A growing body of international evidence suggests that aging populations are not, in themselves, major drivers of rising health care utilization, since utilization is increasing across all age groups. However, as people age they are more likely to experience multiple chronic health and social needs which fragmented, hospital-based curative health care systems are poorly equipped to address. Lacking appropriate community-based care, older persons with chronic needs can “default” to costly hospital beds, leading to lengthy hospital stays with permanent placement in residential long-term care (LTC) often following. Such system challenges are compounded by a continuing decline in informal caregiving associated with the decline of the nuclear family, women’s growing participation in paid employment, and the out-migration of young adults in rural areas. Nevertheless, the literature suggests that integrating models of home and community care (H&CC) which provide coordinated access to non-medical supports for daily living as well as primary health care, can maintain the wellbeing and independence of older persons and caregivers in their own homes and communities, while moderating demand for bed-based care.