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Kansas 4M Nursing Home/Nurse Educator Action Community Application Form

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The Kansas 4M Geriatrics Workforce Education Program invites you to join our inaugural Kansas 4M Nursing Home/Nurse Educator Action Community beginning in early 2026. Applicants will receive notifications about upcoming information sessions, program dates (once confirmed), and updates.

This program is made possible through funding from HRSA (see funding statement below) and in-kind support from the Institute for Healthcare Improvement and Jewish Healthcare Foundation, Pittsburgh, PA. There is no cost to participants.

This virtual training program is being planned by and for Kansas nursing home professionals and nurse educators to implement evidence-based 4Ms care in nursing homes throughout Kansas, strengthen partnerships among nursing homes and schools of nursing, and enhance nursing students' exposure to nursing homes and evidence-based care of older adults.

The program uses an evidence-based Age-Friendly Health Systems framework known as the 4Ms: What Matters, Medication, Mentation (Mind), and Mobility.

An Action Community is a virtual learning opportunity to accelerate the adoption of the 4Ms with teams. Guided by expert faculty and an "all teach all learn model," teams participate in 1-hour virtual webinars and coaching sessions while applying the 4Ms to improve care for older adults. All sessions will be recorded and available for later viewing.

· Level 1: teams conduct a site self-assessment and develop plans to implement the 4Ms in their site.

· Level 2: teams collect and report three months of deidentified data and the number of older adults who received 4M care. Additional information will be provided in advance of data collection and submission.

Upon completion of the program, participating nursing home communities will receive Age-Friendly Health Systems Level 1 and Level 2 national recognition by the Institute for Healthcare Improvement. Participating nursing home professionals and nurse educators will receive continuing education credit and be recognized as Kansas 4M Age-Friendly Champions.

Benefits of participation:

· Nursing Home Professionals: Gain national recognition and improve quality of care for nursing home residents.

· Nurse Educators: Enhance age-friendly and dementia-friendly didactic and clinical skills training for nursing students and build partnerships with nursing home professionals.

· Nursing home communities: Achieve Level 1 and Level 2 Age-Friendly Health Systems Recognition.

· Participants: Receive continuing education credit.

Eligible Facilities for Level 1 and 2 Recognition

· Licensed by the state of Kansas as a Nursing Facility.

Facility types include Nursing Facilities and Long Term Care Units.

NOTE: Settings not eligible for participation include assisted living facilities, group homes/senior housing, acute rehabilitation hospitals, in-patient rehabilitation facilities, rehabilitation centers, mental health nursing facilities, long-term acute care hospitals (LTACH), rest homes, care homes, and convalescent homes.

NOTE: If your site does not meet the definition for a "Nursing Home (Nursing Facility)," please visit www.kumc.edu/kansas4m for opportunities to join an action community.

By submitting this application, you are indicating your intention to join the 2026 Kansas 4M Nursing Home/Nurse Educator Action Community.

Contact kansas4m@kumc.edu for assistance or questions.

Kansas 4M is a Geriatrics Workforce Enhancement Program (GWEP) supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). The award provided 100% of total costs and totaled $5 million with funding from 07/01/2024 through 06/30/2029. The contents are those of the author(s) and do not necessarily reflect the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government. For more information visit HRSA.gov.

Select the choice that best describes your role:

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Nursing Home Administrator or Representative

Nurse Educator

Other

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Please describe your other role:

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First Name of the primary contact person:

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Last Name of the primary contact person:

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Email Address for contact person:

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Phone Number for contact person:

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Job Title of the primary contact person:

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First Name of Team Lead (if different from contact person):

Last Name of Team Lead (if different from contact person):

Team Lead Email Address:

Team Lead Phone Number:

What is the name of your site or facility?

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Site Address: Street Name and Number

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Site Address: Department/Clinic/Other Identifier

Site Address: City

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Site Address County:

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Site Address: State

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Site Address: Zip Code

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Select the type of site that best fits your facility:

Eligible Facilities:
Licensed by the state of Kansas as a Nursing Facility.
Facility types include Nursing Facilities and Long Term Care Units.

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Nursing Facility

Long Term Care Unit

Other

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If Other, please specify:

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Is your facility licensed by the State of Kansas?

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Yes

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Is your facility CMS Certified?

Note: Sites are eligible whether or not CMS certified.

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Yes

Unknown

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Does your facility accept Medicare or Medicaid?

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Medicare

Medicaid

Both Medicare and Medicaid

None

Unknown

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Does your facility partner with any schools of nursing?

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Yes

Unknown

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Which schools do you partner with?

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Which nursing school are you affiliated with?

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Which type of nursing programs does your school offer? (select all that apply)

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Certified Nursing Assistant

Associate Degree in Nursing

Bachelor Degree in Nursing

Master Degree in Nursing

Doctor of Nursing Practice

PhD in Nursing

Other nursing degree or training program

What other nurse education or training programs does your school offer?

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Does your nursing program partner with any nursing homes (i.e., Nursing Facilities or Long Term Care Units)?

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Yes

Unknown

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Please list the names and locations of the nursing homes your school partners with.

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By submitting this application, I confirm my intention to partner with a nursing home community team, participate in the Kansas 4M Nursing Home/Nurse Educator Action Community, and attend virtual webinars and coaching sessions. If my school of nursing does not currently partner with a nursing home, I agree to be assigned to partner with a participating nursing home community team.

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Add signature

By submitting this application, I confirm my intention to form a team and provide a team lead to participate in the Kansas 4M Nursing Home/Nurse Educator Action Community, attend virtual webinars and coaching sessions, and complete the requirements to achieve Level 1 and Level 2 Age-Friendly Health Systems Recognition.

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Add signature

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