Why Age-Friendly Care Is Becoming a Healthcare Standard

00:00:00:01 - 00:00:17:04
Tom Haederle
Welcome to Advancing Health. Over the past several years, the commitment to Age Friendly health care principles has been increasingly embedded across America's health care system. Now, its success is being recognized on the national level with a new award.

00:00:17:06 - 00:00:32:28
Kristin Preihs
Welcome, everyone, and welcome to the AHA Advancing Health podcast. I am Kristin Preihs, vice president with the American Hospital Association, and I am thrilled to be joined today by Rani Snyder, president of the John E. Hartford Foundation. Rani, it is always wonderful to be with you.

00:00:33:00 - 00:00:34:27
Rani E. Snyder
I'm so happy to be here.

00:00:35:00 - 00:01:01:21
Kristin Preihs
Fantastic. For nearly a decade, AHA and John E. Hartford have worked together through advancing Age Friendly care to help hospitals and health care systems put the 4Ms, what matters, medication, mentation and mobility into practice. And what is exciting about this moment is how far this work has come. We're no longer just talking about organizations being their Age Friendly journeys across the country, and hospitals and health care systems.

00:01:01:21 - 00:01:23:03
Kristin Preihs
We're seeing now, for the first time, are really embedding those principles so much more deeply into delivering care, to measuring measurable results and, most importantly, improving the experience of older adults and their families. And that evolution is why we're so excited to together launch the Age Friendly Health Care Impact Award. This is more than another recognition program.

00:01:23:05 - 00:01:41:27
Kristin Preihs
It's an opportunity to shine a national spotlight on organizations that are setting a new standard for what excellent care looks like across older adults. And Rani, before we talk about the award itself, which we're so excited to get into, I want to start a little bit about you and the foundation. For someone who may be newer to this work,

00:01:41:28 - 00:01:48:26
Kristin Preihs
can you tell us a little bit about Age Friendly care and how you have seen Age Friendly health systems and the movement evolve?

00:01:48:28 - 00:02:12:10
Rani E. Snyder
Thanks, Kristen. I could not be happier to be here talking about this today. Age Friendly care really comes from an initiative that we started called Age Friendly Health Systems, which is a national movement to improve both the quality and the safety of care for older people. We're really pleased to have the American Hospital Association as one of our lead partners in this whole movement.

00:02:12:12 - 00:02:33:11
Rani E. Snyder
In addition to the Institute for Health Care Improvement, I'll note that Age Friendly care is grounded in the 4 M's framework and you referenced those 4Ms already. They are what matters, medications, mentation and mobility. And I'll say a little bit more about those. But first I want to note that the four M's represent the biggest drivers of health outcomes for older patients.

00:02:33:13 - 00:03:00:03
Rani E. Snyder
They provide a streamlined evidence based way for health care teams to reduce harm, and also to align care with what matters most to older people and their family caregivers together. What matters I'll note, is certainly the most meaningful starting point. Understanding each older person's goals and preferences and making sure that the care plan itself reflects those are key.

00:03:00:06 - 00:03:29:24
Rani E. Snyder
All 4Ms are interrelated. They're designed to be a set, not a one, one by one. And that's a really important point. So I'm going to give a brief example. My colleague's 86 year old father badly needed a hip replacement. He was nervous to have the surgery and didn't want to do it. And it wasn't until the what matters conversations started happening with his care team and his family about getting back out to his garage, that he agreed to the procedure.

00:03:29:27 - 00:04:02:15
Rani E. Snyder
So the care team then realized that his medications were actually a big risk. He was on two of them that were no longer needed, and the hospital team ensured that his mentation, his cognitive status, was monitored, especially to prevent delirium, which is something that can happen, especially in hospitals, but in other settings as well. And the result was a successful surgery that restored his mobility so that he could do what mattered to him most, which was really getting out into his garage and being able to putter around.

00:04:02:17 - 00:04:34:08
Rani E. Snyder
And that's what we want, ideally for all patients everywhere, is it's that ability to get to what they care most about. And the really exciting thing is that it's starting to happen. Since the movement was launched in 2017, it has grown to now more than 6000 different sites of care. Those include hospitals, ambulatory practices, nursing homes and convenient care clinics, all of which are recognized for delivering Age Friendly, 4Ms-based care.

00:04:34:10 - 00:04:58:16
Rani E. Snyder
And we are particularly excited because the movement, as we call it, is now entering a new phase. So it's moving beyond just adoption of those 4Ms towards what we're referring to as reliable delivery across entire systems and demonstrating measurable improvements in outcomes, safety, and the overall experiences for older people and their care teams.

00:04:58:18 - 00:05:40:00
Kristin Preihs
I love that, Rani, particularly the emphasis on what matters, because when you strip down this work to its core, it's always about seeing a whole person care and an older adult to your exact example, and maybe managing several chronic conditions, taking multiple medications, and interacting with many different parts of the health care system. And when every member of the care team understands especially what matters to that person, and seeing that it has such a significant impact on health outcomes and is consistently considering medication and mentation availability alongside it, suddenly care becomes more coordinated, safer and personal, which is what everyone is looking for and to some degree expects when they roll into a hospital or

00:05:40:00 - 00:06:04:22
Kristin Preihs
health care system with a particular opportunity to improve their own health. We've seen tremendous growth in organizations adopting Age Friendly care. So the next question really logically becomes, how do we identify those organizations achieving extraordinary impact? How do we learn from them and use their successes to bring even more organizations along? Which really brings us to this new and very exciting award.

