Introduction
As Canada’s population ages, older adults (OAs) are expected to comprise nearly 30 per cent of the population by 2068, and communities, particularly in rural and remote areas, face increasing pressure to provide equitable and accessible aging care (Statistics Canada, 2022). With a growing aging population, there is a need for increased attention to OA’s health, wellbeing, and quality of life (World Health Organization, 2026). OAs’ loneliness and social isolation have increasingly become a public health concern both globally and locally (World Health Organization, 2026). OAs are more vulnerable to social isolation due to life, health, and network changes that happen with aging (Townsend et al., Reference Townsend, Chen and Wuthrich2021). These challenges are intensified by the current crisis facing long-term care in Canada, characterized by inadequate staffing and care facilities that fail to adapt to residents’ increasingly complex needs (Estabrooks et al., Reference Estabrooks, Straus, Flood, Keefe, Armstrong, Donner, Boscart, Ducharme, Silvius, Wolfson and Grinspun2020). The literature shows that these issues have worsened since the COVID-19 pandemic began in 2020 (Meisner et al., Reference Meisner, Boscart, Gaudreau, Stolee, Ebert, Heyer and Wilson2020).
The Who Cares? project (2022–2025) took place on the Sunshine Coast, a rural and partly remote coastal region of British Columbia (BC). The study was co-led by Douglas College, Emily Carr University of Art + Design, and an arts-based non-profit on the Sunshine Coast Deer Crossing the Art Farm. This three-year community-based participatory research (CBPR) project used participatory design and community-engaged arts (Wilkinson et al., Reference Wilkinson, Reid, Raber, Hannan, Simeone, Gray, Verhoeven, de Götzen, Bakırlıoğlu, Zohar, Stead and Buwert2026) to explore experiences of aging and care and strategies for fostering and sustaining a culture of care within and outside formal health care systems. Grounded in principles of emergent strategy (Brown, Reference Brown2017), Who Cares? examined how local knowledge can shape more inclusive models of care for OAs. The purpose of this analysis was to investigate the context and lived experience of aging and care on the Sunshine Coast, to examine the structural and systemic barriers to healthy aging in the Sunshine Coast, and to uncover definitions and experiences of aging care (Deer Crossing the Art Farm, 2025).
Literature review
Older adults and aging in Canada
As Canada’s population ages, OAs are expected to comprise nearly 30 per cent of the population by 2068 with a widening gap between the proportion of the population 65 years and older, compared to 14 years and younger (Statistics Canada, 2022). Currently, the Sunshine Coast has a high median age of 55.5 (2016), along with projected rapid growth in the 65+ population (Provincial Health Services Authority, 2025). These demographic shifts are expected to continue to influence Canada’s age structure and government spending for the foreseeable future, including increased government spending on programs specifically related to OAs such as Old Age Security and the Guaranteed Income Supplement (Fuss & Globerman, Reference Fuss and Globerman2020). Additionally, there will be increased pressures in all communities, but particularly rural and remote ones such as the Sunshine Coast, to provide equitable, accessible aging care (Statistics Canada, 2022).
Social determinants of healthy aging
The social determinants of health are the conditions in which an individual is born, grows, lives, works, and ages; these factors significantly impact health outcomes across the lifespan, including aging populations (Chelak & Chakole, Reference Chelak and Chakole2023). Vital determinants such as social and financial status, education, occupation, social support networks, health care accessibility, and environmental conditions shape how well an individual ages by impacting their physical, mental, and social health (Chelak & Chakole, Reference Chelak and Chakole2023; Perez et al., Reference Perez, Perez and Chumbiauca2022). Perez et al. (Reference Perez, Perez and Chumbiauca2022) suggest that although access to medical care is crucial, social conditions such as housing quality, nutritious food, and active social networks have a substantial impact on lifespan and overall health.
Housing is a crucial determinant of healthy aging. The compatibility, flexibility, and safety of a home environment are vital in enhancing OAs’ physical and mental health (Fox et al., Reference Fox, Kenny and Timmons2017). In Canada, OAs are entering long-term care later in life and with more complex health needs, while the long-term care workforce and facilities are ill-equipped to handle the increased needs of residents (Estabrooks et al., Reference Estabrooks, Straus, Flood, Keefe, Armstrong, Donner, Boscart, Ducharme, Silvius, Wolfson and Grinspun2020). On the Sunshine Coast, the housing market is characterized by extreme competitiveness and high cost, as reflected by current real estate listings. This impacts the ability of OAs to age in place, affects the recruitment of younger care workers to the area, and influences the overall socioeconomic environment in which community care is delivered (Realtor.ca., n.d.).
On the Sunshine Coast 12 per cent of the population are lone parents (12%) and 26.4 per cent of households spend 30 per cent or more of their income on housing. These economic and household composition factors are critical social determinants that increase vulnerability to financial strain and care burden, which directly impacts the community’s capacity for elder care (Provincial Health Services Authority, 2025). Transportation is another important determinant of healthy aging. Remillard et al. (Reference Remillard, Campbell, Koon and Rogers2022) found a connection between transportation barriers and social exclusion for persons aging with mobility disabilities, many of whom were OAs. Restricted transportation, insufficient accessibility, and unfavourable societal attitudes frequently restricted individuals with mobility issues from participating in social, medical, and community-related activities (Remillard et al., Reference Remillard, Campbell, Koon and Rogers2022). These challenges amplified mobility challenges and isolation, resulting in a poor quality of life among OAs with disabilities.
Aging, social isolation, and loneliness
Aging increases risk factors for social isolation, including deteriorating health, and restricted mobility, which can have significant adverse effects on mental and physical health (Government of Canada, 2025). Social isolation and loneliness are commonly identified as important public health challenges facing OAs that can lead to depression, cognitive compromise, and mortality (Conn et al., Reference Conn, Billard, Dupuis-Blanchard, Freedman, Hoang, Levasseur, Newall, Sullivan and Wister2024). Social isolation arises from reduced social interactions, and loneliness is a feeling of disconnection, both of which lead to poor health outcomes (Conn et al., Reference Conn, Billard, Dupuis-Blanchard, Freedman, Hoang, Levasseur, Newall, Sullivan and Wister2024). In Canada, 58 per cent of adults over age 50 report some loneliness with 41 per cent at risk of isolation (Conn et al., Reference Conn, Billard, Dupuis-Blanchard, Freedman, Hoang, Levasseur, Newall, Sullivan and Wister2024). Importantly, not all OAs experience loneliness the same way or to the same degree.
