Age-Friendly Action Community Extension

Thank you for taking the time to complete this short survey, as we continue to evaluate enrolled sites current state and needs. Please select answers that best describe your organization's state– please note you may select multiple answer options if applicable.

1. Please enter your email address? This question requires a valid email address.

2. Please enter your organization's name?

3. Has the structure of your team been impacted due to COVID-19? *This question is required.

We no longer have an active Age-Friendly action team
We have had team members transition in and out
Our team is still active but not meeting on this project
Our team is still active and meeting on the roll out of this project
Other - Write In Please enter an 'other' value for this selection.

4. Prior to COVID-19, please select which phase your organization was at in the process of integrating the 4Ms into your standard care: *This question is required.

Understanding our current state
Describing and developing what it means to provide care consistent with the 4Ms in our setting
Designing/adapting our workflow to deliver care consistent with the 4Ms
Testing particular elements of the 4Ms framework on a sample of patients
Deploying and testing care consistent with the 4Ms framework on a sample of patients
Studying our performance
Improving and sustaining care consistent with the 4Ms
Other - Write In Please enter an 'other' value for this selection.

5. Please select a statement that best describes your organizations current 4Ms implementation state:
*This question is required.

All 4Ms implementation activities and testing have come to a halt
We are re-evaluating and planning re-engagement into the 4Ms framework deployment
We continue the work of deploying the 4Ms framework at our organization
Other - Write In Please enter an 'other' value for this selection.