This article is sponsored by CHAP. In this Voices interview, Hospice News sits down with Dr. Khai Nguyen, National Medical Director, Geriatrician for CHAP, to talk about the age-friendly care movement. He highlights the foundational 4Ms framework of Age-Friendly Care and explains how providers can utilize it to uphold and deliver higher standards of care across multiple care settings.
Hospice News: What career experiences do you most draw from in your role today?
Dr. Khai Nguyen: As a National Medical Director at CHAP, I draw from the clinical experiences I’ve been so fortunate to have as a geriatrician, mostly in the community care setting. That setting has had the greatest impact on my mind and heart, but my experiences in home-based primary care, hospice in the home, skilled care and long-term custodial care have enabled me to further develop my professional skillset. My clinical experiences have been foundational to my growth, but my aging health policy experience with the Centers for Medicare & Medicaid Services, and my time with The California Endowment were equally important.
Additionally, I draw on my own personal experience as a caregiver to my older adult father, which started when I was twelve. He was in his early 60s when I was born, and he suffered a stroke in 1989, which threw our family into the post-acute medical care space and encouraged me to take on a caregiving role. We struggled in the home care setting due to his morbidity and illness, and that is something I experienced on a very intimate level.
All of it has shaped who I am today, and these experiences help me better empathize with people as patients in the community care setting. It has also helped me serve our partners in this space as a National Medical Director for CHAP. I will continue to draw on them to make the necessary quality and innovative impact on home health, hospice, home care organizations and their patients.
For those who don’t know, what is CHAP? What does it stand for? What impact are customers seeing from partnering with CHAP?
CHAP stands for Community Health Accreditation Partner, and we are an independent, non-profit crediting organization for home and community-based health care; where most patients get a great majority of their care which is outside of the inpatient or institutional settings. After all, home is where the heart is—it is often where we get the care we need and in the location which we desire.
Our customers and partners are not just feeling the impact of partnering with CHAP, they are witnessing innovation in care standards and quality seen in places like the CHAP Center for Excellence. It’s the foundation of advancing standards and promoting quality of care for our partnering agencies’ patients, but also helping to provide a genuine experience that is heavily rooted in support, customer service and resourcefulness.
As a point of comparison, if you will, it’s not just about accrediting the house, but also certifying the programs within it. Furthermore, we also developed certifications of the people who run the programs in the house, career-specific certifications for hospice operations, home health operations, health care sales, and even ongoing coaching and support.
Why does CHAP have a national medical director, registered nurse and social worker on staff who all specialize in hospice?
The question for me is why wouldn’t it? While CHAP creates and upholds new standards, it understands that collaboration with an interdisciplinary team of clinicians and care providers is paramount to the work we do. All of these positions are essential to both the existing and future work for CHAP.
It is equally important to have all of those voices and all of the validation that happens for a lot of our hospice partners and organizations out there. We want the same flavor of thinking and thought processes to help bring our work to them. That roundtable approach is key in hospice as it is at CHAP.
What is age-friendly care, and why is it important now?
One of the significant innovations that I’m very happy to bring forward on behalf of CHAP is Age-Friendly Care at Home. As many of you may be aware, CHAP received a grant from the John A. Hartford Foundation for bringing age-friendly care and the 4Ms Framework into the home and community-based health care settings—especially hospice.
The Age-Friendly Health System movement has been flourishing in large health systems and hospitals for the past few years. It was funded by the John A. Hartford Foundation with a grant to the Institute for Healthcare Improvement in partnership with the Catholic Health Care Hospitals of America and the American Hospital Association.
These organizations got together to bring national experts together and to say, “Why during this unprecedented time of human longevity have evidence-based geriatric health care models not taken root? How can we promote this?” They were able to put together a set of evidence-based practices called the 4Ms Framework for Developing Age-Friendly Care.
The 4Ms stand for what Matters, Medications, Mentation and Mobility.
Understanding and aligning the care of each older adult’s health outcomes with their preferences is what Matters. This is not just limited to end-of-life care, but also current care planning in addition to advanced-care planning and helping older adults prepare for their care across all health care settings—in hospice it is no different if not even more imperative.
The second M is Medications. When we think about medications, it’s not just reconciling medications, but also thinking about which medications are appropriate for older adults and using age-friendly medications that don’t interfere with the older adults’ functions, mobility, mentation, and, quite frankly, what matters to them across care settings. This is most important in hospice as well, where medications are used for comfort.