Despite the Sunshine Coast’s frequently cited strong sense of community belonging (Deer Crossing the Art Farm, 2025; Sunshine Coast Foundation, 2024), loneliness remains a significant public health issue on the Sunshine Coast that is distinct from social isolation. Living alone, having compromised health status or multiple chronic health problems, lacking access to transportation, being low-income, living rurally, and being a caregiver are all risk factors for OAs’ social isolation and loneliness (Government of Canada, 2025).
The importance of social connectedness
The Office of the Seniors Advocate of BC (2017) reported a need to increase activities for more meaningful experiences overall, noting that a lack of engagement can lead to social isolation, which can negatively influence health and accelerate dementia. A study conducted across the lower mainland of BC found a direct correlation between social connection and mental health (Vancouver Coastal Health, Fraser Health, & Health Strategy Office, 2019). Morgan et al. (Reference Morgan, Wiles, Park, Moeke-Maxwell, Dewes, Black, Williams and Gott2021, p. 1126) found that social connectedness is linked to one’s ‘desire to be recognized as resourceful agents able to foster relationships on the basis of mutual respect’. Social connectedness is viewed by OAs as a multilevel concept at interpersonal, neighbourhood/community, and cultural/societal levels (Morgan et al., Reference Morgan, Wiles, Park, Moeke-Maxwell, Dewes, Black, Williams and Gott2021). Social connection plays a vital role in OAs’ wellbeing, especially when navigating the challenges of aging. Research points to the need to build a national strategy to combat loneliness and promote social connections, working at all levels of government to coordinate efforts across healthcare, social services, and community organizations, to connect individuals to community-based organizations that can provide resources to reduce loneliness (Women’s Age Lab/Women’s College Hospital, 2024).
The impact of the COVID-19 pandemic restrictions
Across Canada and in BC, the COVID-19 pandemic magnified and exacerbated deep-rooted issues in aging care (Women’s Age Lab/Women’s College Hospital, 2024). OAs are not only more susceptible to severe physical consequences of COVID-19 but were also one of the most vulnerable populations affected by public health restrictions (Genoe & Johnstone, Reference Genoe and Johnstone2021). As widely documented, the COVID-19 pandemic subjected the aging population to increased social isolation and loneliness (Ooi et al., Reference Ooi, Liu, Roberts, Gariépy and Capaldi2023). OAs living in the community were also affected by closures of day programs and other community programs (Vescera, Reference Vescera2021). In BC, OAs reported a greater fear of death from loneliness during COVID-19 (Office of the Seniors Advocate BC, 2017). While evidence is emerging, recent studies support the claim that social isolation and loneliness have continued to worsen post-pandemic and have reached epidemic levels (Women’s Age Lab/Women’s College Hospital, 2024).
Approaches to and meanings of care
In 2015 the World Health Organization called for a ‘fundamental paradigm shift in the way health services are funded, managed, and delivered’ to meet the challenges faced by health systems around the world as populations age with increasingly complex and chronic health conditions (World Health Organization, 2015, p. 7). Integrated person-centred care adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of humane and holistic health care systems (World Health Organization, 2015). Integrated person-centred care may be seen as a response to the fragmented delivery of health and social services and moving away from a siloed and referral-based format of care (Canadian Home Care Association, 2026). Strategic directions to move towards models of integrated care include focusing on health promotion and prevention, empowering individuals, and enabling communities to become actively engaged in co-producing healthy environments.
In many BC communities, care for OAs occurs both formally and informally and is often a mix of the two. Formal services include assisted living or long-term care homes, where person-centred integrated approaches to care include attention to the social, emotional, and community-based components of support (World Health Organization, 2015). Informal care provided by family or friend caregivers can play a vital role in empowering and supporting OAs to remain at home as they age (Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019). Informal caregivers may be involved in a multitude of tasks including developing relationships with professionals, negotiating care, gaining access to professional support, managing role expectations, and providing physical and emotional support (Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019). Caregiver stress is directly related to earlier hospitalizations of individuals with dementia, diminished mental health outcomes for caregivers, and increased use of the health system (Warrick et al., Reference Warrick, Prorok and Seitz2018). Ultimately what this means is that care for OAs is highly dependent on their access to formal care institutions and providers and the existence and availability of family and friends (B.C. Ministry of Health, 2021). These realities suggest that the values and practices of integrated person-centred care have not been fully realized in BC or Canada. This is particularly salient in the wake of the COVID-19 pandemic that revealed major gaps in the elder care system in BC, including increased demands on staff, outbreak protocols, and staff shortages. What was also revealed was the critical role of family caregivers in the caregiving continuum, who provide mental, emotional, and physical supports (B.C. Ministry of Health, 2021).
Community is not just the place where care occurs; it is also a vital source of care itself, giving access to respite, support systems, home-based services, and organized case management (Hagedoorn et al., Reference Hagedoorn, Paans, van der Schans, Jaarsma, Luttik and Keers2021). The community care system has a crucial role in supporting OAs as they age and in improving conditions for caregiving (Hagedoorn et al., Reference Hagedoorn, Paans, van der Schans, Jaarsma, Luttik and Keers2021). In person-centred integrated care, the community’s role shifts from passive service delivery to proactive, person-driven health management. Communities co-produce healthy environments through local partnerships, voluntary sectors, and peer support, strengthening care continuity and addressing social determinants of health, ensuring that care for OAs is holistic and localized (Canadian Home Care Association, 2026; Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019; World Health Organization, 2015). The underlying values of person-centred integrated care include ‘collaborative’, ‘co-ordinated’, ‘transparent’, ‘empowering’, ‘comprehensive’, ‘co-produced’, and ‘shared responsibility and accountability’ (Zonneveld et al., Reference Zonneveld, Driessen, Stüssgen and Minkman2018). A broader and more collaborative approach to and meaning of care that involves systemic collaboration and community engagement includes health-focused interventions, engagement, and interpersonal and psychological support (Warrick et al., Reference Warrick, Prorok and Seitz2018).
The research context
The Sunshine Coast, British Columbia
Who Cares? project activities occurred in the Lower Sunshine Coast in BC, the unceded traditional territory of the Sechelt and Squamish peoples. Communities on the Sunshine Coast are dotted along an 80-kilometer highway. The Sunshine Coast is known for its rugged mountains, forests, and coastal communities. Sunshine Coast residents are a blend of long-time residents, retirees, artists, seasonal residents, diverse immigrant groups, and Indigenous communities (Statistics Canada, 2022). Of a population of just under 30,000, 29.6 per cent are aged 65 and over, compared to 18.3 per cent across BC (Sunshine Coast Foundation, 2024). In (Gibsons, BC), almost 60 per cent of the population is over 45 and the 60+ age group is projected to increase to almost 40 per cent by 2026 (Sunshine Coast Resource Centre, 2021). This suggests that an increasing number of OAs on the Sunshine Coast will require care from family members or in traditional care settings such as long-term care and home care.
