18-Month Collaborative: April 2024–October 2025

IHI is excited to announce the Age-Friendly System-Wide Spread Collaborative, which will be the learning and action community for US health systems interested in fully embedding the 4Ms system-wide, to have an equitable impact on older adults across all of their sites and settings of care.

The Collaborative will convene a cohort of 30 teams from health systems with sites of care recognized as Committed to Care Excellence to accelerate system-wide adoption of the 4Ms, with guidance from expert faculty and an “all-teach, all-learn” approach. Collaborative participants will have the opportunity to be among the first to achieve an ambitious new IHI recognition for system-wide spread of age-friendly care.

Image

During the 18-month Collaborative, health systems will test changes to ensure that the 4Ms Framework of an Age-Friendly Health System is implemented equitably as a standard practice to ensure optimal health care for all older adults across the health system. Participating teams will analyze shared data to advance quality improvement goals that align with the IHI change package for scaling the 4Ms system-wide. Participating teams will document and demonstrate the alignment of current health system priorities and programs with the 4Ms Framework, and apply a data-driven, shared learning approach to review progress against an established aim to scale age-friendly care delivery and act on the 4Ms system-wide.

Learn More

• Download the Collaborative Prospectus to learn more about participation criteria, enrollment fees, activities, how to apply, and other important information
• Download the Participant Packet to learn more about the Collaborative schedule and pre-work  
• Watch a recording of the January 2024 informational session and download the accompanying slides
• Watch a recording of the April 2024 Kickoff call and download the accompanying slides

Contact

For questions or further information, please email afhs@ihi.org.

Age-Friendly Health Systems IHI Team and Faculty

• Matt Berry, Marketing Manager (maberry@ihi.org)
• Alice Bonner, PhD, RN, Advisor, Care of Older Adults (abonner@ihi.org)
• Nicole Brandt, PharmD, Faculty
• Cynthia Brown, MD, Faculty
• Kate DeBartolo, Senior Project Director, (kdebartolo@ihi.org)    
• Alex Enxuto, Associate Project Manager (aenxuto@Ihi.org)
• Donna Fick, MD, Faculty
• Luisana Henriquez Garcia, MA Project Manager (lgarcia@ihi.org)
• Laura Howell Nelson, Project Director (lhowellnelson@ihi.org)
• Nicole Korp, Project Manager (nkorp@ihi.org)
• Kevin Little, PhD, Improvement Advisor
• Kedar Mate, MD, President and CEO, Senior Sponsor (kmate@ihi.org)
• Amanda Meier, MA, Project Manager (ameier@ihi.org)
• Ivy Mwangi, MD, Faculty
• KellyAnne Pepin, MPH, Senior Project Director (kpepin@ihi.org)
• JoAnne Reifsnyder, PhD, MSN, MBA, RN, FAAN, Faculty
• Cayla Saret, Senior Managing Editor (csaret@ihi.org)
• Rafael Samper-Ternent, MD, PhD, Faculty 
• Andrea Schwartz, MD, Faculty
• Christina Southey, Im​provement Advis​or
• Mary Tinetti, MD, Faculty

