# CMS Domain 1: Eliciting Patient Healthcare Goals > GEDA guidelines provide specific care processes to obtain patients' healthcare goals ad treatment preferences. Read how they apply to Domain 1 of the Age-Friendly Hospital Measure. Putting Patient Goals Into Practice The first CMS domain focuses on obtaining patients' healthcare goals and treatment preferences, so that clinical decision making can be as informed as possible. For Age-Friendly Health Systems (AFHS) and Geriatric EDs, this means asking the patient and/or caregivers what matters most, to align care plans with their priorities. To apply this effectively in the emergency department (ED) the Geriatric Emergency Department Accreditation (GEDA) guidelines provide specific care processes. Continue exploring to learn how they support CMS requirements. Domain 1 | AFHS 4Ms | GEDA Making the Connections Meeting the CMS Measure means having concrete processes rooted in evidence. The AFHS and GEDA frameworks provide exactly that. Discover how each approach aligns with Domain 1 — 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 Most" Achieved Through GEDA Care Processes C1: Early Access to Palliative Care F3: Eliciting “What Matters Most” Jump to GEDA Care Processes Why It Matters Shaping Smarter Care By reliably identifying what matters most to older adults at the first point of contact, the ED becomes the place where smarter downstream care begins — rather than where problems are handed off. With this framework, health systems can better utilize resources, shorten length of stay, and improve throughput. That directly improves system performance,  which supports a strong business case for care processes that align with Domain 1. Make the Case Review the evidence for investment in age-friendly care processes with a well-summarized pitch deck to share with your C-suite or board of directors. Continue Explore Resources We have a large library of resources to support hospitals and EDs as they work to meet the CMS Age-Friendly Hospital Measure. Enhance your goals of care conversations, and manage your seriously ill older patients with a patient-centered approach. To support your work, we've curated a few relevant resources. WEBINAR What Matters: Eliciting Patient Healthcare Goals and the CMS Hospital Measure Strategies for eliciting patient healthcare goals in an emergency setting with complex older patients. Watch Webinar COURSE GEM104 | End-of-Life and Symptom Management in the Older ED Patient A one-hour AMA and ANCC accredited course covering disease trajectories and prognosis, goals of care conversations, and symptom management. View Course COURSE SGE013 | Palliative and End-of-Life Care of the Older Adult A 30-minute presentation on providing compassionate, clinically appropriate care for seriously ill older patients. View Course View All Palliative Care Resources > GEDA Care Processes Ways to Implement Change GEDA care processes are a practical way to operationalize CMS priorities in the ED. When it comes to Domain 1, they help emergency clinicians support the primary healthcare goals and values of older adults, while deepening collaboration with palliative care. Interested in learning more about GEDA accreditation for your ED? Visit GEDA Eliciting “What Matters Most”  GEDA Care Process F3 F3 provides a structured way to reduce moral distress while strengthening coordination across the hospital. When what matters most to older adults is reliably elicited in the ED, clinicians are less likely to deliver care that feels misaligned with patient values - a major driver of moral injury in emergency medicine. To help you implement this care process, we offer a range of practical tools and resources.  Explore F3 Implementation Toolkit Eliciting What Matters Most Find resources for implementing a program for eliciting patient care goals in the emergency department. Explore F3 Eliciting “What Matters Most”  GEDA Care Process F3 F3 provides a structured way to reduce moral distress while strengthening coordination across the hospital. When what matters most to older adults is reliably elicited in the ED, clinicians are less likely to deliver care that feels misaligned with patient values - a major driver of moral injury in emergency medicine. To help you implement this care process, we offer a range of practical tools and resources.  Implementation Toolkit Access to Palliative Care in the ED Explore our toolkit for developing a care process that would provide early access to Paliative Care in the ED. Explore C1 Early Access to Palliative Care  GEDA Care Process C1 A clear ED pathway to palliative care allows ED leaders to meaningfully reduce moral distress and injury by sharing the responsibility for complex conversations, symptom management, and family dynamics that often fall disproportionately on emergency clinicians. If you’re looking to implement this care process, we have resources designed to help.   Applying These Processes? You're Meeting the Mark By adopting GEDA Care Processes, you're already contributing to your hospital's objectives of meeting national standards. They operationalize Domain 1 while supporting age-appropriate standards — and strengthening system performance. That empowers geriatric care champions like you to advocate for the resources you need. It also helps position your ED as an essential partner in achieving system goals, rather than a pressured entry point. Operationalizing Domain 1 also helps build the case for dedicated palliative support, so complex goals-of-care conversations don't fall solely to ED staff. This allows your team to focus on time-sensitive clinical priorities, while still ensuring older adults receive expert care that aligns with their goals. < Back to Overview Continue to Domain 2 > 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.