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Better at Home – United Way, British Columbia
Background: Aging-in-place model and setting
Better at Home is a seniors-focused and community-centered program developed by Healthy Aging at United Way British Columbia (BC) in partnership with the province and organizations in the community-based seniors’ service (CBSS) sector. The program’s origins date to 2006 and the call by the Premier’s Council on Aging and Seniors’ Issues (following an extensive, provincewide engagement process with seniors and their families) for a non-medical home support program that would enable older adults to remain living independently, with dignity, in their homes and local communities.
The program was designed by teams at United Way BC (known as United Way of the Lower Mainland at the time) and the Province of BC’s newly formed Seniors’ Secretariat through a three-year pilot. Following the success of the Community Action for Seniors Independence (CASI) project and the trial of its seniors-centered community-development approach in five communities across the province, the Better at Home program was launched in 2012 with funding from BC’s Ministry of Health.
Better at Home programs support seniors with services ranging from help with day-to-day tasks to social visits. Initially, the programs delivered a set of seven core services. However, over time, service gaps, evolving needs and the involvement of new host organizations prompted the expansion of these offerings to include a broader range of services. Now, services might include friendly visits in seniors' homes, light housekeeping, transportation to appointments, prescription pick-up, light yard work, minor home repairs, prepared meal delivery, grocery shopping, snow shoveling and, in rural areas, chopping firewood.
The choice of services varies by community, reflecting local assets, organizational capacity and input from seniors. Designed to complement existing resources, they address the specific needs of local seniors. Similarly, Better at Home services are delivered by volunteers, contractors and paid staff from local non-profits, with decisions made at the community level.
Better at Home is funded by the Province of BC, through the Ministry of Health, managed by United Way BC, and delivered locally, largely by not-for-profit organizations in the CBSS sector. Funding is provided to local programs based on the demographics of the community, including the number, age and household income of its older adult population, as well as factors such as urban/rural status, travel distances and climate.
The Better at Home model now exists throughout BC, with more than 90 CBSS agencies delivering services to more than 260 communities. Its seniors- and community-centered approach means that local organizations are responding directly to local seniors’ needs. In 2023 alone, almost 14,000 older adults participated in the program and more than 285,000 services were delivered.
In collaborating actively with the CBSS sector – defined as not-for-profit organizations serving seniors, seniors’ community centres and seniors-led organizations and coalitions, neighbourhood houses, municipal agencies and other organizations offering accessible services and programs, from affordable housing to recreational activities – United Way BC has developed a service model under Better at Home that is adaptable and attuned to seniors' individual needs.
A defining feature of Better at Home is its “nothing about us without us” or “seniors-planning-for-and-with-seniors” approach. In every community, older adults are involved in the planning, implementation, and evaluation of local programs. This inclusive approach ensures that seniors remain actively involved, connected and engaged, resulting in services that are tailored and meaningful to them. By identifying host organizations and building collaborations amongst local organizations, the Better at Home model creates a program that allows for connections to grow and strengthen in ways required by seniors where they live.
Most Better at Home programs start with a local advisory committee composed of older adults, service providers, home and community health practitioners and others who guide the program’s development, ensure its responsiveness to local seniors’ needs and advocate for its integration into the community’s social and service landscape. All programs submit regular reports to the provincial Better at Home office at United Way BC to monitor performance and progress.
Program coordinators (many of whom are older adults) engage in a regional community of practice, which includes sharing learning activities, discussing best practices through an online platform and meeting annually for training opportunities and participation in collective dialogue. These activities help develop the capacity of each local program to best serve and support the older adults in BC. At the core of this is the motivation to keep the program not only community focused, but also community borne.
A basic premise of Better at Home is that independence and connection to community are key to healthy aging. By intentionally committing to community engagement within the program and creating support for seniors to remain at home longer, Better at Home remains relevant and meaningful. Most importantly, through its model of asset-based community development, Better at Home acknowledges and celebrates the unique qualities, demographics and possibilities within each community. What distinguishes Better at Home is its pioneering approach, centered on genuine, person-to-person connections within communities. By fostering these connections, meaningful relationships are developed, and profound insights are gained into the diverse tapestry of individuals shaping the community landscape.
United Way BC Healthy Aging’s new program service model: Better at Home
In 2023, the Province of BC made a 70 million (CAD) investment to expand Better at Home and other community-based programs. Beginning in 2024, United Way BC has been rolling out a new Healthy Aging program and service model that includes a “Better, Better at Home”. This new model addresses key areas of improvement that have been uncovered in past consultations with the CBSS sector and evaluations of the Better at Home program, including:
- the need to shift from task-oriented delivery of services to placing social connection at the heart of all services
- providing increased flexibility for service offerings in response to community needs
- targeting resources towards vulnerable seniors with the greatest need
- encouraging collaboration
Better at Home programs are now able to offer a broader range of non-medical services in response to community need and available funding, including information and referral, social meals, peer support, transportation to non-medical appointments, enhanced light housekeeping and expanded group activities. Grant funds are also available to programs to incorporate friendly visiting within their light housekeeping services.