Age-Friendly Health Systems Advisory Group​

• ​​​Don Berwick, MD, MPP (chair), President emeritus and Senior Fellow, Institute for Healthcare Improvement, former administrator of the Centers for Medicare & Medicaid Services
• Faith Mitchell (co-chair), PhD, Institute Fellow, Urban Institute
• Mary Tinetti, MD (founding co-chair), Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Professor, Institution for Social and Policy Studies; Section Chief, Geriatrics
• Ann Hendrich, PhD, RN (founding co-chair), Researcher & Content Expert, Health System, Nursing and Safety Executive
• Kyle Allen, DO, AGSF, Vice President Enterprise Medical Director, CareSource
• Kevin Biese, MD Associate Professor, Emergency Medicine; Co-Director, Division of Geriatric Emergency Medicine; Director, Emergency Medicine Residency Program;  Advisor to Gary and Mary West Health Institute
• Alice Bonner, PhD, RN, Advisor, Care of Older Adults, Institute for Healthcare Improvement
• Peg Bradke, RN, MA, Vice President, Post-Acute Care, UnityPoint Health - St. Luke's Hospital
• Nicole Brandt, PharmD, MBA, Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy; Executive Director, Peter Lamy Center on Drug Therapy and Aging
• Marie Cleary-Fishman, BSN, MS, MBA, CPHQ Vice President , Clinical Quality AHA Center for Health Innovation American Hospital Association
• Lenise Cummings-Vaughn, MD, Associate Professor of Medicine, Washington University's School of Medicine
• Thomas E. Edes, MD, MS, Senior Medical Advisor, Office of Geriatrics & Extended Care, U.S. Department of Veterans Affairs
• Glyn Elwyn, MD, PhD, The Dartmouth Institute for Health Policy and Clinical Practice
• Wes Ely, MD, MPH, Professor of Medicine, Vanderbilt University School of Medicine
• Donna Fick, PhD, RN, Elouise Ross Eberly Professor of Nursing and Professor of Medicine and Director of Center of Geriatric Nursing Excellence, Pennsylvania State University; Editor, Journal of Gerontological Nursing
• Terry Fulmer, PhD, RN, President, The John A Hartford Foundation
• Sherry A. Greenberg, PhD, RN, GNP-BC, FGSA, FNAP, AGSF FAANP, FAAN Evelyn Lauder Chair in Adult Gerontology and Professor Hunter-Bellevue School of Nursing, Hunter College, New York City
• Scotte R. Hartronft, MD, MBA, FACP, Executive Director, VA Office of Geriatrics and Extended Care, Veterans Health Administration
• Carrie Hays McElroy, MSN, RN, Gero-BC, ACM, VP Clinical Operations/CNO, Chief Integrity and Compliance Officer, Trinity Health PACE
• Kate Hilton, JD, MTS, Senior Consultant, ReThink Health and Faculty, Institute for Healthcare Improvement
• Ann Hwang, MD, Director of the Center for Consumer Engagement in Health Innovation, Community Catalyst
• Barbara Jacobs, RN, Vice President, Nursing and Chief Nursing Officer, Anne Arundel Medical Center
• Maulik Joshi, DrPH, Chief Executive Officer, Meritus Health
• Doug Koekkoek, MD, Chief Executive, Providence Medical Group
• Bruce Leff, MD, Professor, Johns Hopkins Medicine and Director, The Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine
• Shari M. Ling, MD, Acting CMS Chief Medical Officer
• Nancy Lundebjerg, MPA, Chief Executive Officer, American Geriatrics Society
• Joe McCannon, Founder, Shared Nation, Formerly Founder and Chief Executive Officer, Billions Institute
• Angela Patterson, DNP, FNP-BC, NEA-BC, FAANP, Chief Nurse Practitioner Officer, CVS Minute Clinic Vice President, CVS Health
• VJ Periyakoil, MD, Director, Palliative Care Education and Training, Stanford University School of Medicine, VA Palo Alto Health Care System, Division of Primary Care and Population Health
• ​Jonathan Perlin, MD, President and CEO, The Joint Commission
• Eric Rackow, MD, Executive Chairman and Co-Founder, eFamilyCare; President Emeritus, NYU Hospital Center; Professor of Medicine, NYU School of Medicine
• ​Stephanie Rogers, MD, MPH Assistant Professor, Medicine, University of California, San Francisco
• Ronnie Rosenthal, MD, Professor of Surgery, Yale School of Medicine and Surgeon-In-Chief, VA Connecticut Healthcare System
• Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC, Chief Nursing Executive, HCA Healthcare American Group, Vice President, Group Clinical Operations
• Nirav Shah, MD, MPH, Adjunct Professor at the School of Medicine, Stanford University
• Albert Siu, MD , Professor and System Chair, Geriatrics and Palliative Medicine, Population Health Science and Policy, General Internal Medicine
• Victor Tabbush, PhD, Adjunct Professor Emeritus, UCLA Anderson School of Management
• Julie Trocchio, MSN, Senior Director, Community Benefit and Continuing Care, Catholic Health Association of the United States

