NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.

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1 TITLE ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE SCOPE Prvincial DOCUMENT # HCS-117 APPROVAL LEVEL Alberta Health Services Executive Leadership Team SPONSOR Vice President Prvince-Wide Clinical Supprts, Prgrams and Services CATEGORY Health Care and Services INITIAL EFFECTIVE DATE May 27, 2015 REVISED Octber 14, 2015 NOTE: The first appearance f terms in bld in the bdy f this dcument (except titles) are defined terms please refer t the Definitins sectin. plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments. PURPOSE T establish a cnsistent, principle-based, transparent apprach fr patient access t an apprpriate Cntinuing Care Designated Living Optin (Designated Living Optin) fr patients whse assessed unmet needs require a Designated Living Optin. T establish a cnsistent, principle-based, transparent apprach t manage the Cntinuing Care Designated Living Optin Waitlist (Waitlist) that ensures patients wh are placed n the Waitlist are ffered Designated Living Optin spaces based n prvincial criteria. T establish a cnsistent, accessible, fair, transparent and timely prcess fr addressing patient cncerns relating t access t a Designated Living Optin. POLICY STATEMENT Access t Cntinuing Care services is gverned by the Crdinated Access t Publicly Funded Cntinuing Care Health Services: Directinal and Operatinal Plicy. The key principles that shall underlie decisin-making regarding apprpriate Designated Living Optins are: Patient well-being: Access t Cntinuing Care shuld be based n the gal f prmting the health f patients in the brad sense, including their physical, mental, scial, psychlgical, cultural and spiritual needs. Patient chice: Patients and/r alternate decisin maker(s) are active participants in their care, and shuld be respected, listened t, invlved in decisins and prvided with infrmatin that is clear and understandable. Alberta Health Services 2015 PAGE: 1 f 8

2 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 Stewardship: Health care resurces shuld be used efficiently and with due regard fr prmting the gd f all Albertans. Fairness: Patients shall be treated equitably. Decisins regarding placement shuld nt be made n arbitrary r irrelevant criteria. Transparency: Decisins regarding apprpriate living ptins shuld be based n criteria that are publicly available. Access t Cntinuing Care services shall be based n the assumptins that: Hme and/r cmmunity is the ptimal envirnment fr patient recvery and making life changing decisins related t a Designated Living Optin when at all pssible. Acute Care settings are best suited t patients with urgent medical needs. Designated Supprtive Living and Lng Term Care settings are best suited fr patients wh are assessed as requiring a Designated Living Optin. Wait Time measures will be established and reprted based n evidence and in alignment with the AHS Wait Time Measurement, Management and Reprting f Scheduled Health Services Plicy, where applicable. APPLICABILITY Cmpliance with this plicy is required by all Alberta Health Services emplyees, members f the medical and midwifery staffs, students, vlunteers, and ther persns acting n behalf f Alberta Health Services (including cntracted service prviders as necessary). POLICY ELEMENTS 1. Accuntability and Respnsibility 1.1 Alberta Health Services (AHS) a) AHS will make reasnable effrts t balance individual patient s and/r alternate decisin makers chice related t apprpriate Designated Living Optins with the respnsibility t use health system resurces fairly and efficiently fr the gd f all Albertans. b) AHS will use a transparent prcess t: (i) (ii) (iii) determine an apprpriate Designated Living Optin with patients and/r alternate decisin makers; place patients n the Waitlist; and prvide an ffer fr a Designated Living Optin space. plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

3 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 c) AHS staff shall supprt patients and/r alternate decisin makers thrughut the entire placement/transitin prcess required t reach their mst preferred Designated Living Optin. 1.2 Patients and alternate decisin makers a) AHS shall supprt patients and/r alternate decisin makers t be active partners and engaged in finding reasnable ptins. b) Patients and/r alternate decisin makers have the right t initiate a frmal cncerns reslutin prcess. 1.3 AHS Owned/Cntracted Prviders a) Shall be active partners and engaged in the prcess f finding reasnable ptins fr patients. 2. Assessment and Service Needs Determinatin 2.1 Patients shall be assessed fr a Designated Living Optin using a standardized assessment prcess and tl t determine the need fr a Designated Living Optin and the apprpriate level f care. 2.2 AHS shall supprt the patients and alternate decisin makers t make infrmed decisins and allw sufficient time t specify their preferred site(s) frm apprpriate Designated Living Optins. 2.3 AHS shall prvide infrmatin t patients and/r alternate decisin makers abut the access t a Designated Living Optin prcess as early as pssible and thrughut the placement/transitin prcess. 2.4 Patients and/r alternate decisin makers shall prvide Alberta Health Services with their preferred site(s) that will meet the individual patient s assessed care needs. a) Patients and/r alternate decisin makers shall indicate ne (1) mst preferred site, and may indicate up t tw additinal preferred sites. b) The preferred site(s) may be anywhere within the prvince f Alberta. Nte: Access t a Designated Living Optin will nt be limited by AHS Zne bundaries. c) In the event a patient and/r alternate decisin maker des nt specify any preferred site(s), alternate ptins will be determined thrugh negtiatin and review. plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

