Programs

Home to more than 20 percent of the older adult population, rural America faces distinct challenges in supporting the health care needs of those over 65. The older adult population tends to require more economic support and caregiving, hence the need for an age-friendly ecosystem.

There are several definitions of "rural," but rural designation is typically determined using federal criteria established by the U.S. Department of Agriculture Economic Research Service (USDA-ERS), the Health Resources and Services Administration (HRSA), and the U.S. Census Bureau definitions. 

To determine whether a specific location is considered rural, you can use the Rural Health Information Hub (RHIhub) Am I Rural? Tool.

The Older Americans Act (OAA), established in 1965, was designed to expand access to community-based services for older adults. It authorizes a broad range of services, including nutrition programs, caregiver support, elder abuse prevention, community service employment, and long-term care support, administered through the Administration on Aging, and now the Administration for Community Living (ACL). 

While the OAA includes provisions intended to support rural older adults, gaps in access and service delivery remain. Learn more in NRHA's policy brief on the Older Americans Act: Greatest economic and social needs of rural older adults. 

Older Americans Month (OAM) is a national observance led by the ACL. Each May, this observance invites us to recognize not only the contributions of older adults but also the importance of supporting their ability to live healthy and independent lives. It serves as a reminder of older adults' resilience and experiences, as well as our commitment to supporting them through programs, care systems, and policies that promote well-being. 

Aging in place is the ability to remain safely and comfortably in one's own home or community as one ages. For many rural older adults, this can be challenging due to limited access to essential resources. Since rural areas tend to have older populations overall, addressing barriers to aging in place is increasingly important.

Improvements in quality of life, independence, and social connectedness are only a few reasons why aging in place is a vital priority of NRHA.

Common barriers to aging in place

Transportation: Limited public transportation, long travel distances, severe weather, and remote locations can make it difficult to access healthcare, groceries, and other essential services.

Housing: Features within one's home, such as stairs or narrow doorways, can create challenges for daily living. Homes may require modifications to meet changing mobility and accessibility needs.

Community services/social participation: Limited availability of informal caregivers, food insecurity, and social isolation can negatively affect health and well-being. Opportunities to participate in community activities, volunteer, work, exercise, or attend religious services are important for maintaining quality of life as one ages.

Healthcare: Limited access to providers, home health services, medications, and transportation to appointments can make it more difficult for older adults to maintain their independence.

To support rural communities in addressing these challenges, the RHIhub developed the Rural Aging in Place Toolkit, which provides resources, strategies, and examples of successful aging-in-place models.

Age-Friendly Care is a specialized, evidence-based healthcare framework designed to meet the unique health and social needs of older adults. Endorsed by groups like the Institute for Healthcare Improvement (IHI) and the John A. Hartford Foundation (JAHF), it centers around a core set of evidence-based practices known as the "4Ms."

Age-Friendly Care in Action Training is a program that equips providers with the skills and knowledge to implement the 4Ms Framework—What Matters, Medication, Mentation, and Mobility—in a variety of care settings. Through videos, online courses, Action Communities, and other educational resources, participants learn how to deliver evidence-based, person-centered care that aligns with the goals and needs of older adults.

Supported by the JAHF and the IHI, these training opportunities help health systems advance age-friendly care and support implementation of the CMS Age-Friendly Hospital Measure. 

Training Formats

Videos: "Age-Friendly Care in Action" Video Series: Produced by the JAHF and WebMD, these videos highlight practical examples of age-friendly care across different settings, including the Medscape Video Series, and offer free continuing education credits.

Action Communities: A seven-month virtual learning program from IHI and the American Hospital Association (AHA), where health care teams test the 4Ms in practice, receive coaching, and can earn Age-Friendly Health System Recognition. 

IHI Resources

• Online Course with Coaching: An in-depth 9-week program that teaches participants how to implement the 4Ms.
• Providing Age-Friendly Care to Older Adults (PFC 203): A free online course available on the IHI Open School Platform. 
• Certified Professional in Age-Friendly Health Care (CPAFH): A credential that recognizes health care professionals who deliver age-friendly, person-centered care using the 4Ms Framework.

The Age-Friendly Ecosystem brings together six sectors—health systems, public health systems, workplaces, home- and community-based services, communities and states, and education and research institutions—to improve the well-being of older adults. Its focus is on fostering cross-sector collaboration to support healthy aging and age-friendly care. 

Learn more about each sector and its role in advancing age-friendly care below.

An Age-Friendly Health System (AFHS) is a model of care designed to improve health outcomes for older adults by incorporating the evidence-based 4Ms Framework into care delivery. The 4Ms—What Matters, Medication, Mentation, and Mobility—help ensure that care is aligned with each older adult's goals, preferences, and needs. 