Age-Friendly Health Systems What Matters Advisory Group

• Jodi Alei
• Larry Alei
• Revathi A-Davidson
• Joann Austin
• Elissa Brown
• Sandra Cuenca
• MaeMargaret Evans
• Jacalyn Eyvonne
• Kate Hilton
• Janice Hopper
• Andrea Kabcenell
• Rafael Ruiz
• Robert Small
• Randy Smith
• Madge Street
• Bernard Hasan

Resources to Practice Age-Friendly Care

Numerous resources are available to help your team and organization practice age-friendly care and to guide your journey toward becoming an Age-Friendly Health System, including:

• Getting Started Guides
• Age-Friendly Health Systems Measurement
• NEW: CMS Age-Friendly Hospital Measure
• NEW: Register for CMS Webinar
• 4Ms Framework ​of an Age-Friendly Health System
• Making the Business Case for Age-Friendly Health Systems
• Working with Older Adults
• Case Studies
• Equity in Age-Friendly Care
• Additional Resources: IHI Insights, news and journal articles, and more
   

Getting Started Guides

​​​​​​​​​​Guide to Using the 4Ms in the Care of Older Adults in Hospitals and Ambulatory Practices

The guide is designed to help care teams test and implement a specific set of evidence-based, geriatric best practices called the "4Ms": What Matters, Medication, Mentation, Mobility.

• Download the Guide

Guide to Care of Older Adults in Nursing Homes

IHI, along with partner nursing homes, has developed the Age-Friendly Health Systems Guide to Care of Older Adults in Nursing Homes and companion document, Age-Friendly Health Systems Workbook for Nursing Homes Teams. The Guide presents a systems-based approach to implementing the 4Ms throughout the nursing home, and the Workbook is designed by and for point-of-care teams that interact with individual residents each day.

• Download the Guide
• Download the Workbook

Guide to Recognition for Geriatric Emergency Department Accredited Sites

Geriatric Emergency Department Accredited sites are well aligned with 4Ms care. This guide provides an overview of each initiative, illustrates the overlap between them, and provides guidance on incorporating What Matters to older adults into Geriatric Emergency Department care.

• Download the Guide

Guide to Recognition for Geriatric Surgery Verification Hospitals

Geriatric Surgery Verification (GSV) Hospitals are well aligned with 4Ms care. This guide provides an overview of each initiative and illustrates the GSV Standards that meet the requirements for recognition as an Age-Friendly Health System when provided to adults ages 65+.

• Download the Guide

Guide to Using the 4Ms in the Care of Older Adults in the Convenient Care Clinic

This guide contains resources to help convenient care clinics implement the 4Ms (What Matters, Medication, Mentation, and Mobility) into their setting of care.

• Download the Guide

Guide to Using the 4Ms in the Care of Older Adults in Home Health

This guide contains resources to help home health implement the 4Ms (What Matters, Medication, Mentation, and Mobility) into their setting of care.

• Download the Guide

The Three Keys to Cross-Sector Age-Friendly Care

Improving Public Health and Health Care for Older Adults: The Three Keys to Cross-Sector Age-Friendly Care Implementation Guide and Workbook contains resources to improve how public health and health care organizations work across the care continuum. The accompanying materials also provide guidance and specific recommendations to support efforts to provide age-friendly care to all older adults.

• Download the Implementation Guide and Workbook plus related content

Age-Friendly Health Systems EHR Implementation Guides

• Download the EHR Implementation Guide with Cerner Examples
• Download the EHR Implementation Guide with Epic Examples
• Download the Epic Implementation Guide
• Download the Cerner/Oracle Implementation Guide​

For feedback or questions about these guides, please email afhs​@ihi.org.

Age-Friendly Health Systems Measurement

Age-​Friendly Health Systems: Measures Guide

This document provides guidance on how to use and track a series of measures ​​to help study your performance​.