4 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f If the patient is in Acute Care, accmmdatin charges will cmmence effective the date f apprval per the AHS Alternate Level f Care Accmmdatin Charges Patients Waiting fr Cntinuing Care Plicy. 3. Waitlist Management 3.1 AHS shall rganize and manage the Waitlist in accrdance with the Waitlist Priritizatin Criteria fr Cntinuing Care Designated Living Optins (refer t the Cntinuing Care Designated Living Optin: Access and Waitlist Management Prcedure). a) The patient s place n the Waitlist shall be priritized in accrdance with the standardized prvincial criteria. 3.2 While n the Waitlist AHS shall mnitr the patient s health status t identify changes in care requirements that may affect their assessed level f care. 3.3 Transfer, placement and wait time data criteria shall supprt cnsistent measurement and internal reprting. 4. Designated Living Optin Availability and Offers 4.1 If ne (1) f the patient s preferred site(s) has availability and the patient is the mst apprpriate based n Waitlist priritizatin, the patient shall be ffered placement at that site. a) If the patient and/r alternate decisin maker(s) accepts the preferred site the care team will supprt the patient in the transitin. b) If the patient and/r alternate decisin maker(s) is ffered and declines a preferred Designated Living Optin, they shall have their need t be n the Waitlist reassessed. If the patient is in Acute Care, the care team may prceed t discharge/transfer. 4.2 If the patient s preferred site(s) des nt have availability, the patient will be ffered an alternate Designated Living Optin as a temprary measure that: a) meets the patient s assessed care needs; b) cnsiders the factrs significant t the patient and their unique situatin (refer t the Cntinuing Care Designated Living Optin: Access and Waitlist Management Prcedure); and c) is based n Waitlist priritizatin (refer t the Cntinuing Care Designated Living Optin: Access and Waitlist Management Prcedure). 4.3 If the patient and/r alternate decisin maker(s) accepts temprary placement in anything ther than their mst preferred site they will be priritized as per the Waitlist Priritizatin Criteria fr transfer t their mst preferred Designated Living plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

5 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 Optin(s) (refer t the Cntinuing Care Designated Living Optin: Access and Waitlist Management Prcedure). 5. Refusal f a Designated Living Optin Offer 5.1 Patients in Acute Care wh decline the first ffer f an alternate Designated Living Optin as a temprary measure are expected t leave Acute Care by: a) accepting the secnd ffer f an alternate Designated Living Optin as a temprary measure; b) mving t a private pay Living Optin; r c) returning hme if safe t d s with purchased care and/r family supprt. Nte: If AHS and the patient and/r alternate decisin maker(s) jintly identify extenuating circumstances that prevented the acceptance f the Designated Living Optin ffer at the time it was made, the ffer will nt be cnsidered as part f the tw (2) alternate Designated Living Optin ffer limit. Extenuating circumstances may include, but are nt limited t: family crisis, death in immediate family, r natural disasters. 5.2 Patients designated as Immediate in the Cmmunity wh decline the first ffer f an alternate Designated Living Optin as a temprary measure are expected t: 6. Discharge/Transfer a) accept the secnd ffer f an alternate Designated Living Optin as a temprary measure; r b) mve t a private pay Living Optin. Nte: If AHS and the patient and/r alternate decisin maker(s) jintly identify extenuating circumstances that prevented the acceptance f the Designated Living Optin ffer at the time it was made, the ffer will nt be cnsidered as part f the tw (2) alternate Designated Living Optin ffer limit. Extenuating circumstances may include, but are nt limited t: family crisis, death in immediate family, r natural disasters. 6.1 In circumstances where all ptins t place a patient in a Designated Living Optin have been explred and exhausted with n reslutin: a) patients in Acute Care shall be discharged r transferred t an apprpriate temprary Designated Living Optin. The prcess pursuant t the Hspitals Act, RSA 2000, c. H-12 may be used by AHS t transfer r discharge a patient frm Acute Care; r plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

