West Toronto Network of Community Care

The West Toronto Network is committed to addressing the needs of the community by creating a collaborative network of mental health, addictions and community support services. We aim to centralize access to increase capacity, triage needs, improve service searching, and reduce wait times. By sharing accountability and responsibility across the Network, we are able to thoughtfully address our community members’ needs in any setting. A seamless provision of coordinated services will ease the burden on families and individuals who strive to navigate the community service system.

This research project is a collaboration of investigators in Ontario, Quebec, and Alberta to support stronger primary care for older adults living with frailty. Effective assessment of frailty will allow older adults to remain in their homes and communities. Primary care clinicians will use the Assessment Urgency Algorithm tool, which uses a scale of one to six, to determine frailty level. This ensures a client is connected to the right type of service, at the right time.

Caredove has configured services to display results in 3 main categories:

  • Prevention & Health Promotion for scores 1 & 2
  • Community Support Services for scores 3 & 4
  • Specialized Geriatric Services for scores 5 & 6
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Funded ByProject Sponsor

Toronto Central LHIN

Network Search SiteAlberta Network Waterloo Wellington Network

Find and refer to 121 services across 17 organizations.

Lead Agency

Reconnect Community Health Services

Funded ByProject Sponsor

Toronto Central LHIN

Overview

  • Reintegration Care Units (RCU)
    These units support patient transitions from the hospital to short-term transitional care units in the community that provide a safe and supportive place to help patients increase strength, mobility and endurance to support their transition home or into an alternative care setting.
  • Caregiver ReCharge Programs
    These programs provide caregiver relief and improve their capacity to transition their loved one home and continue to provide care for the client while promoting their own wellbeing.  These services include in-home respite (day/night), away from home overnight respite, and/or supervised programming in a group setting during the day (i.e. Adult Day Programs).



  • The Process
    The Centralized Referral Management Team members will confirm eligibility and the client will be matched to a health service provider (of the selected program) by their unique needs and availability, with consideration given to geography where possible.
    The Health Service Provider Team members will then work with the caregiver and/or the clients’ families on a plan for service provision.
  • Agencies
    Bellwoods, Hillcrest Reactivation Centre, LOFT Community Services, Pine Villa Sprint, Providence Healthcare, Reconnect Community Health Services, Rekai Centre Transitional Care Unit, St. Hilda’s Towers Senior Care Unit, Storefront Humber, The Neighbourhood Group, West Neighbourhood House, West Toronto Support Services for Seniors, Woodgreen Community Services

Results

December 2018 project performance

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Join the West Toronto Network of Community Care

This project aims to create a single point of coordinated access to community-based health services within the West Toronto region. This Network provides an effective referral management system helping caregivers and care providers access the range of mental health, addictions and community support services available in the West Toronto region. By connecting all of the available services in our community in a unified Network, we can deliver better coordinated care, closer to home, for everyone.

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