What is the issue?
The ongoing hospital crisis in Ontario, exacerbated by staff shortages and delays in care due to the COVID-19 pandemic, has highlighted the urgent need to address the challenges faced by Alternate Level of Care (ALC) patients. These individuals no longer require hospital-level care but remain hospitalized due to a lack of suitable community settings with necessary supports for discharge.
Among the most vulnerable to this issue are individuals with developmental disabilities who also have a psychiatric condition, often referred to as a dual diagnosis. This group faces a significantly higher risk of becoming ALC patients and, in some instances, endure extended hospital stays, which can lead to adverse outcomes for them and treatment delays for other patients in need of hospital care.
How is H-CARDD helping?
The H-CARDD team conducted a cross-sectoral project to identify the fundamental principles and core components necessary for the successful transition of adults with a dual diagnosis who are currently ALC patients in hospitals, into community settings. Our approach involved three key phases.
First, we conducted a comprehensive review of existing literature, including academic and grey literature related to transitioning ALC patients with a dual diagnosis. To build on established best practices, we used the Ontario Health Quality Standards on Transitions Between Hospital and Home as a foundational framework.
Second, the project included an extensive consultation process involving over 100 stakeholders from various regions across Ontario. These stakeholders included service providers, system planners, researchers, and individuals with lived experiences of ALC hospitalization, along with their families.
Finally, a select group of consultation participants formed an expert panel responsible for reviewing the final report for accuracy, completeness, relevance and clarity.
The project resulted in the development of a comprehensive set of principles and core components designed to guide and support the successful transition of ALC patients with a dual diagnosis from hospitals to community settings in Ontario.
- Download the report Supporting Alternate Level of Care (ALC) Patients With a Dual Diagnosis to Transition From Hospital to Home: Practice Guidance
- Download a summary in English or in French.
Publications
Things that will help people to leave the hospital
This is an Easy Read of a report called: Supporting Alternate Level of Care (ALC) Patients with a Dual Diagnosis to Transition from Hospital to Home: Practice Guidance. Sometimes people can't leave the hospital even if they don't need help anymore. When people are in the hospital longer than they need to be, they are called “Alternate Level of Care” or “ALC” for short. This report is about how to help people move out of the hospital who are ALC and have a dual diagnosis.
Dual Diagnosis Alternate Level of Care: Vignette Series
In this collection of stories, meet Amanda, Taydon, John, Jordan, Monique, and Peter. Learn about the elements that played a pivotal role in facilitating their transition from the hospital to communities across Ontario after experiencing ALC hospitalization and how they align with the core components outlined in our report, Supporting alternate level of care (ALC) patients with a dual diagnosis to transition from hospital to home: Practice guidance.
- Download Dual Diagnosis Alternate Level of Care: Vignette Series
- Visit EENet to read the vignette series online.
Placemat for Supporting High-Quality Transitions Between Hospital and Home for Alternate Level of Care Patients With a Dual Diagnosis
This Quality Standards Placemat offers guidance to health care providers on how the Transitions Between Hospital and Home quality standard can be applied in supporting alternate level of care patients with a dual diagnosis to transition out of hospital.
Download the Placemat in English or French.
This report highlights creative and innovative practices used by hospitals and community organizations across Ontario to support successful hospital-to-community transitions for ALC patients. Organized around the ten core transition components of the Practice Guidance report, it aims to promote knowledge exchange and facilitate implementation, primarily for health and developmental service providers.
Long-Stay Patients in Ontario Mental Health Beds with Developmental Disabilities
NEW! This Snapshot explores the issue of long-stay patients with developmental disabilities in Ontario mental health beds who are unable to be discharged. Researchers reviewed recent data on inpatients occupying mental health beds in Ontario, comparing those with and without developmental disabilities in terms of demographics, clinical characteristics, and healthcare use prior to hospitalization. Over one in four long-stay patients has a developmental disability and faces significant barriers to discharge. Addressing this issue will require intersectoral collaboration to transition these individuals to appropriate community settings.
Journal Articles
Read a recently published commentary that highlights the new Canadian Alternate Level of Care guidance to improving transitions and reducing delays in care: Addressing Delayed Hospital Discharges for Patients With Intellectual and Developmental Disabilities and a Mental Illness by Selick, A. et al. in Psychiatric Services.
Clinical Tools to Support Successful Transitions
- Primary Care Tools
These Primary Care Tools from the Developmental Disabilities Primary Care Program support health care providers implementing the Canadian consensus guidelines on the care of adults with developmental disabilities- About My Health - A tool to communicate the needs and preferences of people with developmental disabilities
- Health Check - This tool helps to organize a comprehensive health assessment, including physical exam, for adults with developmental disabilities.
- HELP with Emotional and Behavioural Concerns in Adults with Intellectual and Developmental Disabilities - This tool reviews the biopsychosocial circumstances that might contribute to emotional distress and behaviours of concern
- Communicate CARE - This tool offers guidance to providers on conducting person-centred assessments of adults with developmental disabilities
- Decision Making in Health Care of Adults with Intellectual and Developmental Disabilities - This tool provides practical guidance to respect the decision-making rights of people with developmental disabilities
- ECHO Ontario Adult Intellectual & Developmental Disabilities - This program provides virtual education and a community of practice for health and developmental service providers to learn together about this population
- Nuts and Bolts of Healthcare: A Toolkit for Direct Support Professionals - This toolkit includes information and resources for staff to help them support the health care of people with developmental disabilities
- Patient-Oriented Discharge Summary and Patient Oriented Medication Tools - These are patient-oriented tools that have been implemented in hospitals across Ontario and can be adapted to different settings and populations
- Successful Housing Elements & Developmental Disabilities (SHEDD) tool - This tool can be used to identify an appropriate home for people with developmental disabilities and complex needs
Questions? Comments?
Do you have any questions, thoughts or comments on the report? We would love to hear from you. Email us at hcardd@camh.ca.
For more information, please contact:
Avra Selick, PhD
Provincial System Support Program
Centre for Addiction and Mental Health
Phone: 416 535 8501 x 30127
Email: avra.selick@camh.ca
Yona Lunsky, PhD, C. Psych
Centre for Addiction and Mental Health (CAMH)
Department of Psychiatry, University of Toronto
Phone: 416 535 8501 x 37813
Email: yona.lunsky@camh.ca
