When Maria Carney, MD, SVP and President of Glen Cove Hospital, first arrived at Northwell Health in 2012, she was focused on a problem that did not fit neatly within one specialty.
More people were living longer with multiple medical conditions. They were also seeing several physicians, taking numerous medications and asking family members to help navigate increasingly complicated care.
“Aging is a proxy for living with multiple conditions,” said Dr. Carney, a geriatrician who has helped lead Northwell Health's age-friendly work. Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Several years later, a conversation about that challenge would help launch Northwell further down the path toward becoming an age-friendly health system.
While serving as Northwell President and CEO, Michael Dowling asked Dr. Carney to give him a one-hour presentation about aging services across the health system. The meeting ran about two hours and included discussion of the Institute for Healthcare Improvement's Age-Friendly Health Systems framework.
At its center are the 4M’s: what Matters, Medication, Mentation and Mobility.
Northwell has since worked to make those elements part of routine care across hospitals and outpatient settings rather than treating age-friendly care as a program owned solely by geriatrics.
That work has earned national recognition. In June 2026, the Institute for Healthcare Improvement (IHI) named Northwell one of 14 health systems recognized for Excellence in System-wide Spread of the 4Ms, demonstrating delivery across multiple care settings, “an accomplishment that would not be possible without strong senior leadership support,” said Susan Kwiatek, DNP, vice president for aging and supportive care.
“Leadership buy‑in is the single most important driver of age‑friendly care,” Kwiatek added. “When leaders champion this work, it becomes a system priority—not a project—and that commitment is what ensures implementation, spread, and long‑term sustainability.” For health systems beginning the same work, Northwell's experience offers several lessons.
Know the population you serve
One of Northwell's first steps was understanding who would need this care. The health system worked with its strategic planning team to map the population older than 65 around its hospitals. Leaders looked at how those populations had grown and how they were projected to change.
But Dr. Carney cautioned against making chronological age the sole focus.
“As we live longer, we get illnesses, we manage them,” she said, noting that chronic conditions “become perhaps more severe, and they start affecting a person’s ability to function and it can get complex.”
That distinction matters because the challenge health systems are trying to solve is more complicated than caring for one age group. Patients may have heart disease, kidney disease, arthritis, cognitive changes and mobility limitations simultaneously.
A specialty-focused health system may address each condition well while still leaving patients and caregivers to reconcile competing recommendations.
For organizations beginning age-friendly work, Dr. Carney recommends using demographic and strategic-planning data to make that need visible.
Find work already underway
The next step does not necessarily require launching four new programs. Instead, health system leaders can look for work already addressing what matters, medication, mentation or mobility.
Northwell assessed the programs, clinical initiatives and stakeholders across the organization that aligned with the 4Ms. That provided a picture of the health system's starting point and helped identify people who could contribute to the work.
The approach also reinforces a central idea behind age-friendly care: The 4Ms are not intended to compete with disease-specific care. They provide a framework for bringing essential elements of care together around the patient.
That is particularly important because no single specialty owns falls, delirium, medication management or a patient's goals.
Dr. Carney described the model as fundamentally multidisciplinary.
The Institute for Healthy Aging now provides an organizational home for that work. Its priorities include age-friendly care, models of clinical care, family caregiving and brain health.
Pilot before you scale
Northwell did not try to transform every hospital simultaneously. The health system began its age-friendly work at one hospital and learned how to measure the 4M’s there. Even within that hospital, implementation began on one unit before expanding.
The pilot hospital, Glen Cove Hospital, was chosen for its patient demographics—its proximity to three nursing homes and several assisted living facilities. Equally important was the strong leadership commitment to age‑friendly care. The initial unit was chosen because it cohorted older adult medical patients, and its nursing staff included RNs who were ANCC‑certified in gerontological nursing (GERO‑BC).
This approach allowed the team to identify what worked, make changes and build confidence before spreading and scaling
“You don't have to boil the ocean. You can just start on one project, one issue,” Dr. Carney said.
The same principle can apply within an individual M in the framework. For example, a hospital trying to improve medication management does not need to tackle every potentially inappropriate medication at once. A team could select one medication or class to review more consistently and build from there.
Starting small also allows health systems to gather feedback from frontline teams before turning a pilot into a standard workflow.