In recent years community organizations on the Sunshine Coast have focused on decreasing social isolation and increasing community connectedness for OAs. In 2015, the Sunshine Coast Resource Centre organized a forum for OAs and community-based seniors’ services to connect and collaborate. Gibson’s Age-Friendly Community Plan identified issues and created a plan to foster social participation, respect, and inclusion to enhance quality of life for the aging population and outlined actions to address social isolation on the Sunshine Coast (Sunshine Coast Resource Centre, 2021).
The Who Cares? Project collaboration
Who Cares? was a 3-year collaboration between Douglas College, Emily Carr University of Art + Design, and Deer Crossing the Art Farm. The project integrated a CBPR framework with participatory design and community-engaged arts to gather and document rich accounts of care and aging from the Sunshine Coast. CBPR is a research framework that recognizes the role of social, cultural, physical, and political contexts in shaping the realities of those living on the margins of society (Reid et al., Reference Reid, Greaves and Kirby2017). It is ‘research rooted in community, serving community interests, encouraging citizen participation and geared towards affecting social change’ (Flicker et al., Reference Flicker, Savan, Kolenda and Mildenberger2008, p. 241). In CBPR all project stakeholders are recognized as active agents in shaping and informing the research design and process. CBPR aims to foster equitable community engagement and active citizenship and works towards positive social change rather than for or in community (Reid et al., Reference Reid, Landy and Henderson2023).
We strategically integrated CBPR with participatory design and community-engaged arts to foster engagement across communities on the Sunshine Coast. While CBPR guided the philosophical commitment to equitable community partnerships, participatory design and community-engaged arts provided the creative tools for inquiry and co-creation. These approaches actively involve all stakeholders in design and creative processes guided by commitments to power-sharing and social impact (Wilkinson et al., Reference Wilkinson, Reid, Raber, Hannan, Simeone, Gray, Verhoeven, de Götzen, Bakırlıoğlu, Zohar, Stead and Buwert2026). By centring the community’s lived experiences and creative input, this blended approach ensured that the research not only documented the reality of aging and aging care on the Sunshine Coast but also activated stakeholders towards systemic change. The research questions guiding this analysis were: (a) What is the context of aging on the Sunshine Coast? (b) What is the lived experience of aging on the Sunshine Coast? (c) What are the structural and systemic barriers to healthy aging on the Sunshine Coast? (d) How does the Sunshine Coast community define care, and where does it occur?
Research methods
Community building phase
The study was approved by the Douglas College’s and Emily Carr University’s Research Ethics Board. Over the 3-year project we used diverse approaches to engage with communities on the Sunshine Coast, BC. In the ‘community building’ phase of the project (fall 2023 to fall 2024), the research team focused on connecting with a broad cross-section of the community through a series of participatory design workshops with community groups in all three regions of the Sunshine Coast, engaging arts-led pop-up activities, online ‘lunch and learn’ conversations with key community members, and interviews conducted with professionals in the care field. At this earlier stage of the project our research goals were to better understand how the community defined ‘care’, where ‘care’ showed up for them, and where care was absent. More specifically, the questions that guided this phase’s research activities were: ‘What does care mean to you?’; ‘Where do you experience care?’; ‘Where do you give care?’; ‘Do you have an older adult in your life?’; ‘What does the current system of care look like for the older adult in your life?’ These questions guided the workshops and community-pop ups, described below.
Participatory design workshops
In this phase of the project, we co-facilitated 11 participatory design workshops. These workshops were hosted by various community groups and took place in a geographically representative range of five community locations across the Sunshine Coast. Each workshop was guided by a question focused on experiences of aging and care. Participatory design activities were planned to cultivate reflection and conversation on the questions through hands-on creative activities. The workshops were jointly led by research team members and fieldnotes recorded by student research assistants. Data gathered from these 11 workshops included over 30 sets of fieldnotes, documenting observations, inferences, and reflections on the impact of the engagement activity.
Community arts pop-ups
In 2024, we designed and organized eight community-engaged arts ‘pop-ups’ in different locations on the Sunshine Coast, including farmers markets, community centres, walking paths, malls, and libraries. These pop-ups used participatory design and artistic activities to involve community members in conversations about aging and care on the Sunshine Coast. Each pop-up was a small installation with a central question and an arts activity to engage passers-by, co-led by three or four team members, including student research assistants, co-facilitating and recording fieldnotes.
The fieldnote documentation was systematic across the 2024 pop-up events. A template was provided to all members of the research team who were recording fieldnotes. They were encouraged to document, as much as possible, conversations they had with community members engaging with the project’s events. In many cases researchers captured verbatim quotes from participants. Pop-ups were held across multiple community locations and centred on participants’ experiences with OAs in their lives, the support they receive, and how care could be enhanced. Altogether, the pop-ups and the Seniors’ Planning Table meeting resulted in multiple sets of fieldnotes that documented community members’ perspectives on care and support systems. In total, 23 sets of fieldnotes were documented across these community events. Throughout the ‘community building’ phase, we engaged in collaborative and reflexive thematic analysis (Braun & Clarke, Reference Braun and Clarke2021) which resulted in the first iteration of the codebook.
One-on-one semi-structured interviews
Twelve (12) one-on-one, semi-structured qualitative interviews were conducted over Zoom in the fall of 2023. The interviews ranged in length between one and 1.5 hours and were transcribed verbatim. The research participants were leaders in healthcare (recreation therapists and supervisors in long-term care, homecare supervisors, a nurse, a physician) and individuals who organized and led community programs for OAs (for organizations such as Memory Cafe, seniors’ groups, Alzheimer’s BC). The purpose of these interviews was to gather baseline information about older adults’ needs, barriers and assets, and to gather reflections on changes needed to better support OAs on the Sunshine Coast. Specifically, these interviews were guided by the questions: (a) what are diverse older adults’ barriers, needs and assets? (b) what are the current assets and needs related to aging care on the Sunshine Coast? (c) what is an ideal model of aging care for the Sunshine Coast? In the proceeding analysis the interviewees are referred to by their role in the community – as either ‘health care provider’ or ‘community organizer’.
