Bringing Age-Friendly Healthcare Home: Implementing the 4Ms on a Home Rehabilitation Service

Abstract Background The Active Recovery Team (ART) provides home based rehabilitation following an acute hospital admission or emergency department presentation. To deliver age attuned care, the team undertook an improvement project to implement the 4Msframework (Mobility, Mentation, Medication, Matters) with the ultimate goal of achieving recognition from the Institute of Healthcare Improvement (IHI) as an age friendly health system participant. Methods A retrospective audit was completed of a sample (n=30) of patient records from May 2024 to measure baseline compliance of the 4Msin the initial assessment. An improvement plan was implemented that included staff education and a re-design of documentation. A re-audit was completed on a sample (n=30) of patients records from January 2025. The 4Msworkbook was submitted to IHI for review. A thematic analysis was completed of the open ended “what matters” responses. Results The baseline audit showed high compliance with domains of mobility (100%) and mentation (80%). However, medication (40%) and what matters (0%) were not captured. Following improvement work the re-audit rates were mobility (100%), mentation (100%), medication (93%) and matters (96%). ART has received level 1 recognition from IHI as an Age-Friendly Health System Participant and is now working towards level 2 recognition as “committed to care excellence” with standardised screening tools and outcome measures for each domain. The most frequently reported theme from “what matters” was family and relationships (31%), followed by recovery (19%) and independence (15%). Conclusion: It is feasible to implement the 4Mson a home-based rehabilitation service. It creates a standardised person-centred approach for working with older adults. For this patient group, family and relationships were identified as what matters most. For the next audit, use of agreed standardized screening tools and outcome measures in each domain will be measured. Future work should explore the older adults’ satisfaction with the 4Msapproach to care.