ABOUT THE MODEL
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Reframing the Aging Experience
Ontario’s aging population is growing rapidly, with the number of older adults projected to increase from 3.1 million in 2025 to 4.4 million by 2046. Yet the systems designed to support aging have remained largely fragmented and reactive. Health care, housing, and social supports continue to operate in silos, often engaging individuals only after a crisis has occurred. This contributes to negative health outcomes and poorer quality of life for older adults, family and caregiver burnout, inequities, and increasing pressures on the Ontario health care system.
The Community Wellness Hub™ (CWH™) model offers a transformative alternative.
What is a Community Wellness Hub™?
A Community Wellness Hub™ is an alliance of health, wellness, housing, and social services providers that coordinate and deliver services to older adults made vulnerable by social determinants of health. Hubs are located in or nearby community housing buildings and provide services to individuals that reside in the building and surrounding area. To date, the model has been implemented and scaled across seven locations in southern Ontario.
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The integrated CWH™ team is made up of interdisciplinary Service Partners providing coordinated services to Hub members. These may include partners in primary healthcare, home and community care, housing, wellness and recreation, mental health, system navigation, and more.
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An on-site Community Connector is foundational to the CWH™ model; they are responsible for onboarding members and identifying their needs through co-designing a goal-based care plan, connecting members with the CWH™’s Service Partners, and acting as the link between members and CWH™ Service Partners.
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The result is one intake point for services, one coordinated care plan for members, and one interdisciplinary team made up of staff from a range of organizations that work together to provide wrap around health, wellness, social, and housing services.
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Each CWH™ is co-designed with its local community members to provide services specific to the local target population needs and community context.
Mission
To offer care and support through trusting relationships and an integrated approach that proactively identifies and responds to physical, mental, and social “flags” before individuals get into crisis where they require acute care resources.
Vision
To keep older adults who are at risk of hospitalization or institutional care living healthily and happily at home for as long as possible.
Motto
"One Team, One Vision, One Plan"
The Journey Here
2017
Burlington Ontario Health Team, Halton Community Housing Corporation, and local community leaders across sectors begin to meet regularly to collaboratively address community needs. This group becomes the “Burlington Anchor Table”.
2018
Burlington Anchor Table completes a feasibility study. There was an identified need from housing, hospital, and community support services to better support the population of aging older adults in Burlington who live in naturally occurring retirement communities and experience social determinants of health.
2019
The first CWH™ is launched at 410 John Street in Burlington in November 2019 under the leadership and oversight of the Burlington Ontario Health Team and Halton Community Housing Corporation. This started as a pilot to implement and evaluate an integrated model of care in a community housing building with a high density of older adults, high use of emergency medical services, and reports of housing instability related to unmet health and wellness needs.
Since 2019
The model has been scaled to seven locations across Ontario, with plans for continued expansion. Collectively, these Hubs have a profound and far-reaching impact.
2026
The Community Wellness Hub™ (CWH™) becomes a trademarked name. The Community Wellness Hub™ name, logo, materials, and evaluation outputs are the intellectual property of the Burlington Ontario Health Team (OHT).
Looking to the Future
As the existing CWH™ model continuous to innovate and scale, there are also opportunities to explore adapting the model to diverse community needs (e.g., adults with disabilities, mental health and addictions, more rural populations, and more).