Story gathering phase
In the next phase of the project, we gathered authentic reflections, stories, and ideas of ‘care’ from community members of all ages and backgrounds, with the goal of inviting as many people as possible from Sunshine Coast communities to share their thoughts, stories, and ideas about aging. This phase strategically built upon the trust and relationships established in the Community Building Phase. The team initiated an iterative design process to create an engaging series of interactive installations for diverse locations. While the main installation was the ‘Listening Tree’ sculpture, engagement was expanded through supplementary means, including posters and small boxes hosted by various businesses, organizations, and libraries. This methodology ensured the project could carry on a ‘conversation over time’ and resulted in collection materials being deployed across 38 locations on the Sunshine Coast.
Listening tree installation
In winter 2024 we initiated an iterative design process to develop an installation to be showcased in diverse locations on the Sunshine Coast. An idea emerged for a ‘Listening Tree’ that could be assembled, disassembled, and toured to different gathering spots. With recognition that a six-foot tree would limit the number of locations we could access, we designed smaller scale listening trees including a poser and box version appropriate for smaller space. This enabled us to have a ‘conversation over time’.
With the ‘Listening Tree’ we gathered written data on tree cards. Tree cards were the ‘leaves’ on the branches of the tree, with either an open-ended question or a data bit or quotation. Community members engaging with the tree were invited to write responses or reflections on a tree card to the questions or respond to the quotations. We used three dominant themes from our initial codebook – ‘stories of need’, ‘meanings of care’, and ‘hopes and dreams’ – to select the quotations and questions posed. In the 3 months that we circulated the Listening Tree we gathered over 1,000 tree cards from 38 different locations on the Sunshine Coast through facilitating eight engagements and six pop-ups, and distributing six posters, 13 boxes, and 10 packets. Locations from where we gathered the tree cards included coffee shops, a laundromat, seniors and community centres, a library, malls, a food bank, and so on.
Collaborative and reflexive thematic data analysis
Reflexive, iterative and thematic analysis was conducted (Braun & Clarke, Reference Braun and Clarke2021) and informed by principles of collaborative team analysis to maximize trustworthiness and credibility (Morrow, Reference Morrow2005). The integration of these approaches involved the constant checking of interpretations, refinement of codes, and the maintenance of a reflexive audit trail throughout the process.
The two phases of data analysis aligned with the phases of the project. The first phase involved analysing the fieldnotes from the workshops, pop-ups, and interview transcripts that were gathered during the Community Building phase of the project. In the first pass at coding these data we used Microsoft Word files and the comments function to descriptively code data bits according to the question posed. In this phase four research assistants were involved in the coding, working together to check their interpretations and ensure consistency.
The second phase of data analysis aligned with the Story Gathering phase and was initiated once we began gathering tree card data. Our first step was to move the coded data from the earlier research phase to NVivo12 to enable the addition of more data and easier data handling and management. Initially, all the data in NVivo were coded with the first codebook. Once all data were inputted and coded, we engaged in four team collaborative analysis sessions, each 2 weeks apart, to discuss, review, and fine-tune initial coding around the themes of stories of need, informal care, connections, and meanings of care. At these sessions seven to nine team members participated. This process involved: (a) identifying overlaps in coding and where coding required further distinction and precision; (b) refining code and theme definitions; (c) providing more context to some coded data; and (d) using Miro boards (https://miro.com) to visualize themes and codes and document changes to the analysis. From this process a new codebook was generated.
Once this codebook was established, we spent several months checking through all data to ensure consistency in coding according to the revised codebook. With the completion of the re-coding the research team examined the themes and codes and ensured they aligned with the overall purpose, goals and research questions of the project. At this time a final refinement occurred to dissolve the ‘hopes and dreams’ theme as data from this theme were moved into other themes and to reframe each theme as a ‘story’ from the community.
The combined application of reflexive, thematic and collaborative data analysis (Braun & Clarke, Reference Braun and Clarke2021) was consistent with standards for research rigour and trustworthiness (Singh et al., Reference Singh, Thirsk, Stahlke, Perumal, LoBiondo-Wood and Haber2022). Specifically, the constant checking of interpretations and refinement of codes with the research team served as a form of peer debriefing to enhance credibility (Reid et al., Reference Reid, Greaves and Kirby2017), while the maintenance of a reflexive audit trail throughout the analysis ensured auditability, allowing the decision trail to be followed from the data to the conclusions (Singh et al., Reference Singh, Thirsk, Stahlke, Perumal, LoBiondo-Wood and Haber2022). Furthermore, the development of rich community narratives supported the fittingness of the findings, enhancing their potential transferability to other contexts (Singh et al., Reference Singh, Thirsk, Stahlke, Perumal, LoBiondo-Wood and Haber2022).
Research findings
The collaborative and reflexive thematic analysis generated four dominant stories from the communities on the Sunshine Coast: stories of the state of things, stories of aging, stories of need, and stories of care.
Stories of the state of things
Stories of the state of things conveyed the context of aging on the Sunshine Coast. It exposed the current state of OA care, including the impact of local socio-demographics, local values and politics, and the COVID-19 pandemic. Participants described the Sunshine Coast as a mix of more densely populated town centres and remote rural areas. Services were typically concentrated in urban zones, leaving rural communities under-supported.
[The Sunshine Coast] combines densely populated communities and municipalities with quite remote and rural logging roads. [It is] difficult to access homes and properties. So those two are existing at the same time. The default for services tends to be in the densely populated areas. […] it’s very difficult for ambulances, home support, and even just neighbourhood or community associations to exist or support people in those remote areas. (interview, health care provider, 2023)
Poor road infrastructure and travelling long distances were some of the main barriers to accessing healthcare (e.g., hospitals, primary care physicians) and community services. Some participants mentioned OAs’ diversity and precarity, noting an increasing number of OAs living in poverty and from migrant backgrounds. ‘People with a lot of money can find good support, but most people don’t have that’ (fieldnotes, 2023). Many participants spoke about the devastating and long-lasting effects of the COVID-19 pandemic on the Sunshine Coast. Health services and support groups were disrupted or reduced. Specialized care groups were discontinued and staffing levels dropped. Restrictions on visits in long-term care homes affected families and many social support systems were disrupted. One caregiver recalled:
We had a close friend whose wife died during COVID. And he wasn’t able to be with her until she was dying. […] that was what happened with my husband. I never had so much pain in my life as when I’m sitting across, and he’s reaching out his arms to hold me and I had to say ‘No’. (interview, community organizer, 2023)
A tree card shared this perspective:
I wish that our community realized how the current care facilities for the elderly are actually ‘prisons of care’. Many of our beloved seniors are placed in these prisons of care and forgotten about. COVID was a crime against the elderly! (tree card, 2024)
For some OAs, anxiety and fear became a lasting experience and contributed to reduced independence and deepened isolation. Long-term care homes were seen as unwelcoming environments. There remained intense frustration with the impact of the pandemic on OAs and a perceived lack of support from the health care system. One health care provider shared: ‘Since post-COVID, there were not many groups happening, especially for dementia, that kind of specialized or specific need’ (interview, 2023). This led many to advocate for themselves and their loved ones.
