CIHR Best Brains Exchange: Community Based Service Models for Seniors

Following the release of our CHRSP Evidence in Context report on Community-Based Service Models for Seniors, the NL Centre for Applied Health Research helped organize a Canadian Institutes of Health Research Best Brains Exchange on January 23, 2014 to address approaches for helping seniors to age in place in Newfoundland and Labrador. This meeting, the first Best Brains Exchange hosted in the province, was initiated at the request of the Government of Newfoundland and Labrador’s Department of Health and Community Services to address a priority issue for our provincial health system.

The one-day, in-camera session brought four national experts to the province to discuss research evidence about community-based service models for seniors with health system decision makers from across Newfoundland and Labrador. The meeting included broad participation from the Department of Health and Community Services, all four provincial Regional Health Authorities, and organizations integrally involved in seniors’ care in Newfoundland and Labrador.

The Best Brains Exchange highlighted relevant research, gaps in the available evidence and expert experience from across the country and beyond, and facilitated candid discussion about the applicability of the research evidence to the local context.

Why This Issue Matters

Three demographic trends are cause for growing concern for Newfoundland and Labrador’s health system:

  1. An increasing proportion of the population are seniors;
  2. Seniors are living longer than before and with increasing rates of chronic disease; and
  3. The informal caregiver base is being eroded as a result of outmigration, especially from smaller communities and more rural areas.

Providing institutional care for seniors who can no longer live at home with existing supports poses service delivery and sustainability challenges for the province. Furthermore, seniors are looking for options in terms of how they age, including the option to continue living at home and in their communities; they generally do not accept institutional care as the sole alternative to independent living and informal care.

Other jurisdictions in Canada and the US have reported that models of integrated care have helped community-dwelling seniors with varying levels of disability and mild-to-complex chronic health conditions to live at home longer with an acceptable quality of life.

Recognizing the need for evidence to inform policy directions on this issue, the Department of Health and Community Services of Newfoundland and Labrador requested, and then collaborated in a CHRSP study that explored, synthesized and contextualized the evidence related to community-based service models for seniors. The resulting report, Community-Based Service Models for Seniors in Newfoundland & Labrador looked at clinical and cost effectiveness of models of integrated care for seniors and their caregivers living in the community in a provincial context. The Best Brains Exchange arose from this report, which provided a baseline of information from which to launch discussions.

The Policy Context

In 2012, the Government of Newfoundland and Labrador’s Department of Health and Community Services launched Close to Home: A Strategy for Long-Term Care and Community Support Services with the aim of strengthening community support services in Newfoundland and Labrador for seniors, adults and children with disabilities, and individuals undergoing rehabilitation at home following hospitalization.

For older adults, the long-term goals of this strategy are to support their choice to remain in their homes safely for as long as possible and to help achieve "an optimal level of independence and quality of life." The strategy sets out guiding principles to assist in the development and organization of all provincial services so as to promote person-centered care based on individual needs. These principles are closely aligned with the design and organization principles underlying models of integrated care.

Identified Need

Further policy and program development in this area has been identified as a priority for the province as it seeks to enhance integrated care for seniors living in the community. Considerations in further developing a model of integrated care for seniors living in the community will include attention to front-line services and program administration, as well as the identification of key features for design, implementation, financing and evaluation.

Objectives of the Meeting

The following objectives were identified for the Best Brains Exchange:

  • To discuss research evidence related to the key features of successful models of integrated care that deliver services effectively to support the health and quality of life of older adults (65+) in NL with complex health conditions living in the community.
  • To review, based on the evidence, key considerations for organizing, administering, staffing and financing models of integrated care.

The Best Brains Exchange: Format, Experts, Presentations

Hosted at the offices of the Newfoundland and Labrador Medical Association, the Best Brains Exchange on Community-Based Service Models for Seniors offered a forum for interaction, exchange, and mutual learning between researchers and decision makers. The exchange facilitated the sharing of research evidence about integrated models of care and looked at how effective models of care might be established in the Newfoundland and Labrador context. During the morning session, a panel of national research experts made presentations to our provincial decision makers and engaged in Q & A sessions on the following topics:

PRESENTERTOPIC/ link to slides
Howard Bergman, MD, FCFP, FRCPC – Chair, Department of Family Medicine, Professor of Family Medicine, Medicine and Oncology, and the Joseph Kaufmann Professor of Geriatric Medicine, McGill UniversitySetting the stage: Context and overview of the CHRSP Evidence in Context report on Community-Based Service Models for Seniors.
Margaret MacAdam, PhD, Associate Professor (Adjunct), University of Toronto and President, The Age Advantage, Inc.Canadian context and overview of integrated models of care for seniors
Janice Keefe, PhD – Professor
Director, Nova Scotia Centre on Aging
Lena Isabel Jodrey Chair in Gerontology
Challenges and considerations for rural communities caring for seniors
Esther Suter, PhD – Director, Workforce Research & Evaluation, Alberta Health ServicesKey Principles of Innovative Care Models and considerations for Health Human Resources












Key messages from the research evidence were then explored in detail during facilitated discussions that followed in the afternoon. The Best Brains Exchange was facilitated by John Abbott, CEO, Health Council of Canada and Former Deputy Minister of the Newfoundland and Labrador Department of Health and Community Services.

About the CIHR Best Brains Exchange

The Best Brains Exchange initiative is part of a larger Canadian Institutes for Health Research (CIHR) provincial/territorial engagement strategy called Evidence on Tap which aims to produce high-quality, timely and accessible evidence that responds to ministry-identified health system priorities and helps inform policy development, planning and program implementation. CIHR’s Institute of Health Services and Policy Research and the Knowledge Translation Branch collaborated to develop Evidence on Tap in an effort to amplify CIHR’s capacity to engage with provincial and territorial ministries of health and to generate applied and relevant research that is responsive to ministries’ priorities.

Learn more here 


Newfoundland & Labrador Centre for Applied Health Research

230 Elizabeth Ave, St. John's, NL, CANADA, A1B 3X9

Postal Address: P.O. Box 4200, St. John's, NL, CANADA, A1C 5S7

Tel: (709) 864-8000