Monaghan Age Friendly Hospital

Description

Monaghan Hospital primarily serves the Monaghan and Cavan areas, which together have a population of 146,992. Its catchment area also extends into parts of Meath, Longford, and Leitrim. According to the 2022 census, these regions experienced an average 20% increase in residents aged 65 and over.
A consistent message from the Monaghan Older People’s Council is that older adults want to live healthy, independent lives for as long as possible. Through its inpatient and outpatient services, Monaghan Hospital continues to play a vital role in:
• Supporting older people to maintain their health
• Enabling independent living within their communities
• Promoting a good quality of life
In 2023, Monaghan Hospital partnered with the Monaghan Older People’s Council to enhance the service user experience for older adults. Guided by Glenn Miller’s principle, “If you design for the young, you exclude the old, but if you design for the old, you include everyone,” the hospital launched a Walkability Study in June 2023. This study featured presentations and input from Age Friendly Ireland, Monaghan County Council, the Older Persons Council, service users from parent and baby/toddler groups, the National Council for the Blind of Ireland, the Disability Network, and hospital staff.
The study identified 43 findings across four key areas:
• Front and rear hospital entrances and outdoor spaces
• Public spaces and facilities
• Safety and comfort
• Aesthetics
Since then, 38 actions have been completed, with five still in progress.
This achievement marks the culmination of a two-year programme of improvements at the hospital aimed at enhancing the experience for patients and visitors, particularly older people. Monaghan Hospital is only the second hospital in Ireland to receive the Age Friendly award, following St. Luke’s General Hospital in Kilkenny, which was honoured in 2019.
This recognition followed a comprehensive process aligned with the World Health Organization’s (WHO) Global Network for Age-Friendly Cities and Communities. The award celebrates the hospital’s commitment to improving accessibility, comfort, and inclusivity, especially for older adults and people with disabilities. This significant milestone was made possible through a collaborative partnership involving Age Friendly Ireland, Monaghan Disability Network, Monaghan Older People’s Council, Monaghan Age Friendly Alliance, and Monaghan County Council.

Aim of Initiative

The initiative aimed at improving the healthcare environment, in order to better meet the needs of Older People using the hospital. It also aimed to make the hospital experience more accessible, supportive and comfortable.
It focused on doing this in three clear ways:
• Improving Physical access: Ensuring that hospital spaces are designed to be more accessible for individuals with mobility issues, by providing ramps, wider doorways and clear signage.
• Addressing Sensory Issues: Amongst the actions taken were to modify the lighting and reducing noise to accommodate age related vision and hearing impairments.
• Enhancing Patient Centred Care: This was achieved by fostering an environment where a patient’s physical, emotional and social needs are prioritised. The positive change towards an Age Friendly Culture amongst the hospitals staff has heightened the focus on patient care.
In collaboration with Monaghan Older People’s Council, service users from parent and baby/toddler groups, the National Council for the Blind of Ireland, Disability Network, and hospital staff representatives participated in a Walkability Audit. This collaborative effort resulted in Monaghan Hospital achieving Age Friendly recognition.
The outcome of the audit also led to several additional positive improvements, including the introduction of a breastfeeding room, additional disability toilet facilities, enhanced signage, compliance with HSE programmes, staff training, and the circulation of an Age Friendly weekly newsletter

Who is it aimed at

Monaghan Hospital, is deeply committed to fostering inclusivity in all its developments. The guiding principle behind this commitment is: “Designing for the young excludes the old, but designing for the old includes everyone.”
Although the primary goal was to partner with the Monaghan Older People’s Council to improve accessibility for older adults, the involvement of the local Disability Network and Women’s Groups broadened the focus to ensure the hospital is accessible to everyone. A wheelchair user from the Disability Network took part in the Walkability Audit, providing essential insights.
Through the Chair of Monaghan Older People’s Council, along with committee members, they received regular updates on progress through the Older Persons Committee and the Age Friendly Alliance from hospital management.
Overall, this initiative strives to create a welcoming and accessible environment for all hospital users, with their needs driving the design and layout improvements.
Serving the Monaghan and Cavan regions, which together have a population of 146,992, Monaghan Hospital is experiencing growing demand. To address this, hospital management and staff are actively working to expand both services and facilities to better serve the community.

