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Rehab program gets patients home sooner

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Runnymede’s Low Tolerance Long Duration (LTLD) Rehabilitation program is playing an increasingly important role in the health care system. Since the program’s inception in April 2012, it has helped over 400 patients—who were occupying a bed as an alternate-level-of-care (ALC) patient in an acute care facility—regain the functional skills necessary for day-to-day living, mobility and independence to return home.

ALC is a classification given to patients who are ready to be discharged but remain in hospital as they await transfer to a more appropriate setting to receive the next phase of treatment. Patients would be designated ALC, for instance, if they are staying in acute care but are actually waiting for—and in need of—a bed in rehabilitation that is not yet available.

According to the Ontario Hospital Association, approximately 2,300 ALC patients occupied acute care beds in the province as of March 2013. Of these, 25 per cent were waiting for a regular rehabilitation bed or a complex continuing care bed. In addition to freeing up beds that may be needed by more acute patients, reducing the prevalence of ALC stays benefits patient safety and wellbeing. Patients who stay in acute care longer than medically necessary may be at risk of declines in physical and mental health due to decreased mobility.

Sometimes known as slow stream rehab, LTLD rehab serves patients who, because of their level of disability, need slower-paced rehabilitation therapy to maximize their abilities after surgery, illness or injury. For example, a senior who has suffered a hip fracture and has a weakened tolerance for physical activity might benefit from this less intensive approach to rehabilitation.


Runnymede’s LTLD Rehab program was formed in collaboration with St. Joseph’s Health Centre and has been successful in transitioning ALC patients waiting at St. Joseph’s for LTLD rehab to a more appropriate care setting at Runnymede.

To date, the results have been extraordinary. As of September 2013, St. Joseph’s has seen a 3.4 day decline in the average length of stay of an ALC patient waiting for LTLD rehab. Further, in the last quarter Runnymede has reduced the average length of stay of an LTLD rehab patient to 55 days, which is significantly lower than the provincial average of 90 to 120 days. This means that the LTLD Rehab program has been instrumental in easing healthcare system pressures by freeing up acute care beds and efficiently transitioning patients to an environment that is more congruent with their clinical needs.

A patient can be classified as ALC at any point in their journey through the health care system. If a patient in the LTLD Rehab program has reached their rehabilitation goals at Runnymede and is ready to return to the community but cannot do so, that patient would also be designated as ALC. A patient might not be able to return home, for instance, if they are on a waiting list for a long-term care facility or if their home is being renovated to accommodate their needs during their hospital stay.


To mitigate factors that may prevent patients from returning home or to the community sooner, as well as minimize the number of ALC patients at the hospital, Runnymede recently implemented an ALC Avoidance Strategy.

Formed in partnership with the Toronto Central Community Care Access Centre (CCAC), the ALC Avoidance Strategy includes policies, education and increased reporting and accountability to support the discharge planning process. In addition, a team consisting of Runnymede and CCAC staff participate in biweekly rounds to discuss each current ALC patient. These consultations enable the team to identify barriers to discharge, assess the patient’s community support needs and develop action plans to facilitate the patient’s safe and smooth transition to the community.


“Our ALC Avoidance Strategy takes a proactive, preventative approach,” says executive lead of the strategy and Vice President, Clinical Programs, Lisa Dess. “Through early identification of patients who may potentially become ALC and taking necessary steps to address factors that might prevent their anticipated discharge, we are able to ensure each patient receives the most appropriate care in the most appropriate setting.”

The Ontario Hospital Association predicts that as the population ages, the need for rehabilitation services will likely increase. A report by the Canadian Orthopedic Care Strategy Group revealed that the number of Canadians with musculoskeletal disease is expected to rise with the aging baby boomer population, from 11 million in 2007 to 15 million in 2031. Since orthopedic conditions such as knee and hip fractures are the most common reason for inpatient rehabilitation, it will be increasingly important to ensure patients are able to access this type of specialized care and rehabilitation therapy that we provide at Runnymede.

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