Background

Unpaid caregivers—family members, friends, and neighbours—form the backbone of Canada’s care system, supporting people with chronic conditions, disabilities, and age-related needs. Yet their essential contributions remain under-recognized and under-supported across health and social systems. Canada’s ongoing healthcare crisis and workforce shortages have intensified pressures on caregivers while deepening inequities in access to care.

To fill critical data and policy gaps, the Canadian Centre for Caregiving Excellence (CCCE) launched the 2025 National Caregiving Survey—a comprehensive, pan-Canadian study designed to inform the development of equitable and integrated care systems. Grounded in co-design, the survey was developed through extensive consultation with caregivers, care recipients, and community partners with lived experience, ensuring its framing reflects the realities and priorities of those most directly affected.

The initiative aligns with four pillars of the International Foundation for Integrated Care (IFIC) framework:

Pillar 2: Population health needs and local context

Pillar 3: People as partners in health and care

Pillar 6: Workforce capacity and capability

Pillar 7: Digital solutions

Approach

The 2025 National Caregiving Survey engaged over 3,000 respondents from all provinces and territories, including caregivers, care recipients, care providers, and double-duty caregivers. Co-developed with individuals with lived experience, the survey prioritized inclusivity and accessibility, amplifying voices from Indigenous, racialized, rural, and newcomer communities.

Key domains examined caregiving intensity, health and well-being, access to services, financial and employment impacts, and interactions with health and social systems. New modules explored digital health use (Pillar 7), culturally safe care, and transitions between care settings. Quantitative data were weighted to reflect national demographics, and qualitative responses were thematically analyzed to identify population-specific differences (Pillar 2) and workforce touchpoints (Pillar 6).

Results

Preliminary findings reveal that one in four Canadians provides unpaid care, averaging 20 hours per week, with nearly one-third identifying as high-intensity caregivers. Despite regular engagement with formal care systems, only 38 percent feel meaningfully included as partners in care planning—underscoring persistent gaps in Pillar 3: People as partners in health and care.

Over half report significant mental health strain, and one in five have reduced paid work or left employment due to caregiving demands, indicating systemic challenges in Pillar 6: Workforce capacity and capability. Caregivers from Indigenous, racialized, rural, and low-income communities experience higher burden and fewer supports, reinforcing Pillar 2: Population health needs and local context. Encouragingly, caregivers engaged with integrated care teams or supported by digital tools (Pillar 7) report greater satisfaction, improved coordination, and enhanced well-being.

Implications

The 2025 National Caregiving Survey underscores that caregivers must be embedded as full partners in integrated care systems. Meaningful inclusion of lived experience (Pillar 3) and responsiveness to population needs (Pillar 2) are essential for equitable, person- and family-centred care. Strengthening the paid and unpaid care workforce (Pillar 6) and expanding inclusive digital solutions (Pillar 7) can improve coordination, sustainability, and outcomes.

By grounding system reform in lived experience and integrated care principles, Canada can build a resilient, equitable, and people-centred care system that truly values caregivers as essential partners in care.

Background:
Half of women over eighty are estimated to have osteoporosis, contributing to 180,000 fractures annually in the UK, with substantial personal and economic costs, despite clinically effective treatments and national guidelines being available.

This work evolved from speaking with 32 women aged 70+ across five groups about the Women’s Health Strategy for England (2021). These women told us they felt ‘unseen’, ‘unimportant’, ‘unheard’, and ‘uninformed’, and that 55+ was too broad a catchment for ‘older women’ (OW). They also prioritised bone/joint health and osteoporosis.

Aim
To use insights from the experiences of OW and primary healthcare practitioners (HCPs) to develop strategies to improve osteoporosis management in primary care.

Methods
Data generation
We interviewed 30 community-dwelling OW (aged 70+) diagnosed with osteoporosis (11 from South Asian heritage), and 30 NHS primary HCPs, including GPs, nurses, physiotherapists, and pharmacists. We used a Constructivist Grounded Theory approach to explore knowledge, communication, care pathways, and self-management practices. We reviewed findings with our co-production group comprised OW and HCPs.

Stakeholder involvement
A local advocate for the Royal Osteoporosis Society joined us as a co-applicant on the Project Management Group and helped produce the protocol and patient facing materials, and facilitate the ‘open days’.

We held two ‘open days’ for the public. Following these, seven OW and three HCPs joined our co-production group. We held a separate group for three South Asian older women which was conducted in Punjabi. We met from August 2024 to August 2025.

Key findings, impact, and outcome
HCPs acknowledged osteoporosis as clinically important, but guidelines were inconsistently applied, and follow-up was erratic due to a lack of standardised care pathways or incentivised monitoring.

OW normalised symptoms as part of ageing, delaying investigations or treatment. Most were unclear about diagnosis, prognosis, or treatment plans. Self-management was accepted but inadequately supported, with information frequently generic or absent. South Asian women experienced additional cultural, linguistic, and logistical barriers.

Routine engagement with the wider primary care team was rare, with allied health professionals an underused resource. Digital communication further limited OWs engagement/re-engagement. Older women wanted accessible, reliable information and empathetic support.

OW and HCPs taking part in the study expressed how their involvement made them think about their attitude and actions regarding osteoporosis in future.

We co-produced a set of recommendations for use in primary care and public health promotion.

