New Brunswick Hospital Per Diem Charges for ALC Patients Waiting for Nursing Home Placement

Your parent's doctor just signed the medical discharge, the social worker mentioned something about "per diem charges," and suddenly a hospital stay you thought was covered by Medicare is generating daily bills. This is the Alternate Level of Care (ALC) per diem — and understanding how it works is the difference between an unexpected $1,700 bill and a managed cost your family anticipated.

What Triggers the Per Diem

Once a physician determines your parent is medically stable for discharge, their hospital status changes from "acute care" to "Alternate Level of Care." At that point, Medicare coverage for the hospital bed effectively ends. Your parent no longer needs acute medical treatment — they need a long-term care placement that isn't yet available.

The health authority then applies a daily per diem charge for continued occupancy of the hospital bed. For patients within the Horizon Health Network (which covers the southern, central, and western regions of New Brunswick), this fee is currently $57.15 per day — approximately $1,738 per month.

The Vitalité Health Network (covering the northern and eastern francophone regions) applies a comparable per diem, though the exact rate may differ slightly. Confirm the current rate with the discharge planner at your parent's specific hospital.

When the Clock Starts

Once the physician signs the medical discharge and the parent is designated ALC, the daily per diem begins. If you need to reconcile an invoice, confirm the exact billing start date with the health authority.

But once the ALC designation is formally recorded and the application process is underway, the daily charge accumulates. Every day your parent occupies an acute-care bed while waiting for a nursing home, Special Care Home, or Memory Care Home placement adds to the total.

Why Families Get Trapped in ALC Billing

New Brunswick has among the highest ALC rates in Canada — between 21.2% and 32.4% of total hospital bed-days are occupied by patients waiting for placement. The nursing home waitlist can stretch weeks to months depending on the region, the assessed care level, and the preferred facilities.

During that wait, the per diem charges accumulate. A 30-day wait costs roughly $1,715. A 90-day wait — not uncommon in high-demand regions — reaches $5,144. And the family has limited control over the timeline: bed availability depends on facility capacity, and the placement process moves through the Department of Social Development's waitlist system.

The pressure compounds because hospital discharge planners are actively working to free beds. They may invoke the "first offer" rule under Regulation 85-187, requiring your parent to accept the first available nursing home bed within 100 km that matches their language and care level. Refusing a valid offer while accumulating per diem charges puts your family in a difficult position: accept a potentially distant or less-preferred placement, or continue paying while waiting for a preferred facility.

How to Manage ALC Per Diem Costs

You can't eliminate the per diem, but you can reduce the time your parent stays in ALC status:

Accelerate the financial assessment. The most common bottleneck is the 30-day window for returning completed financial forms to the Department of Social Development. Have all documents — tax returns, pension statements, the CRA data-sharing consent — ready before the medical discharge is signed. If your parent was already declining, start the intake process through Single Entry Access before the hospital admission.

Accept interim placements. If your parent's two preferred facilities don't have beds, accepting an interim placement at another home within the 100-km radius stops the per diem charges immediately. Your parent stays on the transfer list for their preferred homes and moves when a bed opens. Financially, a subsidized nursing home co-payment (capped by the Standard Family Contribution) is almost always less than the per diem.

Ask about ISP3040 filing timing. If your parent has a spouse at home, file the involuntary separation form (ISP3040) with Service Canada after the care placement to start the OAS and GIS reassessment available under the involuntary-separation rules. File promptly after placement so the reassessment is not delayed.

Request a meeting with the discharge planner. If the wait is extending beyond 30 days, ask for a formal update on waitlist position and expected timeline. Discharge planners sometimes have visibility into upcoming bed availability that isn't communicated to families unless they ask.

For a step-by-step walkthrough of the ALC-to-placement transition, including a timeline checklist that helps you prepare financial documents before the hospital discharge, see our New Brunswick Long-Term Care Costs & Subsidies Guide.

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