (already fragile) healthcare system.

HANYS Joint Hospital Association Survey results revealed inpatient admissions from across New York State dropped 8.3 percent from 2019-2022. This data makes sense on its own — returning to pre-pandemic levels; however, for that same amount of time, the number of inpatient days did not change. This indicates while fewer new patients are being admitted, existing patients are staying longer. Staying longer in the inpatient setting occurs for two reasons — because a patient’s needs are more complex and/or because they do not have a viable discharge option for post-acute care. Patients without a viable discharge option are considered patients who need “alternative levels of care” (ALC) and many inpatient beds are dedicated to caring for them for lengthy periods of time (100+ days).

In the past, these patients would be discharged to a skilled nursing facility, or to their home under the care of a home health nurse. Unfortunately, New York State has 5,600 fewer skilled nursing beds online than before the COVID-19 Pandemic, largely due to the shortage of available health care workers and the lack of sustainable funding. This fall, St. Joseph’s Health at Home became another home health agency closing in New York State, leaving limited options at home for those requiring alternate levels of care.

How does this impact the greater healthcare system? In the midst of COVID, flu and RSV season, the demand for healthcare understandably rises, but without a viable solution for patients with alternate levels of care, access to healthcare is reduced for the rest of the community. Hospital beds are limited, and there are fewer available to the community if patients needing alternate levels of care have nowhere to go. The result is insufficient hospital beds for new admissions, and overcrowded emergency rooms. Hospitals are also currently experiencing limitations due to shortages in staff and budget, making this a complex situation for our healthcare system.

I don’t like to call out a problem without having some ideas for moving toward a solution – what can we do to resolve this issue? I don’t have an easy answer, but it’s going to take a team approach. Individuals needing alternate levels of care often have multiple diagnoses – many of them with a psychiatric condition and/or developmental disability. Do we have the community health, mental health and developmental services resources in the community available to assist these individuals after discharge? If we are lacking resources, what do we need to get in place to support these individuals – and as a result the greater community? Do we need to petition for support from our state and local governments?

I realize I’m leaving you with more questions than answers, but my goal with this blog post is simple – to raise awareness, and hopefully create a spark.