• Download the Measures Guide​
• Video: Measuring the Impact of the 4Ms in Your System
• NCQA Article: A Core Measure Set For Age-Friendly Health Care Delivery

4Ms Evaluation Metrics Resource Library

Developed by the University of California San Francisco and a national Age-Friendly Health System Research Council, the 4Ms Evaluation Metrics Resource Library is a one-stop collection of 4Ms metrics compiled from the literature to help evaluators, researchers, implementers, and other stakeholders jump start their work to assess the impact of 4Ms implementation efforts. Metrics can be easily filtered by each of the 4Ms, measure type (e.g., process, outcome), clinical setting, data source, and subpopulations.

• Access the 4Ms Evaluation Metrics Resource Library 

Cross-Setting Measurement Guide 

The Comprehensive measurement guide has been created to reflect the measurement guidance contained in the guides for Hospital, Ambulatory, Nursing Home, Convenient care and Home care. It contains a comparison of the recommended measures for all settings that can currently be recognized by IHI (as of February 2025) and definitions of the measure for considerations by systems. Additionally, the guide builds on the guidance in the various AFHS Guides by adding in measures that we have gathered from systems looking to spread the 4Ms across their system and provides additional considerations for systems creating their own measurement dashboards to track the impact of the 4Ms on process and outcomes. 

The guide has been created to provide a base for diverse systems to customize their own measures based on their internal systems. IHI will continue to review and revise the guide as required as we learn more from the increasing number of systems engaged in implementing the 4Ms in their system and tracking impact. 

• Access the Cross-Setting Measurement Guide

Spreading Age-Friendly Care: From One Care Location to Reach Older Adults Across Your Health System

The guide will help health systems in spreading the 4Ms through all sites of care by discussing international effort and specific activities to reach this goal.

• Download the Guide

Read these IHI Insights posts to learn how different health systems have spread 4Ms care using the drivers or approaches outlined in the guide. 

• Hartford HealthCare: Celebrate and tell your stories to drive spread
• University of Texas Health Science Center at Houston: Calculate the financial impact of practicing the 4Ms
• Providence Health: Get specific about which health system priorities are advanced by the 4Ms
• MaineHealth: Gather evidence of impact during piloting of the 4Ms

NEW: CMS Age-Friendly Hospital Measure

Advancing Age-Friendly Care: From the 4Ms Framework to the CMS Inpatient Quality Measure

Join the Centers for Medicare & Medicaid Services (CMS) on July 23, 2025, at 2 p.m. (ET) for the webinar “Advancing Age-Friendly Care: From the 4Ms Framework to the CMS Inpatient Quality Measure.” With 1 in 6 Americans over 65, implementing evidence-based practices for older adults is crucial.

• Register to Attend

This brief overview discusses why the measure matters, crosswalks the five domains of the measure to the 4Ms of the age-friendly care, includes a timeline of the measure, and shares resources. 

• Download the Overview

CMS Age-Friendly Measure Completion Checklist

Use this example checklist from Luminis Health Anne Arundel Medical Center as a starting point for documenting and monitoring progress towards attestation. 

• Download the Checklist

CMS, AHRQ, and UCSF on Advancing Age-Friendly Care

The recording of this October 2024 Friends of Age-Friendly Health Systems call is now available to view online or share with a colleague.

• Watch the recording
• Download the slides

The Expert Oversight Committee (EOC), as an advisory body to the Certification Board for Professionals in Patient Safety (CBPPS), is responsible for overseeing the examination and recredentialing processes for the Certified Professional in Patient Safety™ (CPPS) and Certified Professional in Human Factors in Health Care (CPHFH) credentials and ensuring that certification continues to meet the high standards required for the profession.

