Last Christmas, Jack MacTavish, 92, was taken to Foothills Medical Centre in Calgary to be treated for congestive heart failure, a urinary tract infection and, later, pneumonia.
His daughter, Joan MacTavish, says he was living in a seniors’ home in northwest Calgary with his 93-year-old wife at the time.
Joan says she was approached by hospital staff after weeks of care, who said her father would now need to go to a supportive living facility — and that she needed to sign a form agreeing to pay nearly $70 per day while her dad waits in the hospital for a spot to open up.
“I am frustrated. I am disappointed. I am questioning it,” said Joan. “I said I did not understand why we were paying a fee at all because he was in the hospital being looked after by doctors and nurses, and as far as I knew that was something that would be covered under Alberta health care.”
‘Bitter pill’
The Alternative Level of Care (ALC) Accommodation Charge has been in effect in Alberta since 2015.
The fee is charged to hospital patients who no longer require acute care, are medically stable, and are waiting in a hospital bed until a suitable continuing care spot becomes available.
The fee is set by the Alberta government, which says it amounts to what a patient would be charged in a continuing care facility. Currently, it’s $69.20 per day for a shared room.
Joan says a hospital is not a long-term care facility — there are no resident programs or services.
Plus, she says it’s not her fault her father is stuck waiting.
“It feels like we’re being punished because the government didn’t plan ahead for the onslaught of people that they knew were going to be getting up there in age and needing these types of facilities to go to,” Joan said.
University of Calgary health policy researcher Lorian Hardcastle says she can understand that frustration.
“It is probably a bitter pill to swallow to have to pay the government to be somewhere they don’t want to be, and if they had listened to experts for decades talking about this problem then they wouldn’t be stuck there,” said Hardcastle.
But she says it’s also frustrating for ER or surgery patients who are waiting for a hospital bed to become available.
The province has said the fee is to offset accommodation costs such as meals and routine maintenance.
According to the Montreal Economic Institute, the cost per day of an ALC patient in an Alberta hospital bed ranges from $730 to $1,200.
The ALC charge does not apply if the move is for end-of-life care.
And there is a subsidy available.
Disincentive measure?
Alberta isn’t the only province that does this. The fees vary across the country.
University of British Columbia health policy expert Jason Sutherland believes the fee is not only designed to recoup costs, but also to act as a disincentive for patients who don’t need to be in hospital.
“Hospitals have a lot of people in their beds who don’t need the specialized services of nurses or the technology or the therapies — that don’t need to be there,” said Sutherland.
In Alberta, ALC patients represent about 14 per cent of hospitalizations in 2025, according to the Montreal Economic Institute.
Sutherland says the reasons vary from a suitable space not being available in the community, as is the case with Jack, or someone’s home may need adjustments, such as a wheelchair ramp, before a patient returns home.
Sometimes, he says, patients or their families will refuse to take the first available community spot in the hopes that another one will open up closer to where they want to be.
In Ontario, patients refusing to take that first available option may be charged $400 daily to continue to wait in hospital.
Sutherland believes the ALC charge is a blunt instrument that doesn’t always work.
“Charging patients, in my mind, is not the best tool. In my mind, the best tool would be to start to resource community care better so that these patients want to move out of the hospital more quickly,” said Sutherland.
Joan says if this fee is meant to encourage her to take her father home or back to the seniors’ facility, it won’t work. She says since being in hospital, his Alzheimer’s symptoms have worsened, and he’s no longer able to walk because of weakened muscles.
More beds on the way
According to the Alberta government, there are currently about 300,000 continuing care home spaces in the province.
Since 2019, it has funded the development of more than 3,000.
In December, the province announced it was investing $400 million towards building more community care spaces with a focus on shovel-ready projects.
It says that’s part of a larger investment worth billions as part of its Assisted Living Framework, where it aims to build tens of thousands of continuing care space.
In an email, a provincial government spokesperson says since it introduced its Assisting Living Framework last fall, with a goal of freeing up hospital beds and connecting patients with the appropriate care in community, they’ve seen a 40-per-cent reduction in the number of ALC patients waiting for continuing care in hospital and a 20-per-cent drop in ALC patients across Alberta.
Amber Edgerton, press secretary for Assisted Living and Social Services, said the introduction of this framework “will ensure this success continues, creating a robust assisted living sector so that Albertans are able to receive the non-acute care they need within their own homes and communities, including the largest continuing care expansion in the province’s history.”
Not enough levers
But Edmonton-based health policy consultant Stephen Samis says it’s not just a matter of creating more beds; rather, who operates them and how they co-ordinate care with other health system sectors.
For example, he says, in Alberta the public sector only runs some continuing care homes, with the rest being operated by not-for-profits and private companies. That, he says, creates patient flow problems for Alberta Health Services during the transition of care.
“The people who are working in AHS, for example, who are running acute care, they have very few levers to pull when it comes to moving people out and into other care environments because they simply don’t control them,” said Samis.
Whether it’s fair or not, he says, charging people is just part of the bigger challenge of trying to maintain patient flow effectively.
It still doesn’t sit well with Joan.
“I feel like I’m being ripped off in some ways — that I’m paying for something, but I don’t exactly know what I’m paying for,” she says.
