A community anchored integrated care pathway to address alternate level of care designation for older adults
Alicia WickensPurpose
This study aims to examine Alternate Level of Care (ALC) pressures in Ontario as a health system design issue rather than solely a hospital flow problem, and to propose a Community-Anchored Integrated Care Pathway that addresses upstream determinants contributing to delayed transitions of care for older adults living with frailty.
Design/methodology/approach
This conceptual paper synthesizes evidence related to five upstream determinants of ALC pressures: early frailty identification, caregiver well-being, community program capacity, availability of post acute bedded care and digital interoperability. Geriatric care and transitional care frameworks were used to inform the development of an integrated, community-based care pathway.
Findings
The evidence synthesis indicates that gaps in community-based capacity, coordination and system integration contribute significantly to downstream hospital congestion and persistent ALC rates. A cycle-based Community-Anchored Integrated Care Pathway is proposed, incorporating frailty screening linked to Comprehensive Geriatric Assessment, shared care planning, Home First and Hospital at Home models, virtual monitoring and community paramedicine, standardized care transitions and a shared care record supported by governance structures and equity focused performance measurement.
Research limitations/implications
The findings indicate that hospital-focused flow initiatives alone are unlikely to achieve sustained reductions in ALC. Effective solutions require integrated system design, including standardized frailty assessment, stronger interprofessional communication, interoperable digital records and coordinated governance across sectors. Embedding proven clinical interventions within a unified operating model may improve continuity, strengthen community-based care and address the structural factors that contribute to prolonged hospitalization.
Practical implications
ALC should be understood as a system design challenge rather than solely a discharge problem. A community-anchored, integrated approach offers a pathway to shift care from reactive and episodic responses toward proactive, coordinated and equitable support for older adults. The proposed model provides a practical framework for Ontario Health Teams seeking sustainable reductions in ALC.
Originality/value
This paper reframes ALC as a manifestation of health system fragmentation rather than a hospital-based operational issue. By proposing a comprehensive, community-anchored model that integrates health and social care sectors, it offers a novel systems level approach to reducing ALC pressures and advancing proactive, coordinated and equitable care for older adults living with frailty.