Download the latest version of the CBPPS Policies statement

Download the latest CPPS Job Analysis Report Summary
 

Certification Board for Professionals in Patient Safety

• Rollin J. "Terry" Fairbanks, MD, MS, CPPS
  CBPPS Chair
  Senior Vice President and Chief Quality and Safety Officer
  MedStar Health
  Professor of Emergency Medicine
  Georgetown University
• Martin (Marty) Hatlie, JD
  CBPPS Public Member
  Co-Founder, Patients for Patient Safety US
  President and CEO, Project Patient Care
• Michelle Jackson, MSN, RN, SCRN, NE-BC, CPPS, CPHQ
  Division Assistant Vice President of Patient Safety and Clinical Excellence
  HCA Healthcare Houston Gulf Coast Division
• Patricia McGaffigan, RN, MS, CPPS 
  Ex Officio
  CBPPS President
  Senior Advisor, Safety
  Institute for Healthcare Improvement​
• Sam Shen, MD, MBA, CPPS
  CBPPS Vice Chair
  Patient Safety Officer/Associate Chief Quality Officer, Stanford Healthcare
  Professor of Emergency Medicine, Dept. of Emergency Medicine, Stanford University School of Medicine
• Sam R. Watson, MSA, MT(ASCP), CPPS, CAE
  CBPPS Secretary
  Senior Vice President, Field Engagement
  Michigan Health & Hospital Association (MHA) Keystone Center
• Ronald M. Wyatt, MD, MHA 
  CBPPS Member
  Founder and CEO
  Achieving Equity LLC
• Wade J. Westhoff, CFP®, AIF®
  CBPPS Treasurer and Public Member
  The Westhoff Group, Raymond James

Ways to Get Involved

IHI offers multiple ways for health systems and individuals to join the AFHS movement based on your specific needs.

• Join an Action Community: Great resource for teams looking to implement age-friendly care in their health system or practice.
• Enroll in the IHI Online Course with Coaching: Excellent opportunity for individuals looking to learn more about age-friendly practices and make an impact within their daily work.

Learn more about these opportunities below. 

Action Communities

Action Communities enable teams to accelerate reliable practice of the 4Ms in an active community of learners and testers. This 7-month journey to Recognition provides a structure for learning with and from other health systems and expert faculty. 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 to improve care in their health system.

Action Communities are scheduled periodically throughout the year and facilitated by IHI or other organizations. ​If your health system or practice is interested in the Action Community,​​ see the upcoming opportunities below.

Upcoming Action Communities

Action Community: Begins Fall 2025

Register for the Fall 2025 Action Community

Facilitated by: American Hospital Association

• Register here for an informational webinar hosted by AHA on June 12, 2025 titled "Healthy Aging on Chicago's South Side: The SHARE Network and Its Impact" 

Online Course with Coaching

The Online Course with Coaching is a new, in-depth course that teaches the elements of the 4Ms Framework and develops your ability to provide age-friendly care in various settings, including hospitals, clinics, nursing homes, and home health agencies. Get started with age-friendly care as an individual and learn to act as a champion of age-friendly care within your health system.

IHI online courses with coaching combine self-directed sessions and live virtual instruction facilitated by expert IHI faculty. This design gives learners flexibility with their schedule, without sacrificing the deep learning that occurs with our specialized faculty.

Continuing education credits for this program are still being finalized and will be updated shortly.

Register for the September 2025 Online Course with Coaching 

Do-It-Yourself (DIY) Participation

Some health systems are able to adopt the 4Ms without requiring the intensive support of an Action Community or Scale-up Accelerator services. IHI now offers this pathway for systems that are motivated and want to start right away without waiting for an Action Community enrollment opportunity.

• Learn more about how to submit a 4Ms care description and get recognized.
• Looking for a structured primer on Age-Friendly Health Systems (AFHS)? Check out our Open School course to get started.

Consultative Services

For organizations committed to providing age-friendly care, IHI offers customized consultation support to achieve system-wide spread. This includes specialized services aimed at supporting system leadership, clinical leadership, and point-of-care operations to adopt 4Ms care practices through all types of care settings within the health system.

For more details and cost of service, please reach out to our team at consulting@ihi.org. 

