Community-Based Service Models for Seniors

The Research Question:

"What does the scientific literature tell us about the characteristics and the effectiveness of models of coordinated primary medical and community care (including health and social services) that support community-dwelling older persons with ADL/IADL disabilities and mild to complex chronic health conditions (including dementia) and that support their caregivers, in terms of health and economic outcomes for the clients, caregivers, and health system, in the context of Newfoundland & Labrador?"


In Newfoundland and Labrador, senior citizens, their caregivers and families, as well as the provincial government and the Regional Health Authorities (RHAs) are interested in developing workable strategies that will help seniors remain at home, in their own communities, for as long as possible - a concept known as "Aging in Place."  For most seniors, staying at home is intrinsic to both independence and quality of life. From a government/health system perspective, helping seniors remain at home is a sign of successfully and sustainably meeting their needs and supporting their choices.

The population of Newfoundland and Labrador is aging. Seniors are living longer than ever before.  Medical and technological advances have now made it possible for seniors with a range of health and disability issues to remain in their homes, where in the past they might have had to move into institutional care. Simultaneously, the effects of out-migration continue to stretch and erode traditional support networks for seniors. The Newfoundland & Labrador healthcare system has acknowledged the need for new and creative strategies to assist seniors living at home.

The Department of Health & Community Services proposed a CHRSP project to address this issue, with a study on how community-based primary healthcare teams could best support community-dwelling seniors and their caregivers. Such an approach could possibly make more effective use of existing services, as well as efficiently and effectively reallocating support resources.

The CHRSP Project Team

Dr. Howard Bergman (Team Leader), Professor of Medicine, Family Medicine and Oncology & the Dr. Joseph Kaufmann Professor of Geriatric Medicine at McGill University and the Jewish General Hospital.

Dr. Bergman is an internationally recognized research expert in the fields of aging, chronic disease, frailty and health services.  Among his many endeavours to support health system improvement, Dr. Bergman served on the Clair Commission, an independent Commission established by the Government of Quebec to propose reforms to the provincial healthcare system. His work for the Clair Commission was instrumental in promoting primary healthcare reform and the creation of Family Medicine Groups.  Dr. Bergman was also appointed by the Minister of Health for Quebec to table a proposal for the Quebec Alzheimer Plan, a plan to address healthcare for Alzheimer's patients, from prevention to end of life care, as well as promoting research in this critical area of study.

Dr. Michel Grignon (Health Economist), Director, Centre for Health Economics and Policy Analysis, McMaster University.

Dr. Grignon has extensive international experience in research projects and studies in health economics, health-related policies, health insurance and aging. His current research projects cover a broad range of topics, including how an aging society impacts healthcare expenditures in Canada and in France.

Mr. Bruce Cooper (Health System Leader), Deputy Minister, Department of Health & Community Services, Government of Newfoundland & Labrador.

The research team for this project also includes senior decision makers from the RHAs, local research and practice experts, and CHRSP staff:

  • Dr. Stephen Bornstein, Director, NLCAHR
  • Heather Brown, Vice President, Rural Health, Central Health
  • Dr. Roger Butler, Associate Professor, Faculty of Medicine, Memorial University
  • Ms. Theresa Dyson, Regional Director of Community Health, Labrador Grenfell Health
  • Ms. Alice Kennedy, Vice President for Regional Long Term Care and Community Support Services, Rehabilitation, Continuing and Palliative Care, Eastern Health
  • Mr. Henry Kielley, Consultant, Office of Seniors & Aging, Department of Health & Community Services, Government of Newfoundland & Labrador
  • Mr. Pablo Navarro (Project Coordinator), Research Officer, Newfoundland & Labrador Centre for Applied Health Research
  • Ms. Kelli O'Brien, Chief Operating Officer, Long Term Care and Rural Health, Western Health
  • Ms. Stephanie O'Brien, Research Assistant II, Newfoundland & Labrador Centre for Applied Health Research
  • Dr. Carla Wells, Research Coordinator, Western Regional School of Nursing

Dissemination Event:

  • January 22, 2014 | 2:00pm to 4:00pm NST
  • NLCAHR Boardroom | 95 Bonaventure Avenue
  • Contact Rochelle Baker for details



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