Who We Are
Seniors Care Network is responsible for the organization, coordination and governance of specialized geriatric services (SGS) in the Central East Region of Ontario Health East.
Key services include the planning, design, implementation, evaluation, quality improvement, and performance monitoring of SGS. Applied health research is a key component of Seniors Care Network’s mandate. Additionally, subject matter expertise is provided to partner organizations including Ontario Health Teams.
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What's New
2025 GAIN ROI Evaluation Report
Seniors Care Network led a comprehensive Return on Investment (ROI) evaluation to measure the clinical and financial impact of the Geriatric Assessment and Intervention Network (GAIN), a regionally coordinated program that provides specialized, interprofessional care for older adults living with frailty and dementia.
Using a multi-pronged approach, the evaluation combined administrative data, chart reviews, ad hoc interventions data, and client, care partner, and provider surveys to assess outcomes across GAIN.
The analysis identified more than $23 million in annual system benefits, primarily through avoided long-term care placements, reduced falls/falls risk, ED avoidance/diversion, and safer medication use. This resulted in an overall ROI of ~150%, indicating that for every dollar invested, the program generated $1.50 in measurable system cost avoidance.
These findings demonstrate that GAIN provides both measurable economic return and improved quality of care for older adults and their caregivers.
Falls Prevention and Management in the Community
Falls are a leading cause of injury among older adults. This resource is intended to guide the implementation of proactive falls screening and management for older adults across community settings, including, community services, outpatient and outreach clinics, hospital ambulatory services, etc.
It proposes a 4-step, evidence-based approach that emphasizes early detection, holistic assessment, and timely connections with specialized geriatric and community-based rehabilitative services.
Frailty Screening and Management in the Emergency Department
The Guidance Document is intended to support the implementation of proactive frailty screening and management in hospital Emergency Departments (EDs), a strategy to prevent repeat/prolonged hospitalizations and ALC rates. It outlines how an older adult's (65 plus) Frailty Status can be used as a criterion to inform decisions regarding care, flow, and transitions (i.e., from the ED to back in the community and/or acute care). The 4-step approach described in the document builds on recommendations made in the ALC Leading Practices and Ontario Health Operational Direction: Home First documents. This resource was developed through extensive consultations with colleagues across the Province, and includes key implementation considerations (with relevant metrics) to track changes.
An accompanying document has been developed which includes a customizable Post ED Frailty Pathway template that can be populated with local services and programs.