The 5Ms: A Practical Framework for Better Care in Skilled Nursing

By Marianne Hassen, MA, OTR/L, Chief Operating Officer

Every skilled nursing organization is working toward the same goal: helping residents live safely, maintain independence, and enjoy the highest possible quality of life.

The challenge isn't knowing what good care looks like. It's keeping every member of the interdisciplinary team focused on the same priorities.

That's where the 5Ms come in.

Developed through the Age-Friendly Health Systems initiative, the 5Ms provide a simple framework for caring for older adults by focusing on What Matters, Medication, Mentation, Mobility, and Multi-complexity. While the framework began in healthcare systems, it has become especially valuable in skilled nursing, where residents often have multiple medical conditions, changing needs, and complex care plans.

The strength of the 5Ms is their simplicity. Instead of viewing care through separate disciplines, the framework encourages every team member to look at the resident through the same lens. Therapy plays an important role in making that happen.

It Starts with What Matters

The first M, What Matters, is the foundation for everything else.

Every resident has goals that extend beyond a diagnosis. One resident may want to walk safely to the dining room. Another may want to dress independently or communicate more easily with family. While another may wish for a certain meal, to put make-up on, or have a goal of returning home to a loved one. Those goals become the starting point for therapy.

Physical therapists, occupational therapists, and speech-language pathologists each help residents achieve those goals in different ways. When therapy aligns treatment with what matters most to the resident, care becomes more personal and supports a person-centered approach across the entire interdisciplinary team.

Looking Beyond Therapy

The remaining four Ms remind us that successful outcomes depend on more than a treatment plan.

Mobility affects far more than walking. It influences fall risk, independence with daily activities, discharge planning, and overall quality of life. Therapy helps identify changes in function early and works alongside nursing to support safe movement throughout the day.

Mentation includes cognition, mood, depression, communication, and swallowing. Changes in any of these areas can affect participation in therapy, nutrition, safety, and social engagement. Therapy provides valuable insight that helps the care team adjust approaches before small concerns become larger problems.

Medication also has a direct impact on function. Therapists often see how medications affect balance, alertness, endurance, or swallowing during daily treatment sessions. Sharing those observations with the interdisciplinary team helps support informed clinical decisions.

Finally, Multi-complexity recognizes the reality of skilled nursing. Residents rarely face one challenge at a time. Multiple diagnoses, environmental factors, caregiver support, and changing health conditions all influence outcomes. Looking at the whole person helps the team develop care plans that are realistic, coordinated, and easier to carry out.

A Shared Responsibility

One of the biggest misconceptions about the 5Ms is that they belong to one department. They don't.  It involves the entire team. The framework works best when nursing, therapy, MDS, dietary, social services, activities, physicians, support staff and facility leadership all use the same language and work toward the same resident goals.

For therapy, that means more than delivering treatments. It means sharing observations, identifying changes in condition, collaborating during care conferences, and helping translate resident goals into practical daily routines.

When every discipline contributes, the 5Ms become part of everyday operations instead of another initiative sitting on a shelf.

Why It Matters

The 5Ms provide a consistent way to align care, improve communication, and keep the focus where it should always belong, on the resident. Organizations that embrace the 5Ms often find it easier to connect clinical decision-making with quality measures, care planning, and daily operations because every discipline is working toward the same objectives.

At the end of the day, great care happens when the entire team shares responsibility for helping residents achieve the goals that matter most.

In my next article, we'll look at how Concept Rehab incorporates the 5Ms into everyday therapy practice and how integrating therapy with nursing, MDS, and facility leadership helps turn this framework into action.

Marianne Hassen presented this as a session for the American Occupational Therapy Association (AOTA) Elevating OT’s Role in Post-Acute Care: From Policy to Practice Conference.