# CMS Age-Friendly Emergency Department CMS Measure Support Guide for EDs Aligning National & Strategic Priorities CMS Measure | AFHS 4Ms | GEDA Accreditation 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.  Why Specialized Older Adult 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.  Improving the Standard of Care for Older Adults 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 standard to ensure hospitals are consistently providing quality care for older adults. IHI's Age-Friendly 4Ms Framework Provides the foundation for age-friendly care that can be applied across the healthcare system. ACEP's GEDA 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 rooted in evidence. The Age-Friendly Health Systems (AFHS) and Geriatric Emergency Department Accreditation (GEDA) frameworks provide exactly that. Explore how each approach aligns with a specific CMS domain — and brings value to your ED, hospital and 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 C1: Early Access to Palliative Care F3: Eliciting “What Matters Most” 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 A2: Promoting Food and Drink A3: Reducing Restraints  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 "Strategic investment in interdisciplinary resources such as pharmacy, PT, nutrition, palliative care, social work, and patient-flow solutions support GEDA, Age-Friendly Health System principles, and CMS Age-Friendly Measure performance while improving patient experience and outcomes and ROI — demonstrating that compassionate care and sound financial stewardship go hand in hand."  — Payal Sud, MD FACEP 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. Explore Domain 1 CMS Domain 2 Responsible Medication Management Dive deeper into reducing PIMs and improving patient outcomes. Explore Domain 2 CMS Domain 3 Frailty Screening & Intervention Delve into the many interventions for complexity in older patients. Explore Domain 3 CMS Domain 4 Patient Vulnerability Learn to identify elder mistreatment and establish interventions. Explore Domain 4 CMS Domain 5 Age-Friendly Care Leadership Prepare to make the case for your ED — essential for leading the change. Explore Domain 5 More About the CMS Measure Watch Our Webinar Series Discover what experts in the field of Geriatric Emergency Medicine are saying about the CMS 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. Explore the Series 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. FUTURE STATE Resources for Critical-Access In a Rural ED? We have resources for you - DRIVE TO RURAL ED CONTENT