An alternate level of care, the prospective payment system and the challenge of extended care

Due to demographic, morbidity and public policy shifts, the health care system is undergoing a profound change. In this unsettled context the problem of the alternate level of care (ALC), or sub-acute care, patient has acquired a new meaning and importance. An ALC patient falls between the traditional levels of acute and skilled care. This study tries to identify the nature and scope of the ALC problem in Illinois, because it is symptomatic of changing morbidity patterns; because it exemplifies the consequent dilemmas for the health care industry; and because it typifies the ambivalent response of the health care institutions. The data reveals that the ALC patients are backed up in 78% of the hospitals in the state, and they pose a heavy burden and future risk both to hospitals and nursing homes. The hospital industry has sensed the challenge of extended care, but it is not responding with a reasoned and concerted strategy. Rather, in a worsening competitive situation, a unique opportunity to bridge the hiatus between acute and long-term care, and to build towards a humane and equitable system of care, may pass us by.