The new model also requires the formation of Healthy Aging Community Collaboratives to encourage further collaboration between CBSS agencies, other non-profit and voluntary organizations, municipal and health care partners, and other key partners within communities. These Healthy Aging Community Collaboratives have access to new funding for Community Connector (CC) positions and Healthy Aging Enhancement Grants (for transportation supports and innovations, social meals and volunteer coordination and strategy).
The CC positions build and expand upon the success of the social prescribing demonstration project with both stronger connections to the health system and a process for phasing in these positions, over the next two years, in every region and community across BC. Social prescribing is a process that helps older adults access health promotion services, such as wellness programs and social activities, as well as support addressing social determinants of health. Seniors are referred to a local social prescribing program by their primary care physician, other care providers or community agency, and then a CC supports the older adult to connect to community resources. The CC may be based either at the Better at Home agency or another CBSS agency or organization.
Engagement approach with community
Cultivating connectivity: Asset-Based Community Development approach for relationship building
The backbone of Better at Home is built from key takeaways that United Way BC has learned from its engagement with the CBSS sector. First amongst these is a recognition that relationship building is essential for fostering trust and cohesion. This process demands a dedicated commitment of time and resources, using a community development approach where seniors and community agencies collaborate to cultivate a sense of ownership and commitment to the program.
When the Better at Home model first was implemented, participating communities were selected by the provincial office with help from regional experts. These experts provided local knowledge, enabling the identification of communities with high populations of vulnerable seniors who would benefit most from support. United Way BC also assessed the presence of local organizations, their history of collaboration in service or program delivery and whether they had existing relationships with United Way BC.
This asset mapping went beyond evaluating the strengths of seniors and their community, delving into the capabilities of local organizations and relationships between them. It helped identify potential host organizations that were able to lead and build local partnerships. While some communities had strong host organizations with a proven ability to collaborate, others required more time to develop the capacity for robust collaboration.
As the Better at Home program grew, a regional community developer visited potential communities and conducted preliminary asset-mapping. The exercise served to acknowledge and make visible pre-existing strengths as well as needs in the community, its social resources and infrastructure, and the ways in which healthcare, community-based care and other social determinants of health were interconnected. United Way BC’s asset-based community development approach emphasized a strength-based perspective. By leveraging existing strengths, they co-develop programs with local communities, using these assets as starting points and tools for improvement. Their engagement strategies prioritized capability over need, recognizing that inherent capabilities exist within both individuals and communities. Ultimately, their asset mapping and engagement strategies reflect a core belief: community-level solutions are not just possible, but essential.
This approach was further strengthened by a flexible and responsive process during program identification and early implementation. Staying attuned to the intricacies of local contexts and the people who lived there allowed them to identify communities needing additional support to build capacity, foster connections with other communities or collaborate with other organizations. By remaining open to the unique dynamics of each community, United Way BC ensured their programs were both impactful and grounded in local realities.
Unlocking potential: Handbooks as supportive tools for effective engagement
United Way BC developed a handbook during the program’s provincial roll-out in 2012 that has served as a key tool for community-engaged implementation of the Better at Home program. The handbook offers essential support to local coordinators as they navigate the implementation process. It helps ensure the Better at Home program remains aligned with its guiding principles of senior-centred community development. The handbook underscores the importance of collaborating with other local organizations, establishing a local advisory committee, identifying the unique services and programs a community wants, and ensuring engagement remains consistent and meaningful, among other things. The handbook equips coordinators and communities with the framework, steps and inspiration to effectively develop and sustain Better at Home. Central to implementation is the development of a Memorandum of Understanding between the community and Better at Home, ensuring clarity of roles, responsibilities and collaboration. This framework fosters alignment among organizations, engages key actors and amplifies community voices to shape the program effectively.
Creating relationship links: Regional community developers
Regional Community Developers (RCDs) play a key role in supporting Better at Home Coordinators and their programs across BC. RCDs serve as a vital link between the co-ordinator, host agency, community and United Way BC. They possess an intimate understanding of community dynamics in their region, facilitate communication between United Way BC and the community, address questions about the program, create connections with the healthcare system and other entities responsible for the social determinants of health, ensure budgeting and oversee reporting procedures. Their recruitment is based on several factors, including their deep-rooted connections within the community, alignment with the United Way BC team's values, diverse life experiences, established trust within the community and proficiency in asset-based community development.
As the new Healthy Aging Program and service model is rolled out in 2024 and 2025, RCDs will intensify their focus on community development efforts by leveraging existing community assets, mobilizing these resources effectively, fostering regional communities of practice and convening at annual meetings to exchange their insights and experiences. In addition, they will investigate training needs and disseminate best practices throughout their regional networks. This enhanced role and level of engagement underscores the program's commitment to empowering communities and maximizing their potential by valuing relationships at all levels.