Sunshine Coast communities boasted a strong sense of autonomy and local politics that valued local solutions and contributions, at times leading to distrust towards outside intervention. ‘There’s mistrust about things we can do, we don’t need the big city people coming in and telling us what to do, right? We can solve this. We need a local solution. We know what we need’ (interview, health care provider, 2023). Experiences of unkept government promises, environmental changes, misuse of tax money, and inflation contributed to the community’s mistrust. Collective action and holding elected officials accountable were valued as approaches to tackle political issues that impacted aging care, particularly initiatives that supported rural and remote communities in aging in place. A community member wrote:
Standing up for our rights while doing the correct thing by not looking over or ignoring what our elected officials are elected/supported to do for our community, or municipal officials stand up against those who are misusing our tax money for their own benefit rather than the communities. (tree card, 2024)
Stories of aging
Stories of aging revealed OAs’ experiences of aging, isolation, loneliness, and the vulnerability of living rurally or remotely. Participants shared deeply personal accounts of what it meant to grow older on the Sunshine Coast. Isolation and loneliness were major concerns, especially for those living alone in rural and remote areas. ‘Isolation is another barrier or challenge. People are living alone … in remote areas’ (interview, health care provider, 2023). Stories of aging often involved stories of loss: loss of partners, friends and family ‘Nobody checks on him to make sure he’s okay. His wife passed away 2 years ago after 65 years together’ (fieldnotes, 2023) and a decline in or loss of physical or cognitive ability ‘how isolating it is with hearing aids and arthritis … her social system needs to accommodate for that, which can be tough’ (fieldnotes, 2023). With aging also came experiences of grief, a shrinking social network, and a lack of purposeful activities ‘I feel they [OAs] lost all their friends and family members … [it is important to] take care of them [OAs] and visit them’ (fieldnotes, 2023).
Common fears about aging included the loss of abilities, identity, rights, relationships, and independence, and the inevitable process of aging. Many OAs struggled to ask for or accept help due to cultural or personal attitudes, which also affected caregivers who, while caring for their loved one, became isolated themselves. A health care provider said:
Caring is lonely, it’s hard not to have a job to go to every day, or to have your regular routine of your activity, that stuff that adults take for granted. My clients say this all the time, when you’re retired, or when you’re at home caring for a loved one with dementia, it’s hard to stay sharp, it’s hard to feel inspired. That’s when those feelings of depression and loneliness sink in. (interview, 2023)
Asking for and accepting help was viewed as a sign of weakness and reinforced the loss of independence. Participants shared that ‘many resist the loss of independence’ (fieldnotes, 2023) and that ‘[she is] more stuck on things she no longer does or can no longer do’ (fieldnotes, 2023). Participants emphasized the importance of being proactive in making decisions on how they wished to age, yet many OAs avoided accepting and preparing for it. ‘[They are] concerned about being a burden when getting older and losing independence [and are] reluctant to give in to the process of aging … [there is] stubbornness with age’ (fieldnotes, 2023).
OAs’ desire for independence, and at times stubbornness, led some to hide their struggles out of shame, making it difficult for others to recognize when support was needed. One participant shared: ‘[It is] hard to determine to what degree they are struggling. [OAs] often hide their struggles due to shame and they remain very isolated’ (fieldnotes, 2023). When proactive measures were not taken, families often had to make life-altering decisions about care and end of life, such as moving into a long-term care home. Education for preparing for aging was recommended to better support aging. ‘Importance of preparing, if you are younger. Prepare people for what aging is’ (tree card, 2024).
Traditional communication methods, such as printed media, in-person visits, and word of mouth, were preferred methods to reach and communicate with isolated OAs. ‘[…] utilizing this really curious mix of communications channels that exists on the Sunshine Coast. Needing the face to face for some seniors, [others prefer] Facebook groups, libraries, community associations’ (Interview, community organizer, 2023). Local community resources (e.g., libraries, the local newspapers, recreation programs, and senior centres) were important touch points for identifying those individuals and played a crucial role in connecting people to care and services.
Stories of need
Stories of need revealed the structural and systemic barriers to healthy aging, exposing the profound impact of the social determinants of health on OAs’ health and wellbeing. This theme included the multifaceted aspect of ‘need’, either in reference to a specific issue, need, or gap at the individual, family, friend, neighbourhood, community, organizational, and system levels. Stories of need included issues such as housing, transportation, staffing and funding, access to community services and health supports to age in place, difficulty navigating the health care system, and deficit-based models of care.
Research participants frequently shared that it was difficult to identify and reach vulnerable OAs living in the community. Many lived in precarious and unsafe conditions, did not have a family doctor, and often only sought help during a crisis. ‘They [OAs] are living sometimes off the grid, or on a boat … with no power. So, there’s a ton of people that fall through the cracks. People that are in poverty’ (interview, health care provider, 2023). OAs were often unaware of support services due to geographic isolation, bureaucratic hurdles, limited information on care options, and lack of access to technology. ‘Building awareness, one of the issues I have seen over the years is [the] difficult[y] for people to identify what services are available and how to access them’ (interview, community organizer, 2023).
Housing
Housing availability and affordability were recurrent issues raised by participants. Empty homes and seasonal housing use were linked to housing insecurity on the Sunshine Coast. ‘Housing is horrible, so many holiday homes, air bnb, empty homes’ (fieldnotes, 2023). The rise in homelessness and OAs living in unsafe, precarious housing conditions such as living in cars, boats, and couch-surfing, were noted by participants.
We’re going into people’s homes. I see poverty and housing is a real challenge for elders in our community. I’ve seen elders living in unacceptable living situations. Maybe couch-surfing, like at a friend’s house. Someone with dementia sleeping on a couch in the living room. (interview, health care provider, 2023)
Fear of relocation due to housing insecurity and abusive rental agreements threatened social and community support networks, creating an atmosphere of uncertainty among vulnerable OAs and caregivers.