Put the 4M’s into workflow
Scaling age-friendly care depends on moving it from a special initiative into the places where physicians and care teams already work. For example, Northwell has incorporated elements of the 4Ms into outpatient documentation templates and is incorporating that work as part of its transition to Epic.
In hospitals, the framework is also used during interdisciplinary rounds. Teams can discuss what the patient hopes to accomplish during the hospitalization, review potentially inappropriate medications, assess mobility and monitor mentation.
The goal is for those considerations to become part of routine clinical practice rather than another task physicians must remember to complete.
“As a lifestyle medicine and preventive medicine specialist, these are automatic considerations in my outpatient practice,” said Penny Stern MD, MPH, chief of preventive and lifestyle medicine at Northwell Health's Katz Institute for Women's Health.
At Glen Cove Hospital, where Northwell has done some of its earliest age-friendly work, that approach has become part of everyday culture, Dr. Carney said.
Within the 4M Framework, understanding what matters most naturally leads to conversations about goals of care—an essential step in aligning treatment plans with a patient’s values and priorities. The timing of those conversations is critical.
Northwell has pushed goals-of-care discussions earlier in the patient's journey, including into the emergency department. Rather than waiting until a patient has been hospitalized for several days, physicians and care teams can begin by asking about priorities and goals.
Tobe Banc, MD, medical director of Northwell's Institute for Healthy Aging, said the eventual goal is for that approach to transcend specialty and setting.
“It should be everywhere,” Dr. Banc said. “It should be at every patient encounter. Every time a patient walks in the door, no matter who they see … they need to be treated in this age-friendly manner, focusing on what their goals are and what matters most.”
That means age-friendly care should not require a referral to a geriatrician. The framework can inform interactions involving primary care physicians, specialists, nurses, pharmacists, therapists and other health professionals.
Measure and adjust the work
For Northwell, measurement was part of the strategy from the start.
“If we don't measure and show impact, we're wasting everybody's time,” Dr. Carney said.
Northwell developed dashboards to monitor elements of the 4Ms and their relationship to patient and operational outcomes. At Glen Cove Hospital, a monthly age-friendly performance-improvement group reviews measures tied to goals-of-care conversations, medication, mobility, falls and delirium screening.
When the data identifies an opportunity, the group can propose an intervention, try it in a unit and review what happens. Dr. Carney described the approach as a plan-do-study-act cycle.
Alyssa Scully, vice president of operations for Northwell's Institute for Healthy Aging, said the organization is looking broadly at four areas when judging its progress: patient experience, clinical outcomes, operational efficiency and workforce development.
The health system is also developing education to help interdisciplinary team members understand age-friendly care and the processes that support it.
That measurement infrastructure provides another benefit: It helps leaders show physicians and care teams that age-friendly care is connected to the same quality and operational goals they are already working to improve.
Spread beyond geriatrics
Northwell's longer-term strategy is to make the 4M’s a standard way of approaching older adults across the continuum of care.
The IHI system-wide recognition reflects Northwell's implementation of the 4M’s framework across hospitals, ambulatory care, home care and skilled nursing settings, Scully said.
That broader movement is gaining momentum nationally. As of August 2026, more than 6,900 healthcare organizations have earned Age-Friendly Health Systems recognition from IHI.
The Centers for Medicare & Medicaid Services also finalized an Age-Friendly Hospital structural measure beginning with the 2025 reporting period for the fiscal year 2027 payment determination, further raising the visibility of age-friendly practices in hospital quality improvement.
Northwell is now sharing what it has learned beyond its own system. Dr. Carney said a grant from The John A. Hartford Foundation is supporting work to train five hospitals outside Northwell on advancing their own age-friendly health system goals, as well as aligning outcomes to the patient experience.
That outward expansion reinforces one of the central lessons of Northwell's experience: Age-friendly care should not be treated as an isolated geriatrics project.
It is a framework for delivering coordinated care to people whose medical needs increasingly cross specialties, settings and disciplines.
What to do next
For health systems beginning age-friendly work, Northwell's experience suggests a practical sequence: understand the population, inventory existing work, select a manageable pilot, build the 4Ms into established workflows and measure whether the changes are helping.
Then spread what works.
The goal is not to create one more checklist for clinicians. It is to make asking what matters, reviewing medications, protecting mentation and preserving mobility so routine that they become part of how teams care for every older adult who enters the health system.