Empowering community: Bridging gaps through collaboration-building grants
United Way BC's commitment to sustaining community engagement is also evident through its focus on community collaboratives as a part of the new service-delivery model. The commitment to collaboration has been strengthened through the introduction of a collaboration-building grant where communities can apply for up to CAD 5,000 towards establishing close partnerships with other organizations – ultimately creating stronger grant applications. The grant monies can be used for renting a venue and hosting an event with other community members to understand the scope of local resources, and how they want to proceed with applying for Healthy Aging Enhancement Grant funding.
The phased roll-out of community connectors (CCs) across the province over the next two years also will serve to strengthen community collaboration. CCs will support the community at the local level, identifying priorities, addressing service gaps, sharing resources and matching assets. The strength of the CC role lies in their immersion in the community and a growing recognition by the health system of the importance of community-based seniors’ service (CBSS) and role CCs play in supporting seniors to age well in their own homes and communities.
CCs are instrumental in bridging the gap between local communities and organizational resources. For example, a CC might take a senior out to coffee to understand their interests and needs, and then link them with appropriate social connections. A CC might also work at a more organizational level, helping to develop and coordinate services within the community and between the community and the health system (e.g. facilitate referrals not only to CBSS, but also from community to the health system). CCs serve as liaisons, leveraging their intimate knowledge of community dynamics and connections to the health system and other social determinants of health to identify priorities, address gaps and facilitate collaborations. By focusing at both individual and organizational levels, CCs play a pivotal role in maximizing the community’s assets and collaborative potential.
Engagement across the CBSS sector
Better at Home is the flagship program of United Way BC’s healthy aging initiatives. Its impact has been bolstered by the development of a provincial partnership and networking model in collaboration with the CBSS sector. United Way BC was a key partner on the Raising the Profile Project, a grassroots community-driven initiative aimed at uniting and raising the profile of the CBSS sector in BC. This work culminated in the inaugural Provincial Summit on Aging in 2017, which highlighted the crucial role of the CBSS sector in supporting older adults.
Building on this foundation, the Province of BC provided funding for pilot projects, including integrated community-based programs for older adults with higher needs and a social prescribing initiative. Another outcome of this work was the development of the Healthy Aging CORE BC (Healthy Aging Collaborative Online Resources and Education) knowledge hub. This virtual network brings together interest holders to learn, share and collaborate. Healthy Aging CORE BC and its bimonthly newsletter provide a key mechanism for engagement with the CBSS sector.
A cornerstone of United Way BC’s community engagement is their CBSS Leadership Council, a legacy of the Raising the Profile Project. Comprising seniors and diverse community stakeholders, the council serves as a vital advocacy body for CBSS. By intentionally fostering leadership that reflects the diverse backgrounds and regions of BC, the council ensures inclusivity and avoids overrepresentation of urban or Lower Mainland perspectives. This diverse representation allows the council to amplify awareness of CBSS and advocate effectively for policy changes and increased funding.
The CBSS Leadership Council plays a vital advocacy role that United Way BC or any other part of the CBSS sector cannot. By encompassing a truly diverse network across multiple communities, it influences policy and engages with policymakers to address the unique needs of seniors. The Council also advocates for sustained local programs and increased funding.
In addition to its advocacy role, the council reflects the varying perspectives that interest holders have on aging and social services. As a meso-level player within Better at Home, the council mirrors the spectrum of views on what it means to be ‘better at home’. By highlighting these differences, the council emphasizes the importance of inclusivity and engagement dynamics, ensuring the program continues to be effective and sustainable.
Conclusion
Key learnings from Better at Home underscore the prime importance of relationship-building as a component of providing effective and meaningful seniors’ services. By requiring a dedicated commitment of time and resources to nurture meaningful connections and collaborations across organizations and within community, seniors at the local level can visualize a community that works for them. When a community development and assets-based approach is adopted, engagement comes more naturally, and all actors feel ownership and pride over their program’s unique place in their community.
A collective responsibility emerges from Better at Home, not only from the services it provides, but also from the ways in which those services are created. The Better at Home initiative embodies a profound respect for both individuals and communities, rooted in recognizing the strengths, demographics and inherent potential of each community. It mirrors United Way's ethos, which is characterized by a nuanced appreciation for the diverse perspectives that shape policy and program development.
The Healthy Aging community collaboratives, CCs, RCDs and the CBSS Leadership Council are complementary “tools” to not only foster partnership and collaboration and to encourage deeper and new community connections, but also to advocate for broader policy and system changes. Thanks to Better at Home, and United Way BC’s broader Healthy Aging initiatives, there is now nationwide interest in CBSS, a sector that was relatively obscure a decade ago.
Other provincial government leaders now are taking note of United Way BC’s community engagement model. Inspired by the work in BC, Alberta has developed Healthy Aging Alberta and is implementing its own aging-in-place models. At the national level, the inaugural CBSS Sector Summit was held in June 2024, and a National CBSS Leadership Council has been established.
