How the home health and hospice industry utilizes age-friendly care

As the population of older adults increases, so does the need for age-friendly care.

The aging population is rapidly reaching large numbers. By 2040, the number of American adults aged 65 and up is expected to reach nearly 81 million, according to the Administration on Aging. With the fast pace of aging in America, the health care system will need to find a way to keep up.

That’s where age-friendly care comes into play.

What is age-friendly care?

Created by 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 Age-Friendly Health Systems initiative follows evidence-based practices and aligns care plans to what matters most to older adults and their caregivers.

These groups came together to form a framework of care for older adults considering the many older adults entering the health care system in a short time. They knew this would require an extra level of health care management so it wouldn’t put such a strain on the health care system as a whole. Additionally, it would outline affordable, efficient and meaningful care for the patients receiving it.

According to the IHI, “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.”

The essential set of evidence-based practices is known as the “4Ms”: what matters, medication, mentation and mobility.

What is age-friendly care at home?

While age-friendly care is picking up steam in hospital and health care systems, it’s making its way into home-based care as well.

To bring the age-friendly care movement into homes across the country, Community Health Accreditation Partner (CHAP) worked with the John A. Hartford Foundation to develop an Age-Friendly Care at Home certification process.

This certification recognizes high-quality providers who deliver effective care that successfully addresses the unique needs of older adults.

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

How home health incorporates age-friendly care

Age-friendly care in the home still follows the core aims of the Age-Friendly Health Systems initiative but it can look slightly different considering the care setting is a patient’s home rather than a hospital.

Here are the ways clinicians practice each of the “4Ms” with home health care patients, according to CHAP.

What matters

• Ask the home health patient what matters most; document and share with the rest of the home health care team
• If a patient’s health care decisions are made by a family member, caregiver or surrogate decision-maker or durable power of attorney, still ask what matters most for the patient and ensure the decision-maker is aware
• Align the plan of care with what matters most to the patient

Medication

• Review the home health patient’s medications for any high-risk medication and, where applicable, appropriate and up-to-date medication use
• Document medication use and communicate it to the prescriber(s), family, caregiver, surrogate decision-maker and the home health care team
• Review patient’s medication lists for side effects

Mentation

• Screen the home health patient for depression; document and communicate results
• Screen the patient for cognitive changes; document and communicate the results
• Identify and manage factors contributing to a patient’s depression or refer out
• Consider further evaluation and manage manifestations of cognitive changes, educate the patient and caregivers or refer out
• Consider employing, where applicable, delirium prevention strategies in the home

Mobility

• Ensure the home health patient has their personal adaptive equipment and knows how to use it safely
• Screen the patient for mobility risks and limitations; document and communicate the results
• Screen the patient for environmental hazards; document and communicate the results of home safety assessment
• Ensure the patient has consistent and routine mobility in the home setting

How hospice incorporates age-friendly care

Even age-friendly practices in the home may vary depending on the type of care a patient is receiving. Patients receiving end-of-life care don’t have as much mobility and what matters to them may look different than what matters to a home health patient.

Here are the ways clinicians practice each of the “4Ms” with hospice care patients.

What matters

• Ensure the hospice patient’s plan of care aligns with what matters most in the end of life
• Assist with advance care planning and explain what it is to the family member, caregiver or surrogate decision-maker or durable power of attorney

Medication

• Review the hospice patient’s medications for any high-risk medication and, where applicable, appropriate and up-to-date medication use; document and communicate it to the prescriber(s), family, caregiver, surrogate decision-maker and the hospice care team
• Review the patient’s medication lists for side effects
• Evaluate the effectiveness of the medications in relieving pain and other symptoms, ensuring the highest level of comfort and quality of life

Mentation

• Assess the hospice patient for cognitive changes, changes in abilities and depression
• Educate the family on signs and symptoms of approaching death including withdrawal, increasing drowsiness, insomnia or increasing anxiety
• Make patients and loved ones aware of some things they might experience based on the state of their condition or disease, especially with dementia patients
• Adjust plan of care to facilitate interventions to address these changes

Mobility

• Assess the hospice patient’s equipment and ensure it is the proper equipment to keep them safe and help them do what they want to or can do
• Teach the patient’s family how to help them navigate the home safely or transfer positions
• Educate the patient’s family on fall prevention
• Teach the patient’s family how to be proactively ready for decreased mobility and set expectations

At Enhabit, what matters most to our patients also matters most to us. Through our evidence-based, age-friendly approach, we ensure each patient’s unique needs are met by incorporating the 4Ms of age-friendly care into our services.

We’re here to offer patients the quality in-home care they deserve. If you have any questions, don’t hesitate to reach out today.