Towards Social Services System Integration: A report from Alberta’s Elder Care Support Provision Community


  • Connor Martin Walsh
  • Akram Khayatzadeh-Mahani
  • Myles Leslie



Family caregivers are a significant unpaid labour force that provides at least 70% of all care to seniors in the community. It was estimated in 2009 that the formal Canadian healthcare system would have to spend $25 billion annually to replace the contributions of family caregivers. More recent estimates have placed the value of family caregiver labour as high as $66.5 billion.  While a wide range of public and private services are generally available to support family caregivers, many potential clients have difficulty both gaining access, and navigating those services once they have gained access. In this sense, they experience a highly fragmented ‘system’ of social support provision. As the population of older adults living in the community grows, and with it the demand for family caregivers’ provided support, policy attention has become increasingly focused on integration as a solution to the fragmentation challenge.  The family caregiver support sector was singled out by a Special Senate Committee in 2009 as particularly likely to benefit from integration.  Integration, the committee found, would allow the sectors to better address the needs of community-dwelling older adults with chronic health conditions, improve the financial sustainability of the formal healthcare system, and make necessary support services more accessible. Beyond the specifics of family caregiving, policy conversations and major reforms around the world have similarly focused on the need for increased integration of care, both in health and social services.

Recognizing that integrating fragmented social and healthcare systems is a wicked problem generally, and a particularly urgent matter for the family caregiver support services (FCSS[1]) ‘system,’ the School of Public Policy (SPP) organized a day-long event drawing stakeholders together.  The event originated in the FCSS community’s own desire to better understand and accomplish integration.  As a facilitated discussion, it was designed as a space for participants to move away from talking about integration, and towards making both it, and the concept of a ‘system’ of care, real.

In organizing the event and in line with a well-developed scholarly literature, we framed the problem of fragmentation as a ‘structural’ issue caused by, among other factors, divergent mandates, competitive funding models, disjointed assessment processes, and a lack of co-ordinated transition. Similar to other researchers, we saw the solution to fragmentation as integration through the lens of organizational structures, joint services, shared assessments, and coordinated planning. However, when we presented these concepts to the FCSS community, they initially connected with them, but quickly diverged away from the structural recommendations and instead generated their own initiatives through conversations and relationship building.  We found that the act of bringing service providers together to share experiences, learn about each other, and develop their knowledge of services is the foundation upon which the various structural elements are built. The structural interventions are not the pathway to real integration, because they cannot be undertaken without a number of preconditions in place. Trust, consensus, and collaborative relationships are the necessary preconditions to integration, in whatever form it may take. In other words, an unsiloed system does not emerge from structural reforms, but rather from trusting relationships, consensus, and the resources and space for collaboration.  The event provided participants with the opportunity to set agreed-upon goals for the sector to work on together. The collaborative space that FCSS community members envisioned during the event, along with the ambitious work packages they prioritized for action inside that space, were practical, implementable visions of integration as an activity emerging from a community working together.

[1] The acronym FCSS is also commonly used in Alberta's social support community for Family and Community Support Services, which is a unique 80/20 funding partnership between the Government of Alberta and participating municipalities or Métis Settlements. 



Abdelmoneium, A.O., & Alharahsheh, S.T. (2016). Family home caregivers for old persons in the Arab region: perceived challenges and policy implications. Open Journal of Social Sciences, 4, 151.

Anderssen, E. (2015). How to fix Canada’s mental health system. The Globe and Mail.

Armitage, G.D., Suter, E., Oelke, N.D., & Adair, C.E. (2009). Health systems integration: state of the evidence. International Journal of Integrated Care, 9.

Banks, P. (2004). Policy Framework for Integrated Care for Older People. King's Fund. London.

Bergman, H., Béland, F., Lebel, P., Contandriopoulos, A.-P., Tousignant, P., Brunelle, Y., et al. (1997). Care for Canada's frail elderly population: fragmentation or integration? Canadian medical association journal, 157, 1116-1121.

Carstairs, S., & Keon, W. (2009). Special Senate Committee on Aging: Final Report. Ottawa, ON: Government of Canada.

Cohen, C.A., Colantonio, A., & Vernich, L. (2002). Positive aspects of caregiving: rounding out the caregiver experience. International Journal of Geriatric Psychiatry, 17, 184-188.

Cowan-Levine, C. (2017). Death by a thousand cuts. The Walrus.

Eales, J., Keating, N., Donalds, S., & Fast, J. (2015). Assessing the needs of employed caregivers and employers. Edmonton: University of Alberta, Research on Aging, Policies and Practice.

Fast, J. (2018). Unpublished analysis of Statistics Canada 2012 General Social Survey on Caregiving and Care Receiving.

Hollander, M.J., Liu, G., & Chappell, N.L. (2009). Who cares and how much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly. Healthc Q, 12, 42-49.

Keating, N.C., Fast, J.E., Lero, D.S., Lucas, S.J., & Eales, J. (2014). A taxonomy of the economic costs of family care to adults. The Journal of the Economics of Ageing, 3, 11-20.

Kodner, D.L., & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications–a discussion paper. International Journal of Integrated Care, 2.

Kwok, E. (2012). he 13 pieces of a fragmented healthcare system. Canadiem.

MacAdam, M. (2008). Frameworks of integrated care for the elderly: a systematic review: Citeseer.

Philippon, D.J., & Braithwaite, J. (2008). Health system organization and governance in Canada and Australia: a comparison of historical developments, recent policy changes and future implications. Healthcare Policy, 4, e168.

Ramagem, C., Urrutia, S., Griffith, T., Cruz, M., Fabrega, R., Holder, R., et al. (2011). Combating health care fragmentation through integrated health services delivery networks. International Journal of Integrated Care, 11.

Ravenscroft, E. (2005). Access within a fragmented healthcare system: A nurse's perspective on Romanow. Nursing Leadership, 18, 1-12.

Schulz, R., & Sherwood, P.R. (2008). Physical and mental health effects of family caregiving. Journal of Social Work Education, 44, 105-113.

Stacey, A.F., Gill, T.K., Price, K., Warmington, R., & Taylor, A.W. (2016). Unpaid Informal Caregivers in South Australia: Population Characteristics, Prevalence and Age-Period-Cohort Effects 1994–2014. PLoS ONE [Electronic Resource], 11, e0161994.

Taylor, M., & Quesnel-Valle, A. (2017). Caregivers need more support to figure out health and social systems. The Toronto Star.

van Duijn, S., Zonneveld, N., Montero, A.L., Minkman, M., & Nies, H. (2018). Service Integration Across Sectors in Europe: Literature and Practice. International Journal of Integrated Care, 18.

Williams, A., Sethi, B., Duggleby, W., Ploeg, J., Markle-Reid, M., Peacock, S., et al. (2016). A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective. International Journal for Equity in Health, 15, 40.


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Briefing Papers