Best practice in residential care settings should never be in doubt, and, appropriately, there are minimum standards in terms of quality and safety that each facility must comply with.
But what about those that want to go above and beyond the minimum, and instead reorient the standard of care so that the patients – and their wishes – are at the centre? Mowlam Healthcare is doing just that, having secured Age-Friendly Health Systems Participant status for its residential care homes. This international healthcare quality improvement initiative, devised in the US by the John A Hartford Foundation and the Institute for Healthcare Improvement (IHI) follows an essential set of evidence-based practices and ultimately align what matters to the older adult and their care provision.
Mowlam Healthcare is the first residential care provider outside of the United States to have been granted Age Friendly Health System Participant status, explains Dr PJ Harnett, their lead of integrated care since last year. As the previous HSE national programme lead for the Integrated Care Programme for Older Persons, he is well-versed in the needs of older people living in residential care. He points out that this accreditation approach enshrines a truly patient-centric philosophy into daily care procedures and processes.
The experts who drew up the framework initially identified more than 90 evidence-based interventions to improve the care outcomes for older people. “Ultimately these were distilled down to four key pillars, which improves outcomes when implemented in a consistent fashion,” says Harnett, who will be presenting on this work at the Future Health Summit.
These four pillars are known colloquially as the four Ms framework: what matters, medication, mental health and mobility. The first “M”, “what matters to you” may seem obvious, but starting each care plan or intervention with this in mind is a radical shift in thinking when it comes to the care of older people in any setting, Harnett says.
“Healthcare provision in general tends not to focus on individual outcomes. This is a substantial challenge when delivering care at scale as the outcome you might want as an older person (for example, having had hip surgery) may be very different to someone else’s outcome. One person’s aim may simply be to walk independently to the shop whereas another person may want to get back hillwalking.”
‘Our vision is to set the bar by taking our cue from what matters to the older person and that changes the care dynamic’
The four Ms are complimentary and must be used in unison, he adds. “They are very much about balancing positive outcomes and risk or deficits and so for example this can focus on assessing and improving mobility as much as preventing falls.
“It’s about turning the approach on its head and taking our cue from the needs and wishes of what matters to residents.”
Medication is obviously a huge element of the care of older people – polypharmacy and adherence issues are perennial problems. A new digital system, Digicare, has allowed Mowlam facilities to “zone in” on the use of medication, Harnett explains. “It helps us review medications and especially monitor certain medications that may have adverse effects in older people. Digicare allows us to highlight and address this proactively.”
Mowlam has also expanded the assessment tools it uses to screen for mental health issues, particularly for anxiety and depression in older people, he adds. “We know there can be a high prevalence of psychological disorders, and it often goes unrecognised. We are also linking in with the integrated care older person teams (ICPOP) locally so that we have that expert input too.”
Overall, the framework allows for a much more individualised approach, adds Harnett. “In the Mowlam participant care centres every handover is based on the four Ms, as are daily progress reports and care plans.”
By the end of 2025 Mowlam aims to achieve Age Friendly Health System accreditation for all rehabilitation and residential care facilities. Achieving this status was made possible, Harnett explains, as many of the core principles were already in practice by virtue of the “Mowlam way”, but hadn’t been formally recognised as such. This in part involved adjusting its electronic healthcare records to capture the four Ms.
“Staff have really embraced and welcomed this because they feel it recognises the everyday unseen personalised interventions that they do,” he says. “Adopting this approach meets compliance to standards as required for Hiqa but our mission is more than just meeting the minimum standards. Our vision is to set the bar by taking our cue from what matters to the older person and that changes the care dynamic.”
Mowlam is partnering with Age Friendly Ireland to marry Age Friendly Healthcare with Age Friendly Communities. Charleville Nursing Home is an example of this.