The 4Ms Framework of an AFHS includes:

What Matters: Understanding and aligning care with an older adult's health goals and care preferences.

Medication: If necessary, using age-friendly medications that do not interfere with Mobility, Mentation, or What Matters most to the older adult. 

Mentation: Preventing, identifying, and managing conditions such as dementia, depression, and delirium across settings of care.

Mobility: Supporting safe daily movement to maintain function and independence. 

An Age-Friendly Public Health System (AFPHS) is a framework that helps public health departments integrate healthy aging into their programs, policies, and services at the state, territorial, tribal, and local levels. 

Through Trust for America's Health's (TFAH) AFPHS Recognition Program, health departments and professionals are recognized for advancing healthy aging using the 6Cs Framework: Creating, Connecting and Convening, Coordinating, Collecting, Communicating, and Complementing. This program promotes and strengthens age-friendly public health practice across communities. 

Learn more about becoming recognized.

An age-friendly workplace is a business that adapts its environment, policies, and services to better support the needs of older adults. The goal is to remove barriers and ensure older adults can access opportunities, spaces, and services offered by the organization. 

AARP provides guidance and examples to help businesses become more age-friendly, including resources on creating age-friendly workplaces and showcasing best practices. 

Age-Friendly Communities are places where policies, services, environments, and systems are designed to support people as they age. These communities promote healthy aging across key domains that affect quality of life, independence, and participation. 

AARP leads the Network of Age-Friendly States and Communities, which supports local and state efforts to become more age-friendly and share best practices. 

Additional resources, like IHI's State-Based Guide for Transforming Health Care for Older Adults Across States, highlight strategies for implementing age-friendly approaches across states and health systems, including the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). 

Home and Community-Based Services (HCBS) refer to a range of supports provided in a person's home or community to help older adults maintain independence and quality of life as they age. These services can include home-delivered meals, home health care, homemaker and chore assistance, transportation, caregiver support, and other related services. 

Age-Friendly Universities (AFUs) are higher education institutions that commit to the 10 AFU Principles and promote lifelong learning and inclusivity for learners of all ages, including older adults. 

Through the Age-Friendly University Global Network, participating institutions work to expand educational opportunities across the life course and shape more age-inclusive approaches to teaching, learning, and engagement. The Gerontological Society of America (GSA) provides additional resources on Age Inclusivity in Higher Education and pathways for becoming an AFU.

CHWs, also known as promotoras de salud, play an important role in the Age-Friendly Ecosystem by serving as trusted connectors between older adults and health and social care resources. CHWs are community members who receive training and certification to support care coordination, provide education, and help link older adults to services and community-based supports. 

The IHI has developed tools such as My Health Checklist to support CHWs in delivering age-friendly, person-centered care. 

Programs such as Connected Care for Older Adults demonstrate how CHWs are integrated into primary care teams to deliver age-friendly care using the 4Ms Framework.

Certification pathways for CHWs or promotoras de salud vary by state. Individuals must complete a state-approved training program and meet certification or registration requirements set by their state's CHW board or health department.

NRHA's Rural Community Health Worker Training Network provides training and education for CHWs through national partnerships. Learn more about this work in NRHA's blog, "Promotoras de salud: Helping community health workers care for older adults."

Hospitals are utilizing the 4Ms Framework—What Matters, Medication, Mentation, and Mobility—to improve care for older adults by aligning services with patient goals, ensuring safe medication use, supporting cognitive and mental health, and promoting safe mobility. 

For example, Nemaha County Hospital in Nebraska highlights its implementation of the 4Ms Framework through its participation in the "I Love Rural Health" video series, demonstrating how rural hospitals are advancing age-friendly care in their communities. 

The Geriatric Emergency Department Accreditation (GEDA) Program is an initiative that helps hospitals and emergency departments develop and implement care environments tailored to support the needs of older adults. The geriatric emergency department may be either a separate space designated for older adults or, more commonly, the integration of age-friendly practices in an existing emergency department.

The American College of Emergency Physicians (ACEP) also highlights Steps to Successful GED Accreditation Across a Healthcare System.

The Geriatric Surgery Verification (GSV) Program helps hospitals improve surgical care for older adults by promoting a patient-centered approach, addressing unique challenges, improving both quality and cost of care, and reducing the risk of delirium. 

The American College of Surgeons documents the GSV Program Standards.

The Rural Health Research Gateway provides access to research products, policy briefs, reports, and journal articles on rural aging. To find aging-related publications:

1. Visit the Rural Health Research Gateway

2. Click on "Topic"

3. Then select "Aging" under "A"

You can also directly access aging-related publications.