The third M is Mentation. Older adults may be at a higher risk of developing cognitive changes and impairment. The hope here is to prevent, identify, treat and manage such conditions as dementia, depression and delirium which can often be seen in patients towards the end-of-life.
The last M is mobility. The idea here is that we don’t focus on negative outcomes such as falls, but instead think about mobility and functional status in such a way that ensures older adults can move safely in their homes and communities. It also means enabling them to maintain their highest level of function and independence and to do what matters to them, so that medications don’t affect them.
People often say, “Well, we’re already addressing these things here and there and whenever we can. We already focus on what matters, medications, mentation, and mobility.” But the innovation of the 4Ms shines when we deploy it as a cohesive set together every visit, every patient and every setting.
Age-friendly care innovations have been taking root in large health systems, but now is the time for hospice and the community-based care settings to take part in the continuity of the 4Ms, because these are evidence-based practices that are critical to taking care of older adults. I think it’s important to emphasize that this is the time for these organizations and this space to embrace and take up this mantle of providing age-friendly care.
With CHAP being the first to support age-friendly care in the home, where do you see it going and how will CHAP fit into that vision?
We at CHAP are enthusiastic to lead age-friendly care in the home along with support from John A. Hartford, the Institute for Healthcare Improvement, and the American Hospital Association. CHAP is helping to create that vision.
Age-friendly care can be woven into almost every piece of care that hospice providers perform for their patients. It’s fundamental and it naturally fits in with the care the hospice team strives to provide. As a former hospice medical director, I see how the 4Ms Framework can be applied to all parts of the hospice benefit such as routine care, continuing care, respite and general in-patient care, but also how it can improve the quality of care that is provided.
The opportunity presented by the aging of the Baby Boomer generation should be fully realized and embraced as there is much parallel work and effort of care provided in hospice and the 4Ms.
Talk a little bit about the challenges and opportunities surrounding the transition from age-friendly health system hospitals to age-friendly care in the home. What’s the job at hand?
The work that’s being done with Age-Friendly Health Systems is well established, but the work of Age-Friendly Care at Home has yet to be fully realized. The opportunity here to help encourage the reinforcement of existing infrastructure within hospice organizations and care to meet the needs of this aging patient base and clientele.
For many years now, the Age-Friendly Health System has been catching fire across thousands of hospitals and health systems that have achieved recognition. If a hospice is getting a referral from a hospital or a health system that is recognized as providing age-friendly care, it would behoove that hospice to also understand and practice the 4Ms Framework to maintain consistency and continuity of evidence-based care.
The transition from acute care to hospice is such a critical moment for the individual patient and their families, but also for hospices and referral sources. During that transition, things can’t get dropped or missed. This is not just a challenge, but truly it is an opportunity. It is an opportunity to stand apart from the pack. It is an opportunity to ensure that quality of care is being provided using these evidence-based practices.
How does age-friendly care benefit hospice providers, aging populations, caregivers and family members?
It provides a conceptual framework and an all-encompassing mission-vision of what it is we’re doing out there. It’s about taking care of older adults in a way that accounts for what matters to them as individuals, as human beings, as mothers, fathers, brothers, sisters and even children.
For the aging population, I think one of the benefits of age-friendly care is that it addresses ageism in care. Ageism is discrimination based on older age, and when older adults are asked what matters to them, it ensures we are accounting for what is important for that person.
As you can imagine, from a geriatrician standpoint, as people get older, they’re more likely to have more medical problems. More medical problems mean more specialists; more specialists can mean more procedures or surgeries; more medications which can all mean more complexity.
This cycle can get very complex, so being able to address what matters, medications, mobility, and mentation can help to simplify the care for older adults in an evidence-based way. I think when providers are empowered to use this framework, it just makes care more seamless and higher in quality. But anything you can simplify can help to relieve some of the burden on caregivers and families.
Finish this sentence: “The top strategy that care providers should employ in 2022 to best prepare for 2023 is…?”
Being open and ready for Age-Friendly Care at Home.
Editor’s note: This interview has been edited for length and clarity.
CHAP is an independent, non-profit crediting organization for home and community-based healthcare. To learn more about how they are empowering providers across the continuum, visit https://chapinc.org/age-friendly-care.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].