Better Care Closer to Home and the Community

The Canadian Foundation for Healthcare’s emphasis is on driving the adoption of innovations that deliver better care closer to home and the community. For some people, their home is their long-term care homes.

Better care closer to home and the community includes; better transitions from hospital to home, new models of care that enable healthcare to be delivered outside of hospital and specialty care, supporting the management of chronic conditions at home so people need to visit hospitals less often, person-centered care in long-term care homes, and new models of home palliative care.

Programs that are shifting care closer to home

Advancing Frailty Care in the Community Collaborative

Working in partnership with the Canadian Frailty Network, we are supporting teams from across Canada to improve the identification, assessment and implementation of tailored and evidence-based interventions that address frailty in primary care.

Bridge-to-Home Spread Collaborative

The Bridge-to-Home Spread Collaborative improves the quality of care – and patient, caregiver and provider experiences of care – during patients’ transitions from hospital to their homes.

Connected Medicine

In partnership with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, the Connected Medicine Collaborative has spread the adoption of two proven innovations (BASE™ and RACE™) and substantially increased access to primary care specialty services through virtual care.

Embedding Approaches to Palliative Care

Embedding Palliative Approaches to Care (EPAC) is a proven innovation that helps staff in long-term care homes identify residents who could benefit from a palliative approach to care. Through EPAC, staff have conversations with residents, their families and caregivers regarding palliative care preferences, to establish and implement comprehensive, resident-centred care plans that honour the resident’s wishes, values and choices.


The INSPIRED COPD Outreach Program™ is a hospital-to-home care model that provides patients with moderate to severe COPD, and their families, with the information, tools and support they need to better manage their illness in their home. CFHI has recently supported teams to scale the INSPIRED approach to reach even more providers, organizations and patients.

Paramedics and Palliative Care

Together with the Canadian Partnership Against Cancer, the Paramedics and Palliative Care program is bringing vital in-home palliative care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.

Priority Health Innovation Challenge

Through the Priority Health Innovation Challenge, we are supporting project teams to connect and share with others who are working to improve access to mental health and addictions services, or home and community care. This program is running until October 2020 and there are funding opportunities for participating teams.

Momentum Challenge

The Momentum Challenge is a by-invitation program that brings together teams that have completed CFHI collaboratives that are delivering better care closer to home and the community. Through the Challenge, we support teams so they can sustain and spread their improvements even further.

Tool / Resource

Value-Based Healthcare Toolkit
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Tool / Resource

Engagement Guiding Principles
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Working Shoulder-to-Shoulder in an Age of Physical Distancing
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