Building a CMS Age-Friendly Emergency Department
Aligning with National and Strategic Priorities
Why Age-Friendly Care Matters
Older adults make up a growing share of emergency department (ED) visits and hospital admissions, yet their care is often fragmented across settings, teams, and measures. When older adults are cared for in ways that are safer, better coordinated, and aligned with what matters to them, patients benefit and the entire health system works better.
Practicing Age-Friendly Care
Three Frameworks Working Together
The CMS Age-Friendly Hospital Measure aims to improve the care of patients >65 years of age through five domains that address essential aspects of clinical care. While the measure applies to the whole hospital, the emergency department can play a vital role in meeting it.
Commonly deemed “the front porch”, the ED is often the first point of access for high-risk older adults. While it’s likely that your ED has care processes in place for older adults, this resource provides insights on how you may already be meeting the measure — or what you can do to get there.
Review the following frameworks and discover how they support one another.
CMS Age-Friendly Hospital Measure
Sets the national-level standard of care to ensure hospitals are consistently providing quality care.
IHI’s Age-Friendly 4Ms Framework
Provides the foundation for age-friendly care that can be applied across the healthcare system.
GEDA Guidelines & Care Processes
Provides ED-specific standards and tools to operationalize and track care performance.
CMS Domains | AFHS 4Ms | GEDA
Making the Connections
Meeting the CMS Measure means having concrete processes that are rooted in evidence. The AFHS and GEDA frameworks provide exactly that. Explore how each approach aligns with a specific CMS domain — and brings value to your hospital or health system.
Linking CMS With AFHS and GEDA
CMS Domain 1
Eliciting Patient Healthcare Goals
Aligns With IHI’s 4Ms
What Matters
Achieved Through GEDA Care Processes
F3: Eliciting “What Matters Most”
C1: Early Access to Palliative Care
CMS Domain 2
Responsible Medication Management
Aligns With IHI’s 4Ms
Medication
Achieved Through GEDA Care Processes
B1: High-Risk Med Identification & Reduction
B2: Structured Med Rec
B3: Pain Control
B4: Order sets with med dosing
CMS Domain 3
Frailty Screening and Intervention
Aligns With IHI’s 4Ms
Mentation
Mobility (and Malnutrition)
Achieved Through GEDA Care Processes
A3: Reducing Restraints
A2: Promoting Food and Drink
C2: Geriatric Psych consult in ED
C3: Volunteers in the ED D1: Delirium Screening & Intervention
D2: Cognitive Impairment Screening & Intervention
D3: Functional Assessment
D4: Falls and Mobility Assessment
D6: Depression Screening & Intervention
F1: Minimizing Boarding
F2: Optimizing Care for Patients who are Boarding
CMS Domain 4
Patient Vulnerability
Aligns With IHI’s 4Ms
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
CMS Domain 5
Age-Friendly Care Leadership
Aligns With IHI’s 4Ms
Governance
Achieved Through GEDA Care Processes
Geriatric ED Champions
Executive sponsor and leadership support
Level 1 and Level 2 GEDs will meet Domain 5
The Bottom Line
“Investing in ED pharmacy support, PT/nutrition access, palliative pathways, social work and bed-flow solutions lets GEDA processes reliably deliver CMS age-friendly performance from the ED.”
— Dr. Payal Sud
GEDA Care Processes
A Practical Solution for the ED
If your ED is looking to meet CMS priorities, GEDA care processes are a practical solution. You can embed them into everyday workflows to support the hospital or health system’s broader strategic goals. By demonstrating the connections, you can more effectively advocate for ED resources, such as pharmacists, palliative care physicians, dedicated social workers, and expanded observation units.
You can also co-design solutions with hospital partners and improve system throughput, strengthening patient care and flow across the entire hospital.
Meeting the CMS Measure
Five Domains — Supported by Process
Explore the CMS Measure’s five domains and learn which GEDA Care Processes can help you meet them. To enable your work, we’ve also included evidence supporting investment in change — along with other practical resources for your ED.
CMS Domain 1
Eliciting Patient Healthcare Goals
Discover what matters most — and how it leads to better outcomes for all.
CMS Domain 2
Responsible Medication Management
Dive deeper into reducing PIMs and improving patient outcomes.
CMS Domain 3
Frailty Screening & Intervention
Delve into the many interventions for complexity in older patients.
CMS Domain 4
Patient Vulnerability
Learn to identify elder mistreatment and establish interventions.
CMS Domain 5
Age-Friendly Care Leadership
Prepare to make the case for your ED — essential for leading the change.
More About the CMS Measure
Watch Our Webinar Series
Discover what experts in the field of Geriatric Emergency Medicine are saying about the CMS Age-Friendly Hospital Measure. Learn about how the five domains will shape emergency care in the years to come — and how you can take action to improve care today.
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