The 4Ms of Age-Friendly Care at Home

It’s no secret that the population of older adults is increasingly rapidly, as 10,000 American adults turn 65 each day. And with aging comes increased chronic conditions and risks for developing serious health-related complications.

Older adults have unique health care needs yet there are many systemic barriers in place to getting them appropriate care. That’s why Community Health Accreditation Partner (CHAP) created the 4Ms framework and certification program – to bring age-friendly care to the homes of older adults.

In April 2023, CHAP awarded Enhabit Home Health & Hospice the Age-Friendly Care at Home Certification, making Enhabit’s two locations in Petersburg, Virginia, and Clermont, Florida, the first home health providers to receive the certification.

“We are proud to be at the forefront of bringing the Age-Friendly Health Systems movement to home-based care,” Enhabit Executive Vice President of Clinical Excellence and Strategy Bud Langham said. “While we’ve always focused on delivering evidence-based, patient-centered care, this movement provides a clear framework on how to incorporate these elements into our standards of care in a way that benefits our patients, clinicians, referral sources and payors.”

The history of Age-Friendly Care

As the population ages, more and more organizations are seeing the importance of setting standards for patients and their loved ones to get the support they need to achieve their health care goals – especially from the comfort of home.

The John A. Hartford Foundation and the Institute for Healthcare Improvement created the Age-Friendly Health Systems initiative in partnership with the American Hospital Association and the​ Catholic Health Association of the United States. The movement exists so health care providers can understand how to provide relevant care to older adults. 

Recognizing an opportunity for home-based care providers to level up their standards of care, CHAP worked with the John A. Hartford Foundation to bring the Age-Friendly Care movement into homes across the country.

“It’s competition in a way that makes everybody better,” Langham told Home Health Care News. “You can see that in the Age-Friendly Health Systems, there’s thousands of organizations who’ve already gone through a similar process on the inpatient side. You don’t want to be that one system in a marketplace that hasn’t been certified age-friendly. My hope is every single market where we achieve this certification, it raises the bar so that everybody has to step up.”

The Age-Friendly Care at Home initiative is now a subdivision of the larger Age-Friendly Care Movement. Through the Centers for Medicare and Medicaid Services (CMS), CHAP has the authority to survey home-based care agencies to ensure they are meeting the Medicare Conditions of Participation and CMS Quality Standards.

What are the 4Ms of Age-Friendly Care?

The purpose of the 4M’s is to give providers a user-friendly framework that facilitates intentional care for older adults by focusing on what is most important to them. By focusing on each “M”, home health care providers can better support their aging patients.

“With older adults, you can’t just assume you know their goals or what’s most important to them,” Langham said. “The 4Ms set the stage for learning more about your patients and taking their specific needs into consideration when executing their care plan.”

The 4Ms of Age-Friendly Care are as follows:

What matters

Providers should ask their patients what matters most to them – both in their health care journey and in their personal lives. What are their specific goals? Which activities did they love to do and would like to one day do again? What is essential to their health and well-being?

Knowing a patient’s core values can help you better support them in reaching their goals.

Medication

Many older adults take multiple medications to manage different conditions. Advocating for age-friendly medications with minimal risks or side effects will ensure that medications aren’t impacting any of the other 4Ms.

It is also important to ensure patients understand why they are taking each medication and the possible side effects or reactions that come with each medication.

Mentation

This means focusing on and prioritizing the prevention, identification, treatment and management of brain-related mood or memory disorders. These include dementia, depression or delirium.

When a patient’s cognitive decline is well-managed, they can focus on what matters to them.

Mobility

In order to do the things that matter to them, patients must be able to get up and move confidently and safely.

It is important for providers to teach older adults appropriate ways to safely and freely move around their environments. Addressing home safety and fall risks should also always be a focus.

The 4Ms and value-based purchasing

Although created with patient care in mind, the 4Ms also the fit Home Health Value-Based Purchasing (HHVBP) model. This makes it beneficial for providers to follow the framework and become certified.

“In HHVBP, we’re going to be measured on how much we help patients improve,” Langham said in his interview with Home Health Care News. “Two huge parts of that are hospitalization rates and the patient experience. The evidence from the Age-Friendly Health Systems program shows that they lower the overall total cost of care and it improves hospitalization rates.”

Consistent care is attractive to both payors and the patients. Knowing a home health care agency like Enhabit can be relied on to provide consistent, high-quality care is key to the overall success of the company and the satisfaction levels of the patients and their loved ones.

“When we can provide reliable, high-quality care, it benefits all stakeholders – patients, families, health care providers and payors,” Langham said. “Outcomes are better, costs are lower and patients and their loved ones are satisfied. We’ve been prioritizing this for over 20 years at Enhabit. But the Age-Friendly Care at Home framework sets that standard for others to do the work to get certified and make sure all patients receive the best care possible, no matter who their provider is.”