Why It Matters
"Nursing homes are ideally positioned to become age-friendly because their care practices often align with the 4Ms. However — as is true in many settings — this care is often not reliably or consistently delivered in every interaction."
In this second article in our series on nursing homes (read Part I here and Part II here), we explain how the Age-Friendly Health Systems (AFHS) “4Ms” Framework can support nursing home residents and staff.
Age-Friendly Health Systems aim to:
- Follow an essential set of evidence-based practices;
- Cause no harm; and
- Align with What Matters to the older adult and their family caregivers.
Becoming an Age-Friendly Health System entails reliably providing a set of four evidence-based elements of high-quality care, known as the 4Ms, to all older adults your system: What Matters, Medication, Mentation, and Mobility.
Figure 1. The Age-Friendly Health Systems 4Ms Framework
The 4Ms — What Matters, Medication, Mentation, and Mobility — make complex care of older adults more manageable. The 4Ms identify core issues that should drive care and decision-making with older adults and focus on their wellness and strengths rather than solely on disease.
The 4Ms apply regardless of the number of functional challenges an older adult may have, or that person’s cultural, ethnic, or religious background. The 4Ms are a framework, not a program, to guide care of older adults wherever and whenever they encounter a health system’s care and services. Rather than layering them on top, the intent is to incorporate the 4Ms into existing care to organize its efficient and effective delivery. This integration is achieved primarily through redeploying existing resources.
Age-Friendly Care in Nursing Homes
Age-friendly care is appropriate for older adults in any setting. Nursing homes are ideally positioned to become age-friendly because their care practices often align with the 4Ms. However — as is true in many settings — this care is often not reliably or consistently delivered in every interaction. Implementation of the Age-Friendly Health Systems 4Ms Framework provides an integrated, evidence-based foundation from which to consistently deliver 4Ms care to all residents, aligned with What Matters to them, all the time.
Nursing homes can participate in the AFHS movement by joining an Action Community of peers and colleagues or through the Do-it-Yourself (DIY) pathway. For those on the DIY pathway, Institute for Healthcare Improvement (IHI) staff and expert faculty offer support on a self-paced timeline determined by the nursing home.
Active participation in an Action Community helps teams to accelerate reliable practice of the 4Ms with other learners and testers. This seven-month journey to AFHS recognition provides a structure for learning with and from other health systems. Over the course of the Action Community, teams participate in webinars and attend an in-person meeting (when possible) and develop their plan for practicing the 4Ms. IHI staff and faculty who have experience working in nursing homes offer personalized support and opportunities to connect with nursing home peers.
The Benefits of Providing Age-Friendly Care in Nursing Homes
Nursing homes report multiple benefits to their residents of joining AFHS. Marcus Ruopp, MD, a physician with the US Department of Veteran Affairs (Boston, Massachusetts, USA), said, “AFHS has had a transformative impact in our SNF. There was significant improvement in our care and clinical outcomes after adoption of the 4Ms Framework, such as fewer falls, reduced prescribing of potentially inappropriate medications, fewer disruptive behaviors, and increased documentation of What Matters.” He added, “We found the 4Ms easy to implement and the resources extremely valuable.”
Implementation of the Age-Friendly 4Ms — especially the patient-centered focus on What Matters to residents — can have a positive impact on staff and organizational culture. Marie Goode, RN, the Director of Nursing at the Lutheran Home at Kane (Ridgway, Pennsylvania, USA), said, “Touching the hearts of our residents and making it the best stay possible whether they are here for weeks or years is truly our goal. The 4Ms are a foundation for us to use to make that goal achievable.” Ruopp noted, “We found increases in staff morale and engagement after implementation of the 4Ms.”
Nursing home patients and residents often move between siloed settings. However, as more hospitals, ambulatory practices, and nursing homes implement the 4Ms, this “common language” helps to streamline communications between care settings. This can help improve resident care during transitions.
To learn more about joining the nearly 700 nursing homes across the nation that have been recognized as Age-Friendly Health Systems, email Amanda Meier at ameier@ihi.org.
Alice Bonner, PhD, RN, is IHI’s Senior Advisor for Aging. Amanda Meier, BSW, MA, is IHI’s Project Manager, Age-Friendly Health Systems. Editor’s note: AFHS is an initiative of The John A. Hartford Foundation and IHI, in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).
On April 10, 2024, the Centers for Medicare & Medicaid Services (CMS) proposed the Age-Friendly Hospital measure. It encourages hospitals to improve care for patients aged 65 years or older. You can show your support for this important measure to improve the quality of care for older adults by leaving a comment before Sunday, June 2, 2024. For more details: Age-Friendly Attestation Measure in the Federal Register.
The Basics We (and Policymakers) Should Know about Nursing Homes – Part I in the Nursing Home Basics Series
Nursing Home Basics: Who Qualifies, Who Pays, and Other Helpful Facts – Part II in the Nursing Home Basics Series
Centering What Matters: The Core of Age-Friendly Care
To have more efficient, effective, and productive appointments, share this new guide, My Health Checklist, with older adults before the conversation.