Implications
Worldwide, osteoporosis remains poorly understood and inadequately managed. Ageing demographics are a global challenge, compounded by multi-morbidities. Many OW accept care gaps due to limited awareness and lack of meaningful interaction with HCPs. Those aged 70+ face particular barriers, including multimorbidity, digital exclusion, and low self-efficacy. Cultural and communication differences further shape the care experiences of ethnic minorities.

Improved care navigation and greater involvement of the wider primary care team could enhance engagement and support better self-management.

Background: Malnutrition affects 20-45% of hospitalized adults in Canada and when left unresolved can significantly impact post-discharge recovery. The Canadian Malnutrition Task Force outlines pre-discharge actions by hospital dietitians to support patient self-management at home: Action 1: Recommend community resources; Action 2: Refer to community-based dietitians; and Action 3: Facilitate nutrition follow-up by primary care provider. This study aimed to identify barriers and enablers for these actions from the perspective of inpatient dietitians within one Canadian provincial health system serving ~ 4 million people.

Approach: An online survey with open-ended questions was designed with dietitian advisors and circulated to all inpatient dietitians via provincial nutrition services leadership for anonymous completion. Themes related to barriers and facilitators for recommended actions were identified using conventional content analysis. Optional follow-up interviews provided context for emerging themes. Dietitian advisors were engaged in interpretation and dissemination to inform system change.

Results: 57 geographically diverse dietitians completed the survey, working in inpatient-only (39%), inpatient plus community (56%) or inpatient plus administrative roles (5%). Responses indicated that Action 1 (Recommend) was common practice but faced barriers including narrow eligibility criteria for subsidized services; high cost and low availability of grocery or meal delivery; and lack of meal preparation support. Constantly changing community services created reticence to make recommendations. Action 2 (Refer) was also part of usual practice, with barriers including long wait times for community-based dietitians; low confidence that high acuity patients would be prioritized; and uncertainty about “who and how” when referring to primary care dietitians. Low staffing of community-based and primary care dietitians was a clear contributor, while minimal feedback on patient outcomes after discharge caused doubt about whether pre-discharge actions were effective. Action 3 (Facilitate) was rarely part of usual dietitian practice. The main barrier was physician-centric hospital-to-primary care communication, with little room for dietitians to communicate directly with primary care providers. Respondents emphasized that if the hospital physician did not prioritize nutrition, malnutrition would not be communicated to primary care; this was accompanied by doubt that patients would initiate nutrition care in the community. Finally, an overarching theme was the importance of interdisciplinary communication, collaboration and relationships when preparing patients to manage malnutrition.

Implications: Considering the prevalence of malnutrition in hospital, systemic and individual-level actions should be taken to support self-management of malnutrition after discharge. 1) System: Subsidize meal delivery, grocery delivery and in-home meal preparation for people with malnutrition. Individual: Providers of these services connect regularly with inpatient dietitians to support accurate recommendations. 2) System: Prioritize availability of dietitians in primary care and community. Individual: Community and primary care dietitians regularly clarify referral processes with inpatient dietitians and provide feedback about results of pre-discharge actions. 3) System: Re-imagine physician-centric processes to enable inpatient dietitians to communicate with primary care providers about nutrition concerns. Individual: Primary care providers ask hospital physicians about nutritional therapy in hospital and screen regularly for malnutrition. Overall, communication and collaboration between multi-disciplinary hospital providers, community-based providers, patients and caregivers is essential to support nutritional recovery after hospital discharge.

Bevan Exemplar Project
Christine Roach and Jules Godden – EPP Cymru, Performance and Improvement, NHS Wales

Background:
EPP Cymru has delivered self-management education for 20 years, empowering people with chronic conditions to live healthier lives and reduce NHS pressures. With 48% of adults in Wales living with long-standing illness, there is an urgent need for sustainable, community-based support. Peer support offers emotional, practical, and social benefits, aligning with Welsh Government priorities for prevention and person-centred care.

Aims and Objectives:
To establish a national EPP Peer Support Service that complements self-management education, builds resilient communities, and improves health outcomes.
Objectives include creating accessible peer networks, reducing isolation, promoting behaviour change, and supporting NHS sustainability through prevention and reduced service demand.

Approach:
A phased plan:
• Consultation (Late 2024) – engaged patients, health boards and stakeholders via surveys and design workshops.
• Development (Early 2025) – created online and in-person models, engaged health care professionals and developed evaluation criteria.
• Delivery (Mid 2025) – three pilots delivered with immediate reviews and continuous improvement (PDSA cycles).

Outcomes:
For patients – increased confidence in managing conditions, reduced loneliness, stronger coping skills, and improved self-care.
For the NHS – early sign of fewer unnecessary appointments, proactive health monitoring, and potential cost savings through prevention.
Notably, volunteering opportunities have emerged as participants who benefited from peer support are now stepping forward to help lead and sustain future groups – creating a foundation for long-term community involvement.

Impact:
The first three peer support sessions have already driven change.
Lymphoedema (online) 16 patients
Diabetes (online) 23 patients
Osteoporosis (face-to-face) 19 patients
Participants reported feeling more connected and empowered, while health boards noted improved engagement and early intervention behaviours. These developments mark the beginning of a shit toward sustainable community-driven support that enhances wellbeing strengthens social networks and aligns with Welsh Government priorities for prevention and resilience.

Key Conclusions:
Peer support is proving to be a practical, cost-effective complement to clinical care. Early results confirm its potential to empower individuals, reduce NHS pressures, and foster resilient communities. Success depends on continued collaboration across health boards, voluntary partners, and local networks to scale and embed this model nationally.