00:06:04:23 - 00:06:18:25
Kristin Preihs
I would love to hear from you. Why is this the right moment to create an Age Friendly Health Care Impact Award? What motivated and why do you feel like now is the time to recognize this work across the field?

00:06:18:27 - 00:06:44:12
Rani E. Snyder
It's a great question. Our vision at the John E. Hartford Foundation is for every older adult, in every setting, anywhere they go, to receive Age Friendly care. So we want evidence based practices that are, as we said, reliably delivered to see reductions in harm. And we want older people and their families and their health care teams to feel the satisfaction and the joy that comes when health care is focused on what really matters, the goals of the older patient.

00:06:44:12 - 00:07:15:00
Rani E. Snyder
So, as you've alluded to, as the movement has spread now, is the perfect time to create a national, prestigious award from one of the country's premier health care organizations, and that's the American Hospital Association. Why? Well, because we've seen widespread not just adoption, but also enthusiasm for adopting the 4Ms's framework. That's been spurred in part by the Centers for Medicare and Medicaid Services, which implemented an Age Friendly hospital measure this year.

00:07:15:02 - 00:07:47:20
Rani E. Snyder
And we've also seen really important outcomes being published in the literature. A recent study found that older people receiving 4Ms care had a 33% lower rate of the 30 day readmission compared with usual care, and another site reported a 34% reduction in falls and a 53% increase in de-prescribing of those potentially inappropriate medications. That same initiative also saw re-hospitalizations decrease and the 30 day ED utilization fall.

00:07:47:23 - 00:08:10:13
Rani E. Snyder
So we want to shine a light on the enthusiasm and those outcomes that we're seeing, so that other hospitals and other health systems can't help but to want to join in. We'd be very happy to see all the FOMO. We want friendly but fierce competition to be the best at Age Friendly care. And there's certainly moral incentive for this given our growing aging population.

00:08:10:15 - 00:08:21:01
Rani E. Snyder
But there's economic incentive too. And here's a sort of a metaphor for you. When a film receives an Oscar. Everybody wants to see it. So the same can happen in health care.

00:08:21:03 - 00:08:43:11
Kristin Preihs
I love that, and I completely agree that the FOMO is real. One of the things we see again and again and again at AHA or in Hollywood is that recognition can be an incredibly powerful tool for transformation, for thought leadership, and for thinking of different ways to to do things. And when an organization is doing something exceptionally well, we don't just want to applaud it.

00:08:43:12 - 00:09:07:15
Kristin Preihs
We want to understand it. We want to know how they did it. Who made the work successful? How did leadership support it? What barriers did they overcome? And perhaps most importantly, what can other hospitals and health care systems in this case take from that experience to adapt for their own unique community? And that's where I think this award is, enormously important for the time that we're in.

00:09:07:17 - 00:09:32:14
Kristin Preihs
The organizations that we recognize can become somewhat of, I think, our learning laboratories for the field, because health care leaders are hungry for practical examples. So as we think about an older adult who comes into a hospital after a fall, for example, maybe there are medication concerns or mobility has declined. And as you've said, we know that when teens consistently apply the 4M's, those pieces are handled as separate problems.

00:09:32:15 - 00:09:57:28
Kristin Preihs
They become a very well coordinated approach around what matters to the individual. And that's what this partnership, this award is really trying to recognize. So when running, folks are considering applying for this new award for the first time. Can you talk a little bit about what you expect the committee will look at? What will distinguish organizations that are truly leading this work and what you hope folks can learn from them?

00:09:58:00 - 00:10:22:19
Rani E. Snyder
Gladly. First of all, I want to say that the AHA has such expertise in creating rigorous awards that examine the critical dimensions that are needed, really, to drive true outcomes in quality and safety. So we are grateful to you and your team, and your team has worked hand-in-hand with us to determine the what are now five criteria, that fall into different domains.

00:10:22:19 - 00:10:51:14
Rani E. Snyder
And so the specifics of what we're looking for will include evaluating elements like, first of all, leadership engagement and organizational alignment. That includes being embedded in strategy and governance. It's seeing leaders champion the work. It's having accountability for Age Friendly care built into organizational operations. Second, of course, patient safety and clinical quality. Those are major pieces of this work.

00:10:51:19 - 00:11:16:00
Rani E. Snyder
And so it will be a significant domain. Are we seeing reliable delivery of 4Ms care and measurable improvements in health outcomes as well. Third, community and patient partnerships is another area that we're going to look at. Age Friendly care has got to extend beyond the walls of just a hospital or office. Patients, families and caregivers have got to be engaged.

