National Rural Age-Friendly Resources 

NRHA seeks rural healthy aging initiatives, best practices

NRHA has partnered with The John A. Hartford Foundation to enhance access to resources for rural healthy aging and age-inclusive care by engaging stakeholders and disseminating information through the National Rural Age-Friendly Initiative. NRHA is producing a compendium of rural healthy aging initiatives and best practices. If you are part of an organization with programs, models, or policy aimed at enhancing the quality of aging in rural communities, consider completing a submission form. This initiative will share resources with stakeholders and provide accessible and creative practices to communities.

All submissions should have a connection to rural aging initiatives, and must be submitted electronically by 11:59PM ET on Thursday, February 8, 2024. 

Overview of the National Rural Age-Friendly Initiative

The National Rural Age-Friendly Initiative is a joint effort between the National Rural Health Association and The John A. Hartford Foundation to develop resources, partnerships, and strategies to build age-friendly care across rural communities.

The following four approaches are the focus of the planning phase: convenings, communications, educational activities, and community health worker trainings. Through these focus areas, NRHA is utilizing its national network of rural health experts to create a plan for implementation of the initiative. 


  • The National Rural Age-Friendly Interest Group is a group of experts with a focus on rural health and aging formed to study research and guide NRHA’s priorities and best practices for age-friendly care in rural communities. The group guides NRHA’s rural age-friendly policy track and identifies where technical assistance is most needed. The National Rural Health Association, in collaboration with The John A. Hartford Foundation, hosted an in-person National Rural Age-Friendly Initiative Interest Group Meeting on Monday, September 18th, 2023 and Tuesday, September 19th, 2023.


  • NRHA disseminates rural age-friendly information through various avenues to feature age-friendly resources and best practices. NRHA has featured articles in its Rural Horizons magazine and in NRHA Today.

Educational Activities

  • NRHA’s 47th Annual Rural Health Conference, Age-Friendly in Action in Rural Communities

  • NRHA’s 46th Annual Rural Health Conference, The National Rural Age-Friendly Initiative

  • NRHA’s 35th Rural Health Policy Institute
  • NRHA’s 34th Rural Health Policy Institute, Rural Aging in Place

Community Health Worker Trainings

  • NRHA’s Rural Community Health Worker Training Network began in 2012 with trainings on the US-Mexico Border. NRHA has continued to expand our work with CHWs through a variety of partnerships, recognizing their profound value. As part of this Initiative, NRHA is working with a certified CHW trainer through University of Texas at Arlington to develop a curriculum and training for rural CHWs based upon the Age-Friendly Health Systems 4Ms Framework (see below). The team is also partnering with the Institute for Healthcare Improvement (IHI) to utilize existing materials and expertise.

​Age-Friendly Care & Initiatives

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).

​Age-Friendly Health Systems aim to:

  • Follow an essential set of evidence-based practices;

  • Cause no harm; and

  • Align with What Matters to the older adult and their family caregivers.​

IHI recognizes clinical care settings that are working toward reliable practice of evidence-based interventions in the care of all older adults using the 4Ms Framework (What Matters, Medication, Mentation, Mobility). Free 7-month Action Communities are offered by IHI, AHA and others to support implementation of the 4Ms.  

The 4Ms for age-friendly care are the initial and foundational set of practices that systems must include to provide older adults with the best care possible.

The 4Ms Framework for an Age-Friendly Health System include:
  • What Matters: Know and align 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 that older adults move safely every day maintain function and do What Matters.


The Age-Friendly Ecosystem

Age-Friendly Health Systems are one part of an Age-Friendly Ecosystem that promotes age-friendly policies and practices across society so that all of us can age well.

Examples of age-friendly initiatives include:          

Public Health – Age-Friendly Public Health Systems
  • Becoming an Age-Friendly Public Health System (AFPHS) means that healthy aging is elevated as a core function of a state, territorial, tribal, or local health department.
  • The AFPHS Recognition Program of Trust for America’s Health is based on the 6Cs Framework and honors engagement by health departments and professionals in healthy aging.

Education/Research Age-Friendly Universities
  • Age-Friendly Universities (AFU) are a global network of higher education institutions that adopt the 10 AFU Principles.
  • The Gerontological Society of America Age-Inclusivity in Higher Education Workgroup provides resources and information about becoming an AFU.

Healthcare Systems – Age-Friendly Health Systems
  • An Age-Friendly Health System utilizes the 4Ms Framework to equitably provide quality care and services to all older adults.
  • Recognition can be earned through IHI and the American Hospital Association who offer free 7-month Action Communities for health care teams in any setting to join.

Cities, Communities, States – Age-Friendly States and Communities
Learn more about the Age-Friendly Ecosystem.


Aging in Place

Aging in Place is the concept of comfortably remaining in one’s own home or community safely as you age. For many living in rural areas, having the necessary resources to do so, is a substantial challenge; further, rural areas have an overall older population, making the barriers to aging in place more urgently necessary to address. Improvements to quality of life, the level of an individuals’ independence, and decreased social isolation are only a few reasons why aging in place is a vital priority of NRHA.

Examples of barriers to aging in place include:
  • Transportation: lack of public transportation, distances between services, weather, and remote homes can make daily activities increasingly challenging for older adults.
  • Housing: barriers within one’s home may make it difficult to continue with daily life as aging occurs, obstacles such as stairs and unmet mobility needs must be addressed.
  • Community services/ social participation: lack of availability of family caregivers and food insecurity as well as isolation are key contributors to poor health outcomes. The ability to attend religious services, exercise, volunteer, work, and attend clubs or other activities in the community are important as you age.
  • Health care: lack of access to home health care, difficulty getting to appointments, and challenges getting daily resources such as medications make it more difficult to stay in one's home.

An Introduction to Aging Literature


Potential funding opportunities

  • Search the Department of Health and Human Services grant opportunities here.
  • Search the Federal Transit Administration here.
  • Search RHIhub here.

For more information, contact Briana Pistone or Laura Hudson.

Note: A more robust “Resources Hub” is being created to allow for a more complete look at the resources offered by partners within the Age-Friendly Ecosystem.


About The John A. Hartford Foundation

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care.