State-Based Age-Friendly Health Systems Support

IHI recognizes clinical care settings that are working toward reliable practice of evidence-based interventions for all older adults in their care known as the 4Ms (4Ms: What Matters, Medications, Mentation, Mobility). As of July 2025, over 5,300 health care organizations have earned either level 1 (Participant) or level 2 (Committed to Care Excellence) recognition in the Age-Friendly Health Systems movement.

• Level 1 (Participant) teams have successfully developed plans to implement the 4Ms.​
• Level 2 (Committed to Care Excellence) teams have three months of data of older adults who received 4Ms care.

​For more information on who is eligible for recognition, timelines for submission to notification, ​and more, visit the Frequently Asked Questions section below or sign up for Office Hours​ to meet with our team.

Submit Your 4Ms Care Description

Step 1. Select the 4Ms Care Description worksheet that best corresponds to your site of care

Understand which 4Ms care description to select for your facility, with the guidance from this one pager. 

• Hospital
• Nursing Home​​​
• Ambulatory Care​
• Convenient Care Clinic
• NEW: Home Health
• Hospitals That Have Achieved Geriatric Surgery Verification ​
• ​Sites That Have Achieved Geriatric Emergency Department Accreditation
• Committed to Care Excellence Counts (multiple sites​​)*​​

*If your health care system has multiple sites of care, please use the Committed to Care Excellence Counts (multiple sites) spreadsheet. If not, please look on the last page of your Care Description PDF Form.

Step 2. Email your completed 4Ms Care Description worksheet to AFHS@ihi.org 

You should receive an email with information about your recognition status within three weeks.

Please email AFHS@ihi.org for questions or additional information on becoming recognized as an Age-Friendly Health System.​​

Resources for Recognition

• Learn about the recognition process. This video will walk through the steps of submission and achieving recognition.
  • Recording for Recognition
• Download the Guide to Using the 4Ms in the Care of Older Adults for your care setting to learn about the 4Ms Framework and how to become an Age-Friendly Health System.
  • Download the Guide for Hospital/Ambulatory Practice
  • Download the Guide for Nursing Homes
  • Download the Guide for Convenient Care Clinics
  • NEW: Download the Guide for Home Health
  • Download the Guide to Recognition for Geriatric Surgery Verification Hospitals
  • Download the Guide to Recognition for Geriatric Emergency Department Accredited Sites
• Download the What Matters to Older Adults? Toolkit to design better care with older adults but understanding "what matters" most to each adult
  • Download the Toolkit
• Download the Age-Friendly Health Systems Workbook for Nursing Home Teams designed by and for point-of-care teams that interact with individual residents each day.
  • Download the Nursing Home Workbook
• Download the Age-Friendly Health Systems Mobility Assessment Tools Guide to identify accepted mobility tools for use within your facility.
  • Download the Mobility Assessment Tools Guide

Age-Friendly Health Systems Recognized Sites

Please visit the Recognized Sites page to view a list of hospitals and health care practices that have achieved Age-Friendly Health Systems Recognition.

According to the US Census Bureau, the US population aged 65+ years is expected to nearly double over the next 30 years, from 43.1 million in 2012 to an estimated 83.7 million in 2050. These demographic advances, however extraordinary, have left our health systems behind as they struggle to reliably provide evidence-based care to every older adult at every care interaction.

What Is an Age-Friendly Health System?

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), designed to meet this challenge head on.

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.
   

Learn more about upcoming Action Communities and the new Online Course with Coaching

What Does It Mean to Be an Age-Friendly Health System?

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 in your system: What Matters, Medication, Mentation, and Mobility.

4Ms Framework of an Age-Friendly Health System

Image

Learn more about How to Practice the 4Ms by Care Setting

Connect and Learn with the Age-Friendly Health Systems Movement

Join Friends of Age-Friendly Health Systems for updates about the movement, notification about quarterly webinars, access to experts, and further support on the 4Ms Framework.

• Sign up for the Friends of Age-Friendly newsletter
• Friends of Age-Friendly Webinars: Recording links and descriptions for each webinar

Upcoming Webinar: Coming Soon