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Frequently Asked Questions

​What is the Age-Friendly Health Systems movement?​ 

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 of the United States (CHA). The goal is to build a social movement so that all care with older adults is age-friendly. Specifically, it aims to reach older adults in 2,600 places of care by June 30, 2023.

What are the levels of recognition for health systems participating in the Age-Friendly Health Systems movement? 

IHI recognizes clinical care settings that are working towards reliable practice of evidence-based interventions for all older adults in their care known as the 4Ms (4Ms: What Matters, Medications, Mentation, Mobility). Learn more about the 4Ms in the Age-Friendly Health System Guide to Using the 4Ms in the Care of Older Adults.  

IHI recognizes care locations at two milestones on their Age-Friendly Health System journey: 

  • Level 1: An Age-Friendly Health System Participant has completed a 4Ms Care Description to outline how it will assess, document, and act on all 4Ms at its care setting. At first, their 4Ms Care Description might represent a plan that they will test and work towards reliably performing. 4Ms Care Description fillable PDF forms for submission can be found here. 

  • Level 2: An Age-Friendly Health System - Committed to Care Excellence is working towards reliable practice of the 4Ms. They have achieved level 1 and have submitted at least three months of counts of the number of older adults that have received care that included all 4Ms. Counts of older adults reached can be submitted with the bottom portion of the 4Ms Care Description form that was submitted for level 1 recognition. 

Age-Friendly Health System recognitions are made at the facility level including hospitals, practices, nursing homes and convenient care clinics.   

How can one or more care locations in my health system be recognized as an Age-Friendly Health System Participant (Level 1)?  

First, learn the 4Ms Framework by reviewing the Age-Friendly Health System Guide to Using the 4Ms in the Care of Older Adults. For additional guidance from experts and peer health systems, you can sign up to join an Action Community or receive asynchronous virtual support here.  

Building on what you already have in practice, use the 4Ms Care Description worksheet to outline how you will close the gap and reliably practice all 4Ms. Share your 4Ms Care Description with IHI through this electronic form. 

IHI will recognize care locations as Participants (Level 1) for submitting a completed 4Ms Care Description. You will receive an email from within 3 weeks celebrating you as an Age-Friendly Health System Participant.  

The email might indicate the need to make updates to your 4Ms Care Description to bring it into alignment with the Guide to Using the 4Ms in the Care of Older Adults. You can email updates to your 4Ms Care Description to If no updates are needed, you will be invited to begin working toward Committed to Care Excellence (Level 2) Recognition by submitting counts of the number of older adults receiving 4Ms care for 3 months.  

How can one or more care locations in my health system be recognized as an Age-Friendly Health System Committed to Care Excellence (Level 2)?  

After you are recognized as a Participant (level 1) and have received confirmation from that your 4Ms Care Description is in alignment with the Guide to Using the 4Ms in the Care of Older Adults, you are ready to begin working towards Committed to Care Excellence (Level 2) Recognition.  

Measure the number of older adults that receive 4Ms care. There are three options to start measuring that are detailed in Step 5 in the Guide to Using the 4Ms in the Care of Older Adults: (1) real-time observation, (2) chart review, or (3) EHR report.  

Share at least 3 months of counts with IHI using the bottom portion of the fillable PDF form that was used to submit your description. You can also find the fillable PDF forms here. The counts need to be for months that occurred after your 4Ms Care Description was approved for alignment with the Guide to Using the 4Ms but they do not have to be from consecutive months. You may retrospectively submit three or more counts in one form or submit counts each month, for at least 3 months. 

If your health system has more than one site of care, please submit counts separately for each setting of care. You may also use our spreadsheet where multiple sites may be included with their counts of every month. Please submit counts to 

When 3 months of counts are received, you will receive an email from within 3 weeks celebrating you as an Age-Friendly Health System - Committed to Care Excellence.  

Which settings can be recognized as Age-Friendly Health Systems? Is my whole health system recognized?   ​

Recognition is awarded to care locations such as hospitals, practices, convenient care clinics, and nursing homes (post-acute and long-term care settings). Other types of care locations can email to determine if they are eligible. To be eligible, they must provide direct care to older adults.  


Here are a couple case examples:  

  1. If someone from one area of a hospital (e.g., the ED) submits a 4Ms Care Description, the hospital will be recognized as an Age-Friendly Health System Participant.  

    1. If a health system has multiple hospitals, each hospital will be recognized separately for implementing the 4Ms in at least one area.  

  1. If a nurse in one practice within a health system submits a 4Ms Care Description for how they are practicing the 4Ms during Annual Wellness Visits, that practice will be recognized as a Participant.   

    1. If several practices in the same health system have the same approach to providing 4Ms care, each of those practices can be recognized and use the same 4Ms Care Description.  ​

We encourage health systems to work towards scaling-up the 4Ms to all hospitals, practices, and nursing homes in their network. If you have questions, please email and we will work with you over email or set up a call about strategies for scaling up the 4Ms and receiving recognition for several facilities ​

What care locations have been recognized? Has my care location been recognized? ​ 

Click here to see a list of care locations that have been recognized as Age-Friendly Health Systems at the Committed to Care Excellence or Participant level. ​

Is there a cost to be recognized by IHI?

No. Thanks to generous support from The John A. Hartford Foundation, IHI offers implementation support and recognition at no cost to health systems. ​

What are the benefits of recognition? What happens after my organization is recognized?  

When you are recognized, you will receive a toolkit for celebrating your efforts within your organization and community. The toolkit includes a "badge" that you can add to your email signature and slides or print and display. It also includes templates and best practices for communicating your achievement via press releases and on social media. IHI will list the name of your care location here. IHI and The John A. Hartford Foundation may also celebrate recognized care locations in press releases, on social media, and in other settings.  

Why have I not yet received a response from IHI on my submission to be recognized as a Participant or Committed to Care Excellence?  

Submissions are reviewed and responses are emailed from throughout the month. You should receive an email with information about your recognition status within three weeks. Email for questions.

Do I have to take any steps to sustain my recognition as an Age-Friendly Health System? What are the next steps? 

We encourage recognized care locations to continue their Age-Friendly Health Systems journey in the following ways: 

  • ​If you are a Participant, make edits to your 4Ms Care Description to align with the Guide to Using the 4Ms in the Care of Older Adults (if the need was indicated in your Participant email from and measure the number of older adults that are receiving care that includes all 4Ms in your care setting. Submit at least 3 months counts to be recognized as Committed to Care Excellence.  
  • Scale-up Age-Friendly care in your setting by bringing the 4Ms to additional facilities and achieving recognition in those locations.  

You do not need to take additional action to sustain your original recognition. Instead, focus on improving the reliability and spread of the 4Ms within your health system.

Do you have other questions for the Age-Friendly Health Systems team?
Please reach out to us at​.​​​​