The Financial Burden Associated with Alternate Level of Care Patients in Niagara Region Hospitals.

Abstract

Background: One of the key contributors to healthcare pressures is the prolonged hospitalization of Alternate Level of Care (ALC) patients—individuals who remain in hospital due to non-medical barriers to discharge. This study aimed to analyze the cost associated with an ALC designation. Objective: The primary objective of this study was to evaluate the financial impact of an ALC designation from both organizational and societal perspectives. Methods: A convergent parallel mixed methods design was used. The quantitative component included a secondary data analysis of the OCCI database was performed while the qualitative component utilized a deductive content analysis. Results: The OCCI database included 4,367 patient encounters, with an average age of 77.9 years and a median LOS of 19.5 days. The qualitative component included 6 participants, of which three were care-partners (Mage=59 years) and three were ALC-designated patients (Mage=76.7 years). In the OCCI database, males were found to have a higher expense per ALC day, averaging a daily cost of $907 (SD= $275). Younger (<65 years) patient encounters were found to cost more ($965 [SD=$317]) per ALC. Long-stay ALC patients (≥30 days), per ALC day, averaged $200 less than those considered short-stay ALC (≤30 days). In-patient nursing was found to be the highest functional group costing, with an average value of $8,761 (SE $199) per entry. Out-of-pocket costs for ALC patients and care partners can be categorized into four categories: expected/acceptable, unexpected/unacceptable, discretionary, situational and greater patient concerns. Conclusions: Overall ALC-related costs have major impacts on overall hospital budget. Trends in functional group usages can be used to determine and identify areas in which a prolonged discharge yield higher costs. Within the OCCI database, males and those <65 years-old accrue higher costs during the ALC portion of their hospital stay. Systematically, in-patient nursing contributes the highest functional cost associated with an ALC designation. Inovatively, out-of-pocket costs for amenities and transportation were mostly incurred by ALC patients and their care partners.