Geriatrics and Senior Services

The 4Ms Framework

Each of the 4Ms helps identify core issues related to care. Together, the 4Ms form a progressive framework aimed at helping us provide the best experience for patients and families. They are:

• What Matters: Know and align care with each older adult's specific health goals and care preferences – such as end-of-life care – and across settings of care.
• Medication: If medication is necessary, use Age-Friendly medications that don’t interfere with What Matters to the older adult, their mobility or their mentation across settings of care.
• Mentation: Prevent, identify, treat and manage dementia, depression and delirium across settings of care.
• Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.

The following locations are recognized by the Institute for Healthcare Improvement (IHI) as Age-Friendly Health Systems Committed to Care Excellence:

• The Acute Care for Elders (ACE) Unit at Methodist Hospital
• Methodist Jennie Edmundson Hospital
• Methodist Fremont Health
• Methodist Physicians Clinic HealthWest
• Methodist Physicians Clinic Indian Hills

The Age-Friendly Health Systems initiative was launched in 2017 by The John A. Hartford Foundation and the IHI in partnership with the American Hospital Association and the Catholic Health Association of the United States. For more information, visit www.ihi.org/agefriendly.

AgeWISE is a four-month specialty nurse residency that promotes the crucial role nurses play in enhancing the hospital experience for older patients and their families. Upon completion of the program, nurses are required to take a professional nursing certification exam.

AgeWISE nurses gain enhanced knowledge in geropalliative care to provide more specific and sensitive care to patients, as well as a sense of empowerment and increased confidence when having difficult conversations with patients, families and physicians related to geropalliative and end-of-life care. AgeWISE uses the Age-Friendly 4Ms framework – focusing on What Matters to the older adult, Medications, Mentation and Mobility.

Methodist Health System is a national leader in AgeWISE. More than 300 nurses have graduated from the program, which is more than any of the original participating hospitals.

Geriatric resource nurses (GRNs) provide patient care and care coordination to patients age 65 and older who visit the Emergency Department. They work with the staff nurse assigned to the patient and assess and determine the needs of the patient and their family.

Examples of what a GRN may do include:

• Partnering with social workers, who offer referrals and information on skilled nursing, home health, hospice, respite care and other resources
• Calling physical therapists to the ED for on-site assessments
• Referring patients to Methodist’s Balance and Fall Physical Therapy program
• Identifying needs tied to medication, depression, palliative care, Alzheimer’s disease and Parkinson’s disease
• Scheduling follow-up appointments
• Coordinating prescription delivery

The GRN program is one component of the Methodist Hospital’s and Methodist Women’s Hospital’s Geriatric Emergency Department Accreditations (GEDA). Methodist Hospital is home to Nebraska’s only Level 2 GEDA-recognized emergency department, meaning it has integrated and sustained senior care initiatives in its daily operations.

Nurses Improving Care for Healthsystem Elders (NICHE) is a framework and national designation for organizations that consistently implement evidenced-based practices in the care of older adults. Health care staff members who work in NICHE hospitals have advanced knowledge and skills in geriatrics through ongoing education and training.

Methodist Hospital and Methodist Women’s Hospital are each recognized as NICHE hospitals, and Methodist Hospital has received exemplary NICHE designation and utilizes a variety of care models to address the unique needs of older adults.

For more information about NICHE, visit nicheprogram.org.