As I get to 70 years old, I see landlords ready to flip the property. And I can’t take my dog with me [in] 80% of the housing options. That’s wrong! Let’s see if I can afford to be a caregiver at 71 and still live in Canada. Vancouver Highest International #1 rent! (tree card, 2024)
Housing access also contributed to the insufficient number of health care workers living on the Sunshine Coast, highlighting the need for alternative and supportive housing options.
Transportation
Transportation infrastructure on the Sunshine Coast was frequently described as inadequate with one main road linking a vast geographical area. Issues identified included delayed, infrequent, and unreliable public services, unaffordable private transportation, and precarious road conditions, particularly in more rural and remote areas. Limited transit options prevent OAs from accessing medical appointments, specialists, and community services located in urban centres.
What if they need to get to Vancouver? What if they have cancer and they need to go to radiation every day? How are they going to get there? Just right now, people say well, ‘I can’t get there. I’m just gonna die.’ But that’s not okay. We can’t let that happen. (interview, health care provider, 2023)
Lack of public transportation and declining health, such as a decline in eyesight or the use of a mobility aid, prevented OAs from living independently and forced some to rely increasingly on family and friends to meet their basic needs.
There needs to be bus service everywhere on this Sunshine Coast. Because a lot of seniors lose their license, even if they don’t have dementia they lose their license, or they don’t feel competent about driving, and where are they supposed to go? How are they supposed to get into town to access the services, if they don’t? (interview, community organizer, 2023)
In some areas, community initiatives such as carpooling emerged in response to transportation needs. These local initiatives facilitated transportation for some OAs while simultaneously strengthening community bonding and connection.
Something wonderful has started to happen on the Sunshine Coast here. And that is carpooling […]. We have two people here today who live a block apart from each other, a fair distance away from here about 40 minutes […] giving the families [an] opportunity to get to know each other. (interview, health care provider, 2023)
Staffing and funding
Insufficient staffing and funding of community and health care services was viewed as a serious issue to the community. Inadequate staffing levels impacted service capacity and service delivery, limiting availability of support, resources, and programs in aging care. Health care workers were experiencing high workloads, low wages, and limited housing options to work and live on the Sunshine Coast, which impacted new hires and longevity in health care careers. As stated on a tree card: ‘[We need] more places for caregivers to live on the Sunshine Coast. Higher wages for caregivers. They don’t want this as a career’ (2024).
Staffing issues often led to inconsistency in care with frequent staff rotations, failure to meet clients’ needs, and caregiver burnout. A health care provider said: ‘I’m struggling with staffing. My department at one point had five employees, [now] down to two and it’s challeng[ing] to try and meet the needs [of OAs], especially if you had a certain standard that people were familiar with’ (interview, 2023).
Access to healthcare and community support to age in place
On the Sunshine Coast health care facilities were operating at maximum capacity, with overtaxed health care providers and long waitlists for hospitals, rooms in long-term care homes, and homecare services. In response to an overburdened health care system, these stories revealed the community’s hopes for maintaining OAs’ independence and keeping people at home for longer. ‘As I age I would love to see more … focus on “aging in place”. The concept of “home” becomes the most important value as one ages’ (tree card, 2024).
To age in place, participants identified the need for consistent support in managing everyday tasks (e.g., meal services, grocery delivery, laundry, cleaning, house maintenance), social support (e.g., home visits, access to community social groups, leisure programs), and access to healthcare (e.g., getting to appointments, medication delivery, accessing services). However, due to a lack of essential home services and little alternative supportive housing such as homecare, assisted living, and independent living, OAs were remaining at home long after they could safely care for themselves. Stories of self-neglect and unsafe home conditions exposed the reality of many OAs living in similar situations. ‘[I] know someone whose house is in bad shape, doesn’t want to go into [long-term] care because she has a dog. [She] had [home]care people who ended up leaving because of the state of the house’ (fieldnotes, 2023).
With the unavailability of beds, OAs resorted to temporary solutions such as staying in hospital until hospice spots opened or using acute care at the hospital as long-term care, all of which exacerbated emergency wait times.
[There are] 200 people on [the] waitlist for long-term care right now. Thirty to 40 people [are] in hospital waiting for long-term care right now. [The] hospital is at 144%, [it’s a] hospital in crisis. [The] Sunshine Coast has [the] 2nd highest number of seniors in Canada and the least amount of long-term care beds. (fieldnotes, 2023)
Navigating the health care system
Navigating the health care system was reported as difficult and described as bureaucratic, inconsistent, and impersonal. Participants noted that finding relevant information was challenging.
[The healthcare system] is really bureaucratic and really confusing. I’ll see clients and their families [who] are very confused. They’re like ‘Wait, how do I start the ball rolling for long term care?’, and they’ve had a few people tell them different things. (interview, health care provider, 2023)
Improving integration and communication across interdisciplinary teams and systems of care was needed to enhance consistency and quality of health care services and to ensure access to resources and information-sharing, particularly from doctors to patients and caregivers when OAs are transitioning from home care to long-term care. Poor collaboration among health care teams made it more difficult for OAs and families to navigate existing support systems. ‘One of the other challenges is a lack of communication and collaboration across teams’ (interview, health care provider, 2023). The general sentiment shared by many community members was that health and community services were overwhelmed and OAs were often not receiving the care they needed:
Medical services are overwhelmed on the Coast. Staffed by agencies, we are lacking continuity of care which means referrals are lost, people are required to constantly advocate and follow up for themselves to get care. People are left in pain, alone, suffering, frustrated and exhausted. (tree card, 2024)
Models of care
Participants noted that a deficit, fear-based model of care, specifically the medical model, was the predominant framework guiding health care services for OAs living on the Sunshine Coast. This approach was seen as alarming and limiting, viewing the aging population solely based on medical needs. A health care provider shared:
Some of the gaps are just the fact that [the care provided] it’s so medical sometimes. Forgetting that it’s a human that we’re working with. And of course, you have to focus on their medical needs, and sometimes that comes first. But it’s in those times in their life, [that it is] just as important to have a release for some quality of life and some recreation to be there to help them. (interview, 2023)
This model was viewed as a barrier to accessing health services, as OAs avoided seeking help with fear of being defined and limited by their diagnosis. Participants shared values of a holistic approach to care, pointing to alternative models that focused on creative, grassroots, bottom-up, strength-based, and person-centred models of care that promote aging with dignity and agency. ‘We are not all the same, we each have our weaknesses, but we also have our strengths. We need to build on those strengths!!’ (tree card, 2024). Moreover, a health care provider voiced the need for a preventative approach to care:
[I]t would be really nice to see a model that is [based on] health promotion, like a health promotion model that helps to keep people well and feeling good before they get sick. Before they feel [that] their cognition is declining. (interview, 2023)
Stories of care
Stories of care revealed how community was central to care on the Sunshine Coast, illuminating the many and diverse assets of the Sunshine Coast’s communities, known for its deep sense of community responsibility, strong spirit of volunteerism, and engaging neighbourhood initiatives. Participants defined care, identified care values, and uncovered where and who provided care in the community.
