Blog October 01, 2018

Spotlight: Building Age-Friendly Health Systems and a Workforce to Match

Rani E. Snyder, Program Director


As we age, many things change, including our health care needs. We might develop chronic conditions, take more medications, and require assistance with daily activities. To meet these needs, our health systems – and their workforce – must become more age-friendly: better prepared to provide care that matches our goals and preferences as we age.

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association (CHA). The initiative involves implementing evidence-based interventions based on the “4Ms,” which represent the essential and interconnected elements of good geriatric care:

  1. What Matters: Knowing and acting on each patient’s specific health outcome goals and care preferences
  2. Medication: Optimizing use to reduce harm/burden, focusing on medications affecting mobility, mentation and what matters
  3. Mentation: Focusing on depression, dementia & delirium
  4. Mobility: Maintaining mobility/function, preventing and treating complications of immobility

Over the last 18 months, this initiative has grown from 26 teams implementing these age-friendly interventions across five pioneering health systems to a movement that recently expanded to include more than 120 teams testing the 4Ms across 73 systems. Our goal is to reach 20 percent of health systems and hospitals by 2020, so that age-friendly care is reliably delivered in every setting, every time. In doing so, we will be ensuing that older adults get the best care possible, reduce health care-related harm, increase patient satisfaction and optimize value for everyone — patients, families, caregivers, health care providers and health systems.

As the age-friendly movement spreads, we are also simultaneously helping to build a more age-friendly workforce, as called for by the groundbreaking Retooling for an Aging America report a decade ago, and by the Eldercare Workforce Alliance today.

Through training on the 4Ms, health care teams are increasing their competence in the best practices of geriatric care, from medication management to mobility plans. The age-friendly concept is inherently team-based and interdisciplinary, and will help teach those skills. The initiative crosses all health care settings, from the kitchen table to the emergency department to nursing homes. And it is reinforcing the need for better supported direct-care workers who can deliver high-quality home and community-based care.

These workforce development elements will soon be made more widely available to everyone. The CATCH-ON Geriatric Workforce Enhancement Program at Rush University is partnering with IHI to develop online education as part of the Age-Friendly Health Systems initiative. The education will be targeted towards health care staff across the health system. The first set of modules, anticipated in Fall 2018, will focus on a high-level overview of the 4Ms and why they are important, the 4Ms in the hospital and outpatient settings, and how to implement the 4M model.

A second set of modules is planned to expand upon the issues within the 4Ms, including dementia, delirium, and depression, with targeted training for health care staff from reception through doctors, nurses, and allied health.

There are other ways the Age-Friendly Health Systems initiative is helping to make our health care workforce more age-friendly. For one, the initiative has an intense focus on systems change. In the participating systems, the implementation goes beyond training and education to changing workflows and processes, so that staff development can be more sustainable. And as a movement, Age-Friendly Health Systems also focuses on culture change. The commitment from executive leadership in participating systems makes investments across other areas much more likely, including in the workforce.

The John A. Hartford Foundation will continue this workforce development through other related initiatives, as well. We will continue training and education for specialists (through the Geriatric Emergency Department Collaborative and the Coalition for Quality in Geriatric Surgery); for nurses, other hospital staff, and social service providers to better support family caregivers (through AARP’s Home Alone Alliance and new work from the Diverse Elders Coalition); and for walk-in retail pharmacy clinic staff (Case Western Reserve/CVS Minute Clinic partnership).

We hope you will join us in this effort to make our health systems and those who work within them more age-friendly. Visit IHI’s website for more information, email and request to stay informed. Together we can help make the recommendations from the Retooling for an Aging America report real, by creating more age-friendly health systems, with a workforce to match.


For more information on this topic, you can view a webinar, ‘Age Friendly Workforce: Preparing the Workforce to Care for Us as We Age.’