Hospital Discharge to Long Term Care in New Brunswick

Your parent is in the hospital after a fall or a stroke. The attending physician has declared them medically stable, but they clearly cannot go back to living alone. The hospital social worker is talking about "ALC designation" and "discharge planning," and you feel a clock ticking that you did not agree to start.

You are right to feel that pressure. Here is what is happening and what you can do about it.

What ALC Means

Alternate Level of Care (ALC) is a clinical designation applied when a hospitalized patient no longer requires acute medical care but cannot be safely discharged to their previous living arrangement. In practical terms, your parent is taking up a hospital bed that the system needs for incoming patients, and the hospital wants them moved out.

In New Brunswick, ALC patients are a systemic crisis. ALC patient days account for 32.4% of total hospital days across the province. In some health zones the figure is far worse — Zone 6 (Bathurst and the Acadian Peninsula) has seen ALC patients occupying 55.7% of acute care beds, and Zone 5 (Restigouche) reaches 38.3%.

Both of New Brunswick's regional health authorities — Horizon Health Network (primarily Anglophone regions) and Vitalite Health Network (primarily Francophone regions) — operate patient flow centres that actively manage ALC patients. Horizon's centres are in Moncton, Fredericton, and Miramichi.

The $57.15 Daily Charge

Once a parent is designated ALC, Medicare coverage for the acute care hospital bed ceases. The health authority begins billing a daily residential rate of $57.15 to the patient — roughly $1,738 per month. This is not covered by Medicare; it comes out of the family's pocket or the senior's pension income.

This per-diem exerts serious financial pressure, especially when the family is simultaneously waiting for a long-term care placement that may take weeks or months to materialize. The charge begins accumulating from the date of ALC designation, not the date of discharge.

The Fast-Track Powers

Legislative changes to the Nursing Homes Act give the Minister of Social Development emergency powers to override the chronological nursing home waitlist for ALC patients. The fast-track triggers when hospital occupancy exceeds 95% and ALC patients occupy more than 25% of acute care beds in the zone.

When fast-tracking is active, the Department can place ALC patients ahead of people who have been waiting longer on the regular waitlist. For the family of an ALC patient, this can speed up placement significantly. For families already on the waitlist, it means their position may be bypassed.

What the Hospital Discharge Planner Does

The hospital assigns a discharge planner (sometimes called a transition coordinator) whose job is to move your parent out of the hospital bed. The discharge planner coordinates with the Department of Social Development to initiate or expedite the functional assessment, identifies available nursing home beds or interim placements, communicates available options to the family, and manages the transfer logistics.

The discharge planner works under institutional pressure to clear beds. Their primary mandate is hospital flow management, not the family's long-term planning interests. They are a resource, but they are not an advocate for the family.

Your Rights During Discharge

Families have more control than the hospital environment sometimes suggests:

You can request a complete Social Development functional assessment before agreeing to any placement. The assessment determines the appropriate care level and facility type — rushing past it can result in a mismatched placement.

You can ask that home-care community supports be fully explored before accepting facility placement. If your parent could safely go home with Extra-Mural Program clinical care and subsidized home support services, that option should be assessed before defaulting to a nursing home.

You can ask for the interim placement rules in writing. Understand what "interim" means: accepting a temporary bed within 100 km preserves the parent's waitlist position for their preferred homes. Refusing two valid bed offers removes them from the waitlist for 12 weeks.

You can request a meeting with the hospital social worker to discuss the full range of options, including whether home-based care is viable with appropriate supports in place.

What to Do Right Now

If your parent is currently hospitalized and facing ALC designation, your immediate priorities are to contact the Department of Social Development intake line at 1-833-733-7835 to begin the formal Long Term Care Program application, ask the hospital social worker to coordinate with Social Development on the functional assessment, request a clear written explanation of the ALC per-diem charge and when it begins, and identify your parent's top two preferred nursing homes so you are ready when the waitlist question comes up.

The New Brunswick Care Decision Guide includes hospital discharge scripts, a defensive checklist for managing ALC pressure, and step-by-step guidance on the 100-kilometre interim placement decision.

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