Various definitions of care emerged from the data. Care was defined as having specific needs met through consistent, timely, and easy access to health care professionals (e.g., family doctors, in-home nurse practitioners, etc.). The community saw care as individuals being empowered to identify and express their own needs. ‘Being able to understand what your needs are and be[ing] able to express them, I think will carry us into senior life very well’ (interview, community organizer, 2023). Care also meant contributing to and being valued by society despite changes in health status. ‘A community that accepts and understands dementia and that treats those with dementia as an integral and valuable part of society’ (interview, health care provider, 2023).
Participants valued empathy, respect, understanding, and compassion when caring for someone. Community connection, reciprocal relationships, and having a sense of belonging and purpose, were valued as conditions to healthy aging. ‘What keeps me engaged is feeling connection, feeling known and understood, having shared purpose and intention’ (fieldnotes, 2023). Indeed, on the Sunshine Coast care occurred at a personal, community, and societal levels, in both formal and informal ways through care partners, neighbours, and volunteer support.
Care partners
Care was associated with the essential role of caregivers, played by family and friends. Caring for loved ones with little support from homecare was described as a demanding job, and many caregivers struggled to balance one’s own needs while caring for others. ‘People struggle to care for their elders because they struggle to care for themselves’ (fieldnotes, 2023). Limited respite services contributed to caregiver burnout. Participants who were in caregiving roles reported that improvements were needed to support OAs to age in place. ‘The adult day programs, any kind of respite services, [helps] caregivers that are struggling with burnout’ (Interview, health care provider, 2023).
Neighbours and volunteers also made significant contributions to aging care on the Sunshine Coast, filling the gaps in the formal care system. They helped identify and reach out to isolated OAs by supporting daily needs, offering companionship, housekeeping support, leisure opportunities, and so on. Participants identified that volunteering provided a greater sense of purpose for OAs, offering peer-to-peer community support, opportunities to make friendships, and the possibility of retaining a closer connection to the community. ‘My mom is a retired nurse so she’s in high demand for home care … they both volunteer a lot … [for example] hospital auxiliary … It provides [them with] friends and a sense of purpose’ (fieldnotes, 2023). Many community services relied heavily on volunteer work and, at times, the dependency on volunteers led to inconsistencies in services and care.
In addition, participants spoke about how care is expressed in everyday interactions in the community. ‘I wrote “my local grocer”. And my pharmacist. They are very good at remembering very small details about you. And they follow up in a very casual way about the things you were worried about’ (fieldnotes, 2023). There was a range of community programs, resources, and initiatives supporting aging care on the Sunshine Coast, including places for gathering and socializing (e.g., local cafes, libraries, mall, parks, senior’s centres), opportunities for building skills and education (e.g., public speaking, cooking classes, Elder College, etc.), active living (e.g., hiking, seated yoga), recreation therapy programs (e.g., adult day program for dementia care), and financial aid (e.g., tax clinic, food security program).
Discussion
The stories were gathered in multiple and diverse ways across 38 sites on the Sunshine Coast. Through iterative cycles of listening, storytelling, and sharing, four dominant thematic stories were generated: stories of the state of things, stories of aging, stories of need, and stories of care. Participants reported that historical challenges in aging care were exacerbated by the COVID-19 pandemic, with disruptions in health services and support groups and inadequate staffing levels, all of which compromised the quality and consistency of care services (Vescera, Reference Vescera2021). OAs on Sunshine Coast were severely impacted by public health restrictions that curtailed family visits in long-term care homes, deepening experiences of isolation and loneliness (Estabrooks et al., Reference Estabrooks, Straus, Flood, Keefe, Armstrong, Donner, Boscart, Ducharme, Silvius, Wolfson and Grinspun2020; Genoe & Johnstone, Reference Genoe and Johnstone2021; Meisner et al., Reference Meisner, Boscart, Gaudreau, Stolee, Ebert, Heyer and Wilson2020). There is significant and still growing literature on the impact of the COVID-19 pandemic on OAs and the aging care system in BC and Canada (Office of the Provincial Health Officer and BC Centre for Disease Control, 2024). This is particularly salient on the Sunshine Coast because of the relatively high median age and the projected rapid growth of the 65+ population (Provincial Health Services Authority, 2025).
Challenges and fears of aging
OAs on the Sunshine Coast reported experiences of isolation and loneliness and the vulnerability of living rurally or remotely. Participants confirmed these experiences by expressing, across the data set, concerns over OAs’ social isolation and loneliness, specifically OAs vulnerable to the impacts of rurality: having few or no family or friend support, living on low-income, lacking transportation, living outside town sites, and experiencing health and mobility challenges. OAs living in rural or remote communities are especially vulnerable to social isolation and loneliness due to changes in life, declining health, physical isolation, and reduced social networks, which can lead to poor health outcomes (Conn et al., Reference Conn, Billard, Dupuis-Blanchard, Freedman, Hoang, Levasseur, Newall, Sullivan and Wister2024; Townsend et al., Reference Townsend, Chen and Wuthrich2021). These findings align with what is known about rurality, location and geography as social determinants of health (Fox et al., Reference Fox, Kenny and Timmons2017).
Many participants raised common fears surrounding aging including the loss of ability, identity, rights, relationships, and independence. Many struggled to ask for or accept help due to cultural or personal attitudes, which deepened OAs’ and their caregivers’ feelings of isolation. Asking for and accepting help was viewed as a sign of weakness and reinforced the loss of independence. While it is commonly documented that aging raises fear of decline, disability and death (Reid et al., Reference Reid, Landy and Henderson2023), some participants suggested the need to be proactive and accepting (and grateful) for aging.
Understandings of the aging population on the Sunshine Coast must be contextualized by the local challenge of retaining younger adults and families. The documented struggles of the Sunshine Coast to attract and retain this demographic due to high housing costs, limited employment opportunities, and lack of childcare directly exacerbated the aging care crisis. This shortage increased the dependency burden on the existing population and threatened the staffing stability of all essential OA services, including healthcare, in-home care, and transportation (Sunshine Coast Foundation, 2024). Although elected officials and policy bodies on the Sunshine Coast have been actively discussing the rapidly aging population, there is a persistent lack of substantive public discourse regarding the high risk and vulnerability faced by OAs in regions such as the Sunshine Coast. This diminishes the widespread political will necessary for proactive system change (National Institute on Ageing, 2025).
