As Ontario’s population grows and ages, the health care system faces a growing challenge: how to meet increasingly complex needs while preserving dignity, independence, and human connection. The Projected Patterns of Illness in Ontario study predicts that by 2040, one in four adults will be living with a major illness — a reality that will place even greater strain on hospitals, long-term care homes, community agencies, and families. Yet within these challenges lies an opportunity to reshape how we care for older adults, shifting away from fragmented, reactive models toward collaborative and person-centered approaches. ​

At Baycrest, this work is already underway. Deb Galet, President and CEO at Baycrest Hospital and Apotex Centre, Jewish Home for the Aged, shares how new models such as the Neighbourhood Care Team are bringing health and social care directly into seniors’ homes, easing system pressures, and helping people remain safely connected to their communities. In the conversation that follows, she reflects on the urgent need for integration, the power of team-based care and the importance of keeping older adults at the centre of every decision. 

Meeting Evolving Needs with Humanity 

Every day I meet older adults and families navigating the realities of aging — balancing resilience with uncertainty and a strong desire to remain independent. Longer lives now often come with multiple health conditions, memory changes, and a growing (albeit reluctant) reliance on supports. The result is mounting pressure across hospitals, long-term care homes, community services, and families, all working to keep pace with needs that are growing faster than the system is equipped or funded to handle. The challenge before us is how to meet this demand with compassion while building care that protects what matters most: dignity, independence, and connection. 

Care Beyond Hospital Walls 

The Neighbourhood Care Team (NCT) is reimagining how seniors receive support by bringing health and social care directly into their homes. Led by Baycrest, Sunnybrook, and SPRINT Seniors Care, in collaboration with the Toronto Seniors Housing Corporation and local health partners, the NCT connects existing providers into one coordinated team. 

With physicians, nurses, social workers, pharmacists, rehabilitation specialists, and community agencies working together, the program helps older adults overcome barriers to accessing care and avoid unnecessary moves into hospital or long-term care. Since its launch, the NCT has supported seniors across eight Toronto Seniors Housing buildings, improving access, easing system pressures, and, most importantly, helping people remain safely at home and connected to their communities. 

Preventing Decline Through Early, Team-Based Support 

The most effective way to prevent decline and avoid emergency visits is through early, team-based care. Medication reviews, falls prevention, caregiver education, and psychosocial supports all make a difference. When these are delivered together, with the older adult and family as part of the team, outcomes are stronger, and lives are more stable. 

For Dorothy, who lived alone in a Toronto Seniors Housing building, an acute medical episode nearly meant a permanent move to long-term care. Instead, the NCT coordinated with her primary care provider, prepared her home for her changing needs and connected her with the proper supports. Nearly two years later, Dorothy remains safely at home, illustrating how proactive, collaborative care can transform lives. 

Integrating Care Across the Continuum 

Integration is the next frontier. Too often, gaps appear when older adults move between hospital and community. By strengthening connections with primary care, sharing information more seamlessly, and involving community agencies early, we can ensure older adults experience care as a continuum, not a series of disconnected steps. 

Our work beyond the Baycrest campus, with care teams and partners across the system, is focused on building that integration. That may involve transitional care units that bridge the hospital-to-home gap, or joint planning sessions with community agencies to prepare families well before discharge. In one case, a team approach helped ensure a newcomer to Ontario received essential psychiatric medication at home after discharge, avoiding relapse and re-hospitalization. The common thread is partnership — recognizing that no single organization can meet the needs of older adults in isolation.

A Message to Leaders 

My career began as an occupational therapist, where I learned to look beyond illness and see the person, their abilities, their goals and what gives them meaning, which is different for everyone. That perspective continues to guide me. When we design health systems, the same principle applies. We must focus on ability rather than limitation. 

By listening to older adults and their families, we hear what matters most, including safety, independence, connection, and dignity. When we build services around these priorities, care becomes both compassionate and sustainable. 

The opportunity before us is to transform aging by keeping older adults at the centre of every decision. If we do that, we will not only ease pressure on the system but also create a future where every person can age with purpose and fulfilment. 

I am reminded every day, in conversations with older adults and families, why this work matters. Their courage and resilience inspire me to keep pushing for a system that truly honours them. ​