6 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 b) patients designated as Immediate in the Cmmunity wh refuse t transfer shall have their need t be designated as Immediate in the Cmmunity reviewed by AHS. 7. Cncerns Reslutin DEFINITIONS 7.1 Patients and/r alternate decisin maker(s) may, at any time, initiate a Cncerns Reslutin prcess, as per the AHS Cntinuing Care Access t a Designated Living Optin: Cncerns Reslutin Prcedure. Acute Care means all urban and rural hspitals, psychiatric facilities, urgent care facilities, and sub acute settings that are c-lcated with acute care, where care is prvided fr patients with acute illnesses r injuries, r wh are recvering frm surgery. Alternate decisin maker means a persn, wh is authrized t make decisins with r n behalf f the patient. These may include specific decisin-maker, a minr's legal representative, a guardian, a nearest relative in accrdance with the Mental Health Act [Alberta]; an agent in accrdance with a Persnal Directive; r a persn designated in accrdance with the Human Tissue and Organ Dnatin Act [Alberta]. Alternate Designated Living Optin means a Designated Living Optin that is nt (ne f) the patient/alternate decisin maker s preferred Designated Living Optin chice(s). Placement in an alternate Designated Living Optin is reprted as temprary and the patient remains n the Waitlist fr transfer t their mst preferred site. Assessed Unmet Need means the care requirements that remain after the strengths and resurces f the patient and family and f the cmmunity have been cnsidered in relatin t the functinal deficits and needs identified n initial assessment. The assessment includes the patient s ability t learn the skills necessary fr self-care and the willingness, ability and availability f the family and cmmunity t participate r learn. Cmmunity/Cmmunity Living means, fr the purpses f this plicy suite nly, a permanent living arrangement where an individual resides alne r with thers in a setting that can vary frm independent living in a private residence t a variety f cmmunal settings where health and persnal supprt services may r may nt be prvided. These settings may include: Private hmes, apartments, Cngregate living settings that prvide husing and hspitality services (e.g. ldges, grup hmes etc), Designated Supprtive Living levels 3, 4 and 4D. Cncern means a written r verbal expressin f dissatisfactin that may be related t: The prvisin f gds and services t a patient, A failure r refusal t prvide gds and services t a patient, Terms and cnditins under which gds and services are prvided t the patient, by Alberta Health Services r by a service prvider under the directin, cntrl r authrity f Alberta Health Services. plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

7 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 Cntinuing Care means an integrated range f services supprting the health and wellbeing f individuals living in their wn hme, a supprtive living r lng-term care setting. Cntinuing care clients are nt defined by age, diagnsis r the length f time they may require service, but by their need fr care. Cntinuing Care Designated Living Optin (Designated Living Optin) means publicly funded residential accmmdatin that prvides health and supprt services apprpriate t meet the patient s Assessed Unmet Needs. The level f care is accessed thrugh a standardized assessment and single pint f entry prcess and cnsists f Designated Supprtive Living Level 3 (DSL3), Designated Supprtive Living Level 4 (DSL4) and Designated Supprtive Living Level 4 Dementia (DSL4D) and Lng Term Care (LTC). Cntinuing Care Living Optin Waitlist (Waitlist) means a priritized list f patients waiting fr admissin t a cntinuing care Designated Living Optin wh have been assessed and apprved fr a Designated Living Optin. Immediate in the Cmmunity means, fr the purpses f this plicy suite nly, patients waiting in cmmunity whse needs cannt be safely managed in their current envirnment fr mre than 48 hurs. Immediate admissin t an apprpriate Designated Living Optin is required due t a change in cnditin r circumstances. Patient means an adult r child wh receives r has requested health care r services frm Alberta Health Services and its health care prviders r individuals authrized t act n behalf f Alberta Health Services. This term is inclusive f residents, clients and utpatients. Preferred Designated Living Optin means ne r mre Designated Living Optin site(s) that the patient identifies in rder f preference fr placement. Only admissin t the first f these chices is cnsidered admissin t their mst preferred and reprted as placed in preferred. Admissin t their secnd r third preferred site(s) is reprted as temprary placement and the patient remains n the Waitlist fr transfer t their mst preferred site. Site means, fr the purpses f this plicy suite nly, a specific residential cntinuing care building and services. Temprary means, fr the purpses f this plicy suite nly, any Designated Living Optin placement that is nt the mst preferred chice. Admissin is reprted as temprary placement and the patient remains n the Waitlist fr transfer t their mst preferred site. Wait Time means the time the patient waits fr a specified health care activity r task, such as an appintment, cnsult, r health services. The patient can experience a wait time between any tw wait time timestamps. REFERENCES Alberta Health Services Admissin Guidelines t Publically Funded Cntinuing Care Living Optins Alberta Health Services Alternate Level f Care Accmmdatin Charges Patients Waiting fr Cntinuing Care Plicy plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.

8 ACCESS TO A DESIGNATED LIVING OPTION IN CONTINUING CARE May 27, 2015 HCS f 8 Alberta Health Services Appeal Panel Prcess (Cntinuing Care) Alberta Health Services Charges Reductin/ Waiver Plicy Alberta Health Services Designated Living Optin: Access and Waitlist Management in Cntinuing Care Prcedure Alberta Health Services Cntinuing Care Service Needs Determinatin Guide Alberta Health Services Cntinuing Care Services Added Care Plicy Alberta Health Services Wait Time Measurement, Management and Reprting f Scheduled Health Services Plicy Gvernment f Alberta / Alberta Health Services - Crdinated Access t Publicly Funded Cntinuing Care Health Services: Directinal and Operatinal Plicy Hspitals Act (Alberta) VERSION HISTORY Date May 27, 2015 May 27, 2015 June 23, 2015 Octber 14, 2015 May 2016 Actin Taken Initial apprved Initial effective Revised: Husekeeping changes nly Revised: Husekeeping changes nly Scheduled fr review plicy@albertahealthservices.ca. The Plicy & Frms website is the fficial surce f current apprved plicies, prcedures, directives, and practice supprt dcuments.