Call for Applications Open: Advancing Frailty Care in the Community Collaborative

July 9, 2019

The call for applications is now closed. CFHI will communicate directly with all applicants. A merit review will take place and teams will be announced in the coming months.

To improve care for older people with frailty and support their caregivers, the Canadian Foundation for Healthcare Improvement and Canadian Frailty Network invite you to join the Advancing Frailty Care in the Community (AFCC) Collaborative. This initiative will help you enhance your capacity to partner with patients and family/friend caregivers to improve the identification, assessment and implementation of tailored evidence-informed interventions that address frailty in primary care. Whether your organization already has clearly established approaches for older people with frailty or is looking to develop some for the first time, our goal is to help you deliver more improvement, for more people, that lasts.

As the Canadian population ages, there is an urgent need and a tremendous opportunity to improve care and quality of life for older people living with frailty and to support their family/friend
caregivers. These caregivers are often the family and friends of older people, with more than two million Canadians providing care to family members because of age-related needs. Although the
emergence of frailty and its progression are not inevitable and pre-determined outcomes of aging, as the population continues to live longer the likelihood of frailty increases, with 25% of Canadians over the age of 65 becoming frail, increasing to more than half in the over 85 age group.3 With this shift, and greater awareness that this growing population is currently under-recognized and under-served, the time is right to improve the lives of those impacted by frailty and their caregivers, while ensuring older Canadians are getting the right care, closer to home.

This 23-month collaborative, taking place between November 2019 and September 2021, is based on some of the top frailty innovations from the 2018 CFN Frailty Matters Innovation Showcase. These applied innovations were presented by practitioners and experts across Canada and have been selected to be spread further across the country through this collaborative.

Using a quality improvement (QI) approach in a primary care setting, teams will systematically identify and assess frailty in populations 75 years of age and over, with opportunistic screening for those 65 and over. Teams will then implement customized care plans for those who are frail, in partnership with their caregivers, towards slowing the progression of frailty and maintaining or enhancing quality of life.

This collaborative will use an all-teach-all-learn approach, with numerous peer-to-peer networking opportunities, measurement and evaluation support and access to a network of expert faculty and coaches. It will provide up to $1,000,000 in implementation seed funding support shared across up to 20 interdisciplinary teams. This amount will be divided and distributed based on demonstrated needs of each team during the application process.

Through this process CFHI and CFN aim to:

• Support teams to implement the AFCC Collaborative intervention areas.

• Improve quality of life for older adults presenting to primary care who score 4-6 (vulnerable to
moderately frail) on the Clinical Frailty Scale.

• Support capacity development for QI, change management and leadership, particularly as it
relates to spreading and sustaining frailty-related improvements

Teams will test and adapt evidence-informed innovations (or portions thereof) that address each of the seven areas below: Frailty Identification; Geriatric Assessment; Tailored Interventions; Person and Family Centred-Care; Collaborative Care; Community Supports; and Quality Improvement.

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