Addressing Social Risk Factors
As part of the CMS Age-Friendly Hospital Measure, hospitals and health systems are required to be aware of social vulnerabilities in older adults — elder mistreatment, social isolation, food insecurity, and transportation barriers — and address them appropriately. When the ED identifies these risks, the system can better align downstream resources with patient complexity. This supports better outcomes and reduces avoidable healthcare utilization.
To help your team meet this criteria, the Geriatric Emergency Department Accreditation (GEDA) program has defined specific care processes. Discover how each one connects to Domain 4 and the Institute for Healthcare Improvement’s (IHI) 4M framework.
Domain 4 | AHFS 4Ms | GEDA
Making the Connections
Meeting the CMS Measure means having concrete processes rooted in evidence. The Age-Friendly Health System (AFHS) 4Ms and GEDA frameworks provide exactly that. Discover how each approach aligns with Domain 4 — and brings value to your ED, hospital and health system.
Linking CMS with AFHS and GEDA
CMS Domain 4
Patient Vulnerability
Aligns With IHI’s 4M
Whole-Person Care
Achieved Through GEDA Care Processes
D5: Elder Abuse Screening
D7: Social Isolation Screening
D8: Substance Abuse Screening
D9: Food Insecurity Screening
E10: Access to Transport
Why It Matters
Providing Support, Preventing Harm
In high-volume EDs, unmet needs such as lack of transportation, food insecurity, social isolation, substance use, or unsafe living environments often present indirectly through medical complaints. When unaddressed, they can lead to repeat visits and preventable admissions that strain hospital capacity and increase costs.
For example, older adults discharged without reliable transportation or access to medications may return with worsening symptoms. This requires additional evaluation, treatment, and potential readmission. Similarly, delays in arranging safe discharge plans can prolong ED length of stay and decrease bed availability for new arrivals.
These gaps worsen patient outcomes and reduce throughput. They also increase variable cost per case, hurt quality metrics, and compromise hospital reputation. By putting Domain 4 into practice, the ED can improve outcomes and system performance alike, enabling better coordination, safer discharge, and fewer downstream care demands.
Explore Resources
Structuring your EDs within your health system to provide high-value age-appropriate care can help your entire system meet its priorities.
These resources explore value-based care organizations, CMS standards through the lens of the ED, and the growing capacity crisis.
TOOLKIT
The Elder Mistreatment Emergency Department (EMED) Toolkit
Resources to help address under-diagnosed elder-mistreatment, with interventions for vulnerable patients.
COURSE COLLECTION
EMED Toolkit Training Program
Four brief e-learning modules to train your staff in EMED screening and intervention protocols.
WEBINAR
Implementing the EMED Toolkit in the Geriatric ED
A discussion on how to identify elder mistreatment in the ED and intervene appropriately.
View Webinar
Stories From the ED
EMED Toolkit in Action
The EMED (Elder Mistreatment Emergency Department Response) Toolkit provides the foundation for any ED to identify Elder Mistreatment and respond. Read stories from hospitals that have implemented this protocol, and learn more.
SYSTEM SPOTLIGHT
Inova Fair Oaks Hospital
Find out how ED leadership worked closely with the NACEM mentorship program to address elder abuse screening and intervention.
SYSTEM SPOTLIGHT
Lyndon B. Johnson Hospital
Meet an interdisciplinary team refining how EM-SART integrates into EPIC protocols for ED social work consults.
SYSTEM SPOTLIGHT
Louis Stokes Cleveland VA Medical Center
Learn how a VA hospital found success with a modified EM-SART tool — and led change across their entire system.
GEDA Care Processes
Ways to Implement Change
Age-appropriate care that addresses social vulnerability begins with having the right processes in place. To help your ED operationalize Domain 4, GEDA has outlined care processes focused on older adults facing social and situational barriers. Designed to identify social risk factors early and optimize downstream care, these protocols hardwire Domain 4 standards into ED operations — all while supporting IHI guidelines around whole-person care.
Interested in learning more about GEDA care processes and accreditation?
Applying These Processes?
You’re Meeting the Mark
If your department is adhering to these care processes, it’s already meeting CMS standards. This is because they directly support Domain 4 of the CMS Measure — along with IHI guidelines for whole-person care. By operationalizing CMS requirements around social risk factors, EDs can improve the patient and caregiver experience through a clearer view of individual circumstances.
Early identification of social needs allows for smoother coordination of care. From there, targeted intervention can improve discharge reliability, reduce preventable returns, and support more efficient use of resources. Ultimately, this approach enhances performance in value-based payment models and solidifies the hospital’s reputation for patient-centered care. And that allows the ED to influence outcomes well beyond the initial visit.
Subject Matter Expert
Payal Sud, MD, FACEP
Payal Sud, MD, FACEP, an Associate Professor of Emergency Medicine and a Medical Toxicologist, is a leading voice in Geriatric Emergency Medicine (GEM). As Chief of GEM for Northwell Health and Associate Chairperson of Emergency Medicine at North Shore University Hospital, she works to optimize patient flow in the emergency department (ED) based on what matters most to older adults and caregivers.
Beyond her administrative work, Dr. Sud investigates the impact of early Palliative Care in the ED, and conducts NIH-funded research on ED care for older adults with delirium and dementia. Applying her extensive experience leading successful GEM initiatives, Dr. Sud now helps shape national standards as a reviewer for ACEP’s GEDA program.
