Abstract

Ontario's aging population requires integrated, community-based models to help older adults age in place. The Community Wellness Hub (CWH) model meets this need by embedding proactive, interdisciplinary care within housing sites with high concentrations of older adults. Using a co-located “one-team” approach, CWH integrates health, social and housing services for individuals with complex needs. Implementation is described across seven stages: partner collaboration, governance, site selection, service tailoring, team integration, continuous evaluation and scaling. Impacts include improved member wellness and provider experience while reducing hospitalizations for ambulatory care-sensitive conditions and lowering per capita healthcare costs. This paper provides a blueprint for implementing this scalable, equity-focused model in other jurisdictions.