Rurality and the impact of the social determinants of health
The structural and systemic barriers to healthy aging on Sunshine Coast exposed the profound impact of the social determinants of health on OAs’ health and wellbeing. Disparities in the social determinants of health in Sunshine Coast communities, such as inaccessible and unaffordable housing, an ineffective transportation system, poverty, and inaccessible healthcare and homecare, exposed the fragility of the institutions and systems intended to support healthy aging. Like many rural and remote communities in Canada, data from stories of need revealed the precarious and unsafe living conditions of many OAs and captured the community’s persistent concerns about housing on the Sunshine Coast. This is particularly salient on the Sunshine Coast where the housing market is competitive and high cost, impacting OAs’ ability to age in place, the recruitment of younger care workers to the area, and the socioeconomic environment in which community care is delivered (Realtor.ca., n.d.).
Challenges with transportation are common for many rural and remote communities. Safe and accessible transportation – a sub-theme of stories of need – was raised repeatedly across all data sets and participant groups. Transportation barriers, such as delayed, infrequent, inaccessible, and unreliable public services, unaffordable private transportation, and precarious road conditions in rural and remote areas, prevented OAs with limited mobility or living with disabilities from accessing healthcare and community services, contributing to social exclusion (Remillard et al., Reference Remillard, Campbell, Koon and Rogers2022). For several years safe and accessible transportation has been front and centre as an equity and health issue for residents on the Sunshine Coast but few improvements have been made (Sunshine Coast Resource Centre, 2021).
Care is community
While individual, structural, and systemic barriers exposed significant challenges to aging on the Sunshine Coast, the stories also illuminated the many and diverse assets of the Sunshine Coast’s communities. Findings demonstrated that care extended beyond institutions, functioning as a collective, creative, and socially embedded practice. Participants defined care in multifaceted ways: as empathy, respect, compassion, community connection, having a sense of belonging and purpose, and having needs met through consistent, timely, and easy access to healthcare. The community saw care as a relationship that empowered individuals to identify and express their own needs. Caring also meant continuing to contribute to society, despite changes in health status. These findings reflect the underlying values of person-centred integrated care (Zonneveld et al., Reference Zonneveld, Driessen, Stüssgen and Minkman2018) and point to the crucial collaborative role community can play in providing health-focused interventions, engagement, and support (Warrick et al., Reference Warrick, Prorok and Seitz2018).
The notion of care articulated by residents on Sunshine Coast was not restricted to clinical and institutional settings but was associated with the essential role of care partners and included promoting independence, reducing uncertainty, and improving quality of life for both individuals and those who care for them (Warrick et al., Reference Warrick, Prorok and Seitz2018). The many and diverse assets of the Sunshine Coast’s communities exposed a tight network of informal care systems supporting OAs bolstered by a strong sense of autonomy and community responsibility, spirit of volunteerism, and engaging neighbourhood initiatives. Neighbours, volunteers, and OAs themselves provided significant contributions to aging care on the Sunshine Coast, filling the gaps in the formal care system. Care involved emotional dialogue, advocacy, and collaborative decision making (Warrick et al., Reference Warrick, Prorok and Seitz2018) and occurred in unexpected ways and with unexpected groupings in the community, such as impromptu visits with neighbours and neighbourhood carpooling arrangements. Indeed, care can be seen as a joint commitment based on community partnership, support systems, and shared goals where relationships interplay between personal and professional networks regularly (Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019).
In essence, the data revealed that community was not just the place where care occurred but was also a vital source of care itself. In some instances, participants reported a symbiotic relationship between informal and formal systems and structures of care, with their own examples of how they provided care or ensured the care for their family member, friend, or community member. ‘Every member of the community holds pieces of the solution, even if we are all engaged in different layers of the work’ (Brown, Reference Brown2017, p. 63). These data suggest that the tight network of connections between informal and formal care systems on Sunshine Coast reflected the promises of person-centred integrated care where communities co-produce healthy environments through local partnerships, voluntary sectors, and peer support. Despite the many challenges facing OAs reported in the data, the community’s commitment to holistic and localized care strengthened care continuity and is beginning to address the social determinants of health (Canadian Home Care Association, 2026; Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019; World Health Organization, 2015).
Towards a community-driven model of care
This analysis revealed the community’s strong foundation of values and commitments to care. This foundation supported a care network where relationships interplayed between personal and professional networks, and in some instances, created community partnerships and support systems based on shared goals (Ris et al., Reference Ris, Schnepp and Mahrer Imhof2019). A broader and more collaborative approach to care that involves systemic collaboration and community engagement – and that reflects the values and promises of person-centred integrated care - is paramount to OAs’ care (Canadian Home Care Association, 2026; Warrick et al., Reference Warrick, Prorok and Seitz2018). Collectively, these findings emphasize the importance of community-engaged strategies in informing equitable, sustainable care and promoting aging in place. All levels of government can play a role in coordinating efforts across healthcare, social services, community organizations, and informal community networks, to provide the resources, supports, and systems to reduce loneliness, promote social connection, and ultimately build healthy and resilient communities (Women’s Age Lab/Women’s College Hospital, 2024).
Conclusion
Although elected officials and policy bodies in Canada and local municipalities are actively discussing the rapidly aging population, there is a persistent lack of substantive public discourse regarding the high risk and vulnerability faced by OAs in regions like the Sunshine Coast, BC (National Institute on Ageing, 2025). This study revealed the individual, structural, and system barriers that posed significant challenges to aging on the Sunshine Coast, while demonstrating that community-based and informal care networks can strengthen social connectedness, enhance mental wellbeing, and reduce reliance on overstretched care systems. The thematic narratives revealed the resilience of informal care networks despite challenging social determinants of health and the potential of community relationships to mitigate structural inequities. Collectively, the findings emphasize the importance and potential of community-engaged strategies in informing equitable, sustainable care and promoting aging in place. By demonstrating how collective care practices can foster inclusion and resilience, these findings offer actionable pathways for public health policy by supporting interventions that reduce isolation, improve quality of life, and promote aging in place through community-engaged models of care.
Acknowledgements
This project would not have been possible without the commitment and dedication of our partnering organization Deer Crossing the Art Farm. We appreciate their devotion to this work and engagement with the local community. We are grateful for project funding from the Community and Community Social Innovation Fund and the Canada Council for the Arts (2022–2025).
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