Some say the fees charged to hospital patients waiting for long-term care point to a bottleneck in the system

Last Christmas, 92-year-old Jack McTavish was airlifted to Calgary’s Foothills Medical Center for treatment of heart failure, a urinary tract infection and later pneumonia.

His daughter, Joan McTavish, says he was living in a seniors home in northwest Calgary with his 93-year-old wife at the time.

Joan says that after weeks of care she was contacted by hospital staff who said her father would now need to move to an assisted living facility — and she needed to sign a form agreeing to pay them about $70 per day while her father waited for a spot to open up in the hospital.

“I’m frustrated. I’m disappointed. I’m questioning it,” Joan said. “I said I didn’t understand why we were paying a fee because she was being cared for by doctors and nurses at the hospital, and as far as I knew it was something that would be covered under Alberta Health Care.”

‘bitter pill’

Alternative Level of Care (ALC) Housing Fee Effective in Alberta since 2015.

This fee is charged to hospital patients who no longer require acute care, are medically stable, and are waiting in a hospital bed until a suitable continuing care space becomes available.

This fee is set by the Alberta government, which says it is the fee charged to a patient in a continuing care facility. Currently, it’s $69.20 per day for a shared room.

Joan says the hospital is not a long-term care facility – there are no resident programs or services.

Also, she says that it is not her fault that her father is waiting.

“It feels like we’re being punished because the government didn’t plan in advance for the onslaught of people they knew were going to arrive and need these types of facilities,” Joan said.

Lorien Hardcastle, a health policy researcher at the University of Calgary, says she can understand that frustration.

Hardcastle said, “It’s probably a bitter pill that the government is going to have to pay to get to a place they don’t want to be, and if they had listened to experts talking about this problem for decades they wouldn’t be stuck there.”

But she says it’s also frustrating for ER or surgery patients who are waiting for a hospital bed to become available.

The province said This fee is to offset housing costs such as food and routine maintenance.

According to the Montreal Economic Institute, the daily cost of an ALC patient in an Alberta hospital bed ranges from $730 to $1,200.

If the move is for end-of-life care the ALC fee does not apply.

And subsidy is also available in this.

Discouraging solution?

Alberta isn’t the only province to do so. Fees vary across the country.

Jason Sutherland, a health policy expert at the University of British Columbia, believes the fee is not only designed to recover costs, but also creates a disincentive for patients who don’t need to stay in hospital.

“There are a lot of people in their beds in hospitals who don’t need the specialized services of nurses or technology or treatments — who aren’t needed there,” Sutherland said.

In Alberta, ALC patients will account for about 14 per cent of hospital admissions in 2025, according to the Montreal Economic Institute.

Sutherland says reasons vary from suitable spaces not being available in the community, as is the case with Jack, or someone’s home may need adjustments, such as a wheelchair ramp, before a patient can return home.

Sometimes, he says, patients or their families will refuse to take the first available community space in the hopes that another space will open up closer to where they want to live.

In Ontario, patients who refuse to take the first available option may be charged $400 per day to continue waiting in hospital.

Sutherland believes the ALC charge is a blunt instrument that doesn’t always work.

“Charging patients, in my view, is not the best tool. In my view, the best tool would be to better introduce community care so that these patients want to get out of the hospital sooner,” Sutherland said.

Joan says that if this fee is to encourage her to take her father home or move him back to a senior citizens facility, it won’t work. She says her Alzheimer’s symptoms have worsened since her stay in the hospital and she is no longer able to walk due to weak muscles.

More bed on the way

According to the Government of Alberta, there are currently approximately 300,000 continuing care home spaces in the province.

Since 2019, it has funded the development of over 3,000.

In December, the province announced it was investing $400 million to create more community care spaces with a focus on shovel-ready projects.

It says it is part of a larger investment worth billions as part of its Assisted Living Framework, where it aims to Create thousands of continuing care locations.

In an email, a provincial government spokesperson says since it introduced its assisted living framework with the goal of freeing up hospital beds and connecting patients to appropriate care in the community, saw There has been a 40 per cent decline in the number of ALC patients waiting for continuing care in hospital and a 20 per cent decline in ALC patients across Alberta.

Amber Edgerton, press secretary for the Department of Assisted Living and Social Services, said the launch of this framework will “ensure that this success continues, building a stronger assisted living sector so Albertans are able to receive the non-acute care they need within their homes and communities, including the largest continuing care expansion in the province’s history.”

not enough liver

But Edmonton-based health policy consultant Stephen Samis says It’s not just a matter of making more beds; Rather, who operates them and how they coordinate care with other health system areas.

For example, he says, in Alberta the public sector runs only a few continuing care homes, with the rest being run by non-profits and private companies. That, he says, creates patient flow problems for Alberta health services during transitions of care.

“The people who are working in AHS, for example, who are running acute care, they have very few levers to pull when it comes to moving people out and into other care environments because they simply don’t control them,” Samis said.

He says whether it’s fair or not, blaming people is part of the bigger challenge of effectively maintaining the flow of patients.

This still doesn’t sit well with Joan.

“I feel like I’m being scammed in some ways — that I’m paying for something, but I don’t know exactly what I’m paying for,” she says.