Coming up Aces! VA at the forefront of age-friendly health care

As the life expectancy of our Nation's Heroes continues to rise, it's critical that our Veterans receive safe, high-quality health care based on what matters most to them as individuals and delivered reliably.

The Ralph H. Johnson VA Health Care System (HCS) Acute Care for the Elderly (ACE) inpatient unit is leading the way in ensuring that older Veterans receive age-friendly health care every day. As part of the Age-Friendly Health Systems movement, it's part of 98 Veteran Health Administration sites implementing age-friendly health care.

By being at the forefront of age-friendly health care, the Institute for Healthcare Improvement (IHI) recently recognized the RHJ ACE Unit as an Age-Friendly Health System - Committed to Care Excellence.

“It is an honor for all the team's hard work to be recognized," said Rhema Sanford, ACE Unit Nurse Manager. "Our goal is always to provide the best care and resources we can for our Veterans and their families."

The award is given to health systems committed to providing high-quality, age-friendly care.

The four essential elements of age-friendly care are known as the 4Ms:

• What Matters: Know and align care with each older adult's specific health outcome goals and care preferences, including, but not limited to, end-of-life care and across settings of care.
• Medication: If medication is necessary, use Age-Friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
• Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.
• Mobility: Ensure older adults move safely daily to maintain function and do What Matters. You can learn more in the Guide to Using the 4Ms in the Care of Older Adults.

"This is a recognition for consistently caring for older adults using the 4Ms model," said Dr. Lauren Visserman, ACE Unit Medical Director. "This means that with each patient, we are aligning their care with what matters to them, carefully considering their medications, prioritizing a hospital environment that prevents delirium, and working to maintain their functional independence."

The ACE unit at the Ralph H. Johnson VA HCS is an 8-bed unit that provides care for Veterans 65 years and older.

The unit is staffed by a team of nurses, doctors, social workers, geriatric pharmacists, recreational therapists, and other health care professionals specially trained to care for older adults.

"We prioritize and manage the care of acutely ill older adults by integrating the patient's goals and values, co-morbidities, and prognosis into every decision," said Dr. Visserman. "For example, this means that we ensure we only perform tests and procedures consistent with their goals of care; also, we advocate for them and their goals throughout their hospitalization."

The unit has several features that make it age-friendly, including:

• A focus on preventing falls and other injuries
• A focus on getting the Veteran up and moving often
• In-depth older person assessments and community referrals as needed
• An in-depth review of the Veteran's medications
• A focus on minimizing interruptions overnight to help the Veteran rest and heal

The ACE unit at the Ralph H. Johnson VA Health Care System exemplifies how health systems can provide high-quality, age-friendly care to Veterans. The unit's recognition by the IHI as an Age-Friendly Health System - Committed to Care Excellence is a testament to the unit's commitment to providing excellent care to older adults.

“It's rewarding to know we can provide the Veterans and their families with the tools and resources that matter most to them," Rhema stated. "When you go to a hospital, you tend to lose choices, we are able to provide some of the autonomy back to the Veteran."

The unit's recognition is also a valuable resource for other health care systems looking to improve their care for older adults.

"Our ACE unit creates an environment that is safer for older adults through consistent communication with our close-knit interdisciplinary team and our consideration of all aspects of hospitalization," said Dr. Visserman. “This model can be adopted to other VHA Health Care Systems and civilian hospitals."