Supporting alternate level of care patients with a dual diagnosis to transition from hospital to home

The journey from hospital to home can be a significant challenge, especially for individuals with a dual diagnosis, which means they have both a developmental disability and a psychiatric condition. This group faces a higher risk of being designated as Alternate Level of Care (ALC). An ALC designation is given when patients no longer require hospital-level care but remain there, sometimes for extended stays, due to a lack of appropriate community settings and support. This situation not only adversely affects the ALC patient but also results in delays for other patients in need of hospital resources. 

Each image below introduces you to the story of an individual with a dual diagnosis who experienced an ALC hospitalization and successfully transitioned to living in the community. Through their experiences and those of their families, we can understand some of the obstacles they faced and the strategies that paved the way to a successful transition. While the experiences of these individuals were far from perfect, they were guided by some key elements that made their transition smoother. Each story concludes by highlighting how these key elements align with the core components detailed in Supporting alternate level of care (ALC) patients with a dual diagnosis to transition from hospital to home: Practice guidance.

Meet John

“Until you are in that situation, you don’t realize there is not much out there. And you can’t plan for it.  John being in a home was not part of our parents’ plan, or the route we wanted to take. But you have to be open to change your mind. We all wanted what was best for John to lead a self-fulfilling life.” - Isabelle, John’s sister

Meet Jordan

“Everyone in his family is completely gone. He will say “don't leave me”. He believes if he acts a certain way he may be taken away, like he felt he was with his mother.” - Residential supervisor

Meet Monique

“You need to believe in yourself that you can do it. Have confidence in yourself. Because it is really hard.” - Monique

 

Meet Peter

“Transition is key...There shouldn't be a timeline. It should be very flexible so that you can do it according to what the person needs and what staffing needs.” - Peter’s community services supervisor

 

Download the full vignette report here. 

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Download the companion report here. 

This companion report highlights creative and innovative practices used by hospitals and community organizations across Ontario to support successful hospital-to-community transitions for ALC patients. Organized around the ten core transition components of the Practice Guidance report, it aims to promote knowledge exchange and facilitate implementation, primarily for health and developmental service providers.

The Azrieli Adult Neurodevelopmental Centre’s H-CARDD team, in partnership with CAMH’s Provincial System Support Program, has developed practice guidance on supporting successful transitions for ALC patients with a dual diagnosis who are experiencing prolonged hospital stays throughout Ontario. As part of the process, we spoke with individuals with a dual diagnosis and their families about their ALC experiences.