00:11:16:02 - 00:11:46:24
Rani E. Snyder
Fourth, we talk a lot about technology in all of our work, and we are seeing innovation and technology playing a key role in supporting the sustainability and the scaling of Age Friendly care. So that's another domain. Last but not least, thinking about spread and sustainability itself is going to be a marker of a successful applicant. Patients are going to benefit most when Age Friendly principles become part of the organization's DNA, and not just isolated projects.

00:11:46:25 - 00:11:48:13
Rani E. Snyder
So that's an important piece.

00:11:48:16 - 00:11:55:18
Kristin Preihs
Rani, from your point of view, what does readiness look like and why would you encourage an eligible organization to apply right now?

00:11:55:20 - 00:12:25:06
Rani E. Snyder
So perfection is not required, but if organizations can demonstrate the following points, they should consider applying. So first of all, implementation of the 4MS across multiple settings. They really need to have achieved the highest level of recognition in the Age Friendly health systems movement. There are two levels of recognition. They need strong leadership engagement. It is useful to be able to show measurable improvements in care and outcomes.

00:12:25:06 - 00:12:55:11
Rani E. Snyder
And we're seeing this more and more all across the country. It will be helpful to demonstrate effective partnerships across the care continuum. And sustainable processes that have been maintained over time as well. But honestly, I highly encourage every Age Friendly health system out there to go through the application process. And the reason is the award criteria are structured in a way that can be very helpful in moving your Age Friendly journey forward.

00:12:55:14 - 00:13:21:23
Rani E. Snyder
So there are a whole host of benefits that go with winning, and there are some that go beyond winning, so it's definitely worth a shot. First of all, applying for the Age Friendly Health Care Impact Award itself offers an opportunity for organizational reflection. And that matters. Applying can lead to a greater leadership engagement for your Age Friendly work, because you got to really step into it and examine it.

00:13:21:26 - 00:13:45:12
Rani E. Snyder
And then you'll be able to very publicly recognize the team accomplishments internally. And then, of course, if you win, you will have tremendous visibility as a national leader. The accolades will be very public and well promoted as well. Pioneering this movement sets a powerful new standard for organizational excellence, and that's part of what we're so excited for.

00:13:45:15 - 00:14:07:25
Kristin Preihs
And I want to underscore, two things that you said. First, that organizations sometimes underestimate the value of the application process itself. I've had the privilege of sitting on a few AHA award committees, and I have seen time over time that when individual hospitals and health care systems apply, it's it's almost not about the application, but it's about the process.

00:14:07:25 - 00:14:29:06
Kristin Preihs
And that they're recognizing their team members incredible work. They're preparing and making space for celebrating that, something it doesn't always happen. And that can make a significant difference to really stopping and reflecting on the impact that an organization has had and how far they've come. And the second piece I want to underscore is don't talk yourself out of applying because everything isn't perfect.

00:14:29:08 - 00:14:54:08
Kristin Preihs
This award is about progress, about measurable results and sustained commitment. And so if your organization has done that work, tell that story. Lean into it. Celebrate. Because behind every data point, every piece of progress is an adult, a caregiver or family whose experience of health care was better because your teams chose to approach care differently. And those stories right now deserve to be told.

00:14:54:10 - 00:15:06:18
Kristin Preihs
So, Rani, before we close, I have two final questions for you. First, for the hospital health care system that's listening today who again might be considering applying. Is there one piece of advice you would give to them?

00:15:06:20 - 00:15:29:06
Rani E. Snyder
Well, you referenced stories, and I want to say not only tell your story, but tell your story with confidence. Focus on the impact you've achieved for your older patients, their families and caregivers, your full care teams and their communities. Share both your results and the lessons that you've learned. Because you're going to see benefits from sharing your work no matter what,

00:15:29:12 - 00:15:31:28
Rani E. Snyder
even if you aren't selected as a winner.

00:15:32:01 - 00:15:44:15
Kristin Preihs
I love that, so well said. One final question for you, and let's look a little farther into the future. When we come back several years from now and look at what this award has accomplished - what do you hope we'll see?

00:15:44:18 - 00:16:08:02
Rani E. Snyder
I'm going to have three points to respond to that. First of all, we want this award to celebrate the leaders in the Age Friendly field. This is about telling stories, but it's about so much more than telling stories of how best care for older people really looks. It is also illustrating how much this initiative really means to real people in real communities and health systems.

00:16:08:04 - 00:16:40:00
Rani E. Snyder
Second, I firmly believe that this award is going to continue to accelerate adoption of Age Friendly care nationwide by creating visibility, by inspiring innovation, and by helping organizations to learn from one another as well. And then finally, the award is going to be an important component of our larger strategy to use every lever available to make sure that care for all of us, every one of us as we age, is safe and patient centered and Age Friendly to the core.

00:16:40:03 - 00:17:04:24
Kristin Preihs
And that is a wonderful place to end, and I share that hope. This award will become so much more than something organizations aspire to win. Rani, thank you for your leadership, for the John E. Hartford's extraordinary partnership with AHA and for continuing to push this movement forward. And to everyone listening, we cannot wait to see the stories and impact represented in this first round of applicants.

00:17:04:26 - 00:17:07:24
Kristin Preihs
Thank you so much for joining us.

00:17:07:26 - 00:17:16:07
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.