Hospital Stay Extended Until Home Care Services or Supports Ready
A low number is desirable for this indicator. It is also important to examine the number and percentage of cases with and without extended stays to support the interpretation of the indicator results.
Median (50th percentile) length of time, in days, a hospital stay is extended until home care services or supports are ready.
Specifically, the indicator measures the median number of days patients spend in an inpatient acute care hospital bed when they don’t need acute care (also known as alternate level of care, or ALC) before they are discharged to home care.
Unit of analysis: Hospital discharge
Not applicable
Median length of time, in days, that patients spend in hospital as ALC before they are discharged to home care
Methodology
Name
Hospital Stay Extended Until Home Care Services or Supports Ready
Short/Other Names
Hospital Stay Extended Until Home Care Services or Supports Ready
Description
Median number of days patients remain in hospital when they no longer need that level of care, until home care services or supports are ready.
For details, please see the General Methodology Notes (PDF).
Rationale
Measuring the length of time a hospital stay is extended until home care services or supports are ready provides an indication of whether Canadians are getting timely access to home care when they no longer need inpatient acute care in a hospital.
A higher value may signal inadequate anticipation of needs, challenges in coordinating care, or lack of resources in the community to provide care at home. In some cases, it is possible that extended stays become longer when there are increased efforts to arrange home care services from hospital.
This indicator can also help to
- Show where additional community and home supports could help to accelerate the discharge of patients and reduce the need for more expensive extended hospital services; and
- Raise awareness of the importance of planning for the release of the patient as early as possible during the hospital stay to ensure that services are ready for patients at home.
Interpretation
A low number is desirable for this indicator. It is also important to examine the number and percentage of cases with and without extended stays to support the interpretation of the indicator results.
HSP Framework Dimension
Health system outputs: Access to comprehensive, high-quality health services
Areas of Need
Getting Better
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories except Quebec
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
Indicator Results
Web Tool:
Your Health System: In Brief
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
Description
Median (50th percentile) length of time, in days, a hospital stay is extended until home care services or supports are ready.
Specifically, the indicator measures the median number of days patients spend in an inpatient acute care hospital bed when they don’t need acute care (also known as alternate level of care, or ALC) before they are discharged to home care.
Unit of analysis: Hospital discharge
Type of Measurement
Number - Median, in days
Denominator
Description:
Not applicable
Numerator
Description:
Median length of time, in days, that patients spend in hospital as ALC before they are discharged to home care
Inclusions:
- Records from acute care hospitals (Facility Type Code = 1)
- Sex recorded as male or female
- Records with a valid ALC length of stay greater than 0
- Discharge disposition identified on the record as:
- Home or a home setting with support services (Discharge Disposition Code = 04, prior to 2018─2019 data);
- Home with support/referral (excluding support services other than home care, i.e. excluding Community-based clinic, Other health facility, Other non-health facility, Community-based mental health services and Ambulatory care clinic) (Discharge Disposition Code = 04, excluding Institution To values for referral types above, 2018─2019 data onward); or
- Group/supportive living (Discharge Disposition Code = 40, 2018─2019 data onward).
Exclusions:
- Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)
- Records with selected mental health diagnoses (i.e., most responsible diagnosis ICD-10-CA codes F10–F99). Selected jurisdictions submit mental health discharges to the Ontario Mental Health Reporting System (OMHRS) and are therefore not in the Discharge Abstract Database (DAD). In order to create a standard hospital population, discharges with mental health disorders (with the exception of organic — including symptomatic — mental health disorders, which includes dementia: ICD-10-CA codes F00–F09) were excluded from all provinces.
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code =73)
Method of Adjustment
Not applicable
Adjustment Applied
None
Geographic Assignment
Place of residence
Data Sources
- DAD
Caveats and Limitations
This indicator is a starting point to measure access to home care after a hospital stay and can be further refined as data collection across sectors of care improves.
- There may be differences among provinces and territories in how extended hospital stays are classified and recorded. CIHI introduced standards for ALC or extended stay designation in 2016; comparability of the indicator will improve as implementation of the CIHI standard continues to increase. It is also possible that health professionals will differ on when to designate someone as “on extended stay” given that it requires careful assessment of care needs.
- This indicator does not show whether a patient actually received home care, only that he or she was discharged from hospital expecting to receive formal home care.
- This indicator includes a broad scope of home care services that captures discharge to both short- and long-term home care as well as home care in private residence and supportive living. Data sources do not distinguish between different types of home care services provided.
- In some cases, it may be that a patient discharged to home care was initially waiting for long-term care (or some other service). This scenario could increase the number of patients included in this indicator.
- Hospital stays for mental health are not included because of variations in how provinces and territories collect this type of data.
- In some cases, there may be an increased number of cases or longer extended stays when there are increased efforts to arrange home care services from hospital.
- Additional considerations:
- Quebec has no equivalent data, so results are not included.
- Nova Scotia commonly describes patients as “waiting for nursing home,” which may contribute to some variation and under-reporting of patients discharged to home care.
- Access to group/supportive living may differ among jurisdictions and could contribute to variation in indicator results.
- In the territories and provinces with smaller populations, the number of admissions overall is small, and few extended stays are reported. For this reason, results should be interpreted with caution and may not be comparable.
Trending Issues
Trending is assessed using a quantile regression approach with 3 years of record-level data for Nunavut and for regional-level results. However, please note that fewer than 5 years of data might mean there is greater uncertainty in indicating a real temporal trend. The trending methodology will switch to a 5-year assessment once the data is available. Therefore, trending for these jurisdictions should be interpreted with caution.
References
- Canadian Institute for Health Information. Inpatient Hospitalizations, Surgeries and Newborns Indicators, 2016–2017 (XLSX). Accessed September 13, 2024.
- Canadian Institute for Health Information. Your Health System: In Depth — Technical Notes for Contextual Measures (PDF). Accessed September 13, 2024.
- Canadian Institute for Health Information. Dementia in hospitals. Accessed September 13, 2024.
- Canadian Institute for Health Information. Seniors in Transition: Exploring Pathway Across the Care Continuum (PDF). 2017.
- Canadian Institute for Health Information. Your Health System: Insight. Accessed September 13, 2024.
- Canadian Institute for Health Information. Patient Pathways: Transfers From Continuing Care to Acute Care. 2009.
- Ontario Hospital Association. Managing Transitions: A Guidance Document. 2018.
- Cancer Care Ontario. Alternate Level of Care (ALC): Reference Manual (PDF). 2017.
- Ontario Hospital Association. Alternate Level of Care (ALC) Capacity Challenges and Long-Term Care Placement (PDF). 2012.
- Health Canada. Home and community health care. Accessed September 13, 2024.
- Statistics Canada. Formal Home Care Use in Canada. 2018.
How to cite:
Canadian Institute for Health Information. Hospital Stay Extended Until Home Care Services or Supports Ready . Accessed April 24, 2025.
If you would like CIHI information in a different format, visit our Accessibility page.
Comments
This indicator belongs to the Shared Health Priorities portfolio measuring access to mental health and substance use services and to home and community care.
More information on this indicator is available in the 2019 companion report (PDF).