Ontario Wait Times

Alternate Levels of Care (ALC) Patient Definition

To support reductions in ER wait times, improve patient flow and inform decision making, better information on patients waiting in hospitals for alternate levels of care is required. As a first step, a comprehensive, standard, provincial definition of an ALC patient will be implemented across the province.

Beginning July 1st, 2009, all acute and post-acute hospitals in Ontario will be expected to designate patients as ALC according to the Provincial ALC Patient Definition.

The healthcare system aspires to deliver care in a setting that is congruent with the clinical needs of a patient as defined by the patient’s health status, treatment plan and goals.

The definition applies to all patient populations waiting in all patient care beds in an acute or post acute care hospital in Ontario.


When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (acute, complex continuing care, mental health or rehabilitation), the patient must be designated ALC1 at that time by the physician or his/her delegate. The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination2 (or when the patient’s needs or condition changes and the designation of ALC no longer applies).

Note 1

The patient’s care goals have been met or :

 · progress has reached a plateau or
 ·  the patient has reached her/his potential in that program/level of care or
 ·  an admission occurs for supportive care because the services are not accessible in the community (e.g. “social admission”).

This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Note 2

Discharge/transfer destinations may include, but are not limited to :

 · home (with/without services/programs),
 · rehabilitation (facility/bed, internal or external),
 · complex continuing care (facility/bed, internal or external),
 · transitional care bed (internal or external),
 · long term care home,
 · group home,
 · convalescent care beds,
 · palliative care beds,
 · retirement home,
 · shelter,
 · supportive housing.

This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Final Note

The definition does not apply to patients :

 · waiting at home,
 · waiting in an acute care bed/service for another acute care bed/service (e.g., surgical bed to a medical bed),
 · waiting in a tertiary acute care hospital bed for transfer to a non tertiary acute care hospital bed (e.g., repatriation to community hospital).

If you have any questions regarding the Provincial ALC Definition or this initiative, please visit CCO - Alternate Level of Care or email :

For More Information

Call ServiceOntario, INFOline at 1-888-779-7767
(Toll-free in Ontario only)

E-mail :

TTY 1-800-387-5559. In Toronto, TTY 416-327-4282
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