Bold truth: Alberta’s long wait for long-term care charges families a daily fee that some say amounts to a systemic bottleneck. And this is where the conversation gets thorny.
Last Christmas, 92-year-old Jack MacTavish was admitted to Foothills Medical Centre in Calgary for congestive heart failure, a urinary tract infection, and later pneumonia. His daughter, Joan MacTavish, explains he lived at a northwest Calgary seniors’ residence with his 93-year-old wife at the time. After weeks of hospital care, staff told Joan that her father would need to move to a supportive living facility, and she would have to sign a form agreeing to pay nearly $70 per day while he waited for a vacancy to open in continuing care.
“I am frustrated. I am disappointed. I am questioning it,” Joan 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 covered by Alberta health care.”
What’s happening here is the Alternative Level of Care (ALC) Accommodation Charge, a policy Alberta has had in place since 2015. The charge applies to hospital patients who no longer need acute care, are medically stable, and are waiting in a hospital bed for a suitable continuing care spot. The province sets the rate, saying it mirrors what a patient would pay in a continuing care facility. Currently, the rate stands at $69.20 per day for a shared room.
Joan argues that hospitals aren’t long-term care homes—there are no resident programs or ongoing services—and that her father’s delay isn’t his fault. “It feels like we’re being punished because the government didn’t plan ahead for the surge in aging populations that would need these facilities,” she said.
Health policy scholar Lorian Hardcastle of the University of Calgary acknowledges the frustration. “It’s probably a bitter pill to swallow to pay the government to be somewhere they don’t want to be, and if experts had been listened to for decades, this problem wouldn’t be as acute,” she noted. Yet she also points to the broader tension: ER and surgery patients waiting for a bed too.
The province says the fee offsets accommodation costs such as meals and routine maintenance. The Montreal Economic Institute estimates daily costs for an ALC patient in an Alberta hospital bed range from $730 to $1,200. The charge does not apply if the move is for end-of-life care, and a subsidy is available in some cases.
Across Canada, fees for ALC-like arrangements vary. Jason Sutherland of the University of British Columbia argues the charge serves two purposes: recouping costs and discouraging use of hospital space by patients who don’t need high-level hospital care. He notes that many hospital beds house people who don’t require specialized nursing, technology, or therapies.
In Alberta, ALC patients made up about 14% of hospitalizations in 2025, per the Montreal Economic Institute. Advocates highlight that some patients end up waiting because there simply isn’t a suitable community placement, or because homes need modifications—like wheelchair ramps—before a patient can return home. Some families even decline the first available option in hopes of a closer fit later. In Ontario, refusing a first option can lead to a $400 daily charge to continue waiting in hospital.
Sutherland says the ALC charge is a blunt instrument that doesn’t always yield the desired outcome. “Charging patients isn’t the best tool. A better approach would be to more robustly fund and coordinate community care so patients move out of hospital faster.”
Joan says the fee won’t persuade her to move her father home or back to the seniors’ residence. Since hospitalization, his Alzheimer’s symptoms have worsened, and he has become less mobile due to muscle weakness.
The Alberta government reports progress: about 300,000 continuing care spaces exist in the province, with over 3,000 added since 2019. In December, it announced a $400 million investment to expand community care spaces, part of a broader billions-long plan under the Assisted Living Framework to create tens of thousands more spaces. A government spokesperson says the framework has been associated with a 40% drop in in-hospital ALC patients waiting for continuing care and a 20% decrease overall, as the system connects people with non-acute care closer to home.
Yet policy experts like Stephen Samis of Edmonton warn that simply adding beds isn’t enough. He points to questions of who operates these facilities and how care is coordinated across health system sectors. In Alberta, publicly run facilities coexist with not-for-profit and private operators, which can complicate patient flow during transitions of care.
Whether the policy is fair or not, the reality remains: for some families, the ALC charge feels like a financial obligation for a situation they didn’t choose and can’t fully control. Joan sums it up simply: “I feel like I’m being ripped off in some ways— paying for something, but not knowing exactly what I’m paying for.”
Would you support reform that ties these charges to clearer, faster pathways out of hospital and into suitable community care, even if it means rethinking who funds and runs those facilities? What balance between patient protection, hospital efficiency, and fair cost sharing would you consider acceptable?