3 Steps critical to success

1. Age Friendly Ireland and Monaghan County Council approached the Hospital Manager to explore the possibility of evaluating the hospital from the perspective of older people. In collaboration with the Hospital Manager, Age Friendly Ireland, and Monaghan County Council, an improvement plan was developed, which included undertaking a Walkability Study. It was recognised that involving multiple stakeholders—such as the Disability Network and the National Council for the Blind—was essential for success.
   The guidance and support of Mairead Cranley from Age Friendly Ireland and Barry Eaton from Monaghan County Council, combined with insights from the Older People’s Council and the Age Friendly Alliance, were instrumental in establishing the initiative. Their efforts, together with the engagement and collaboration of HSE Project Teams, contributed significantly to the project’s success.
2. The second and key step was the setting up and carrying out of Walkability Audit which took place in June 2023. The audit was carried out by members of:
   • Monaghan Hospital staff (Parents Toddlers & babies)
   • Monaghan Older People’s Council members
   • Disability Network / National Council for the Blind(Monaghan)
   • Blayney Blades (Women’s Group)
   • Hospital Staff
   The members were divided into two separate teams which ensured that both the interior of the hospital and its grounds and entrance points were covered as part of the audit. The participation of a wheelchair user & partially sighted was key in relation to identifying access issues, particularly in relation to access from the two carparks to the main building.
3. The final step was the development of a quality improvement plan (QIP) which addressed the issues raised as part of the audit. The actions were identified as
   • Red (long term goal)
   • Amber (Medium term goal)
   • Green (short term goal)

   The audit led to 43 findings. Thirty eights have been completed (green & amber goals) and five are currently being progressed and are at design stage or funding stage.
   The initiative focused on making the hospital and its grounds more accessible by concentrating on three key areas:
   • Improving Physical Access: Enhancing hospital spaces to better accommodate individuals with mobility challenges through the installation of ramps, wider doorways, and clear, visible signage.
   • Addressing Sensory Issues: Implementing modifications such as improved lighting and noise reduction to support those with age-related vision and hearing impairments.
   • Enhancing Patient-Centred Care: Creating an environment where patients’ physical, emotional, and social needs are prioritised. The development of an Age Friendly culture among hospital staff has significantly increased the focus on compassionate, holistic patient care.
   The synergy created by the QIP directly led to the Hospital staff taking on new initiative which directly benefit Older People / Service Users for example internal and external murals which detail scenes from Monaghan, electronic display points, dementia / rehabilitation Garden, achieving full compliance towards HSE Clinical Programmes, Health Services Healthy Ireland Implementation Plan 2023 – 2027 and World Health Organisation ,

3 Challenges in Planning / Delivery

1. The initial challenge was turning the idea of Monaghan becoming an Age Friendly Hospital into reality. The first step was when the Hospital Site Manager & Corporate Business Manager Lynda McGrory was invited to be part of the Older Persons Council & Monaghan Age Friendly Alliance.

   From there Lynda linked up with the Age Friendly Programme Manager, who was immediately supportive. It also led to ideas from and the creation of contacts with local stakeholders, of whom many contributed such as the Older People’s Council, Men’s Shed, Blayney Blades and the Disability Network & National Council for the Blind.

   Lynda was able to use her role as Corporate, Business and Site Manager to incorporate Age Friendly improvements into existing projects such as the refurbishment of the carpark. New projects quickly emerged and local groups were supportive, such as the wooden garden features which were created by the Men’s Shed in Monaghan.

   Lynda has also to convince the Management Team and staff of Monaghan Hospital that becoming an Age Friendly Hospital would be hugely beneficial. The incremental Age Friendly improvements made it easier to get funding for larger projects, as the initiative progressed.

   The staff have fully embraced the Age Friendly Culture in the hospital, with many implanting new small changes in their own areas. They received Age Friendly Communications Training which helped gave them a greater degree of empathy and understanding of the older patients.

2. The second challenge was to develop a Quality Improvement Plan (QIP) that would satisfy the criteria for achieving Age Friendly Hospital status. This was accomplished with the support of Mairead Cranley from Age Friendly Ireland and the local Age Friendly Programme Manager.
   A comprehensive QIP consisting of the 43 actions was quickly drafted and approved. It was agreed that these actions would be implemented over short, medium, and long-term timeframes.
   Progress meetings were held regularly over an 18-month period. To date, 38 actions have been fully completed, with the remaining five scheduled for completion in 2025
3. The final challenge has been to ensure that an Age Friendly Culture continues in the hospital. There was a fear that impetus could be lost post receipt of Age Friendly Recognition.
   However, the staff have fully embraced Age Friendly and continue to implement positive changes in their areas. Recent improvements include improved bathrooms, an outdoor seating area, raised beds and the murals which depict beautiful landscapes from throughout Monaghan.
   The sod for the new Dementia Garden was turned this week (May 19th 2025). Plans are also progressing on accommodation for families of patients. There continues to be changes that make Monaghan Hospital a better place for service users, visitors and families of patients.
   Monaghan Hospital has certainly achieved their aim of designing for the old and including all users.
   To finalize, it is important to recognize that achieving Age Friendly Status was a team effort. This accomplishment was made possible not only through the involvement of Age Friendly Ireland, the Older Persons Council, the Age Friendly Alliance, Disability Networks, and Monaghan County Council, but also through the dedication of many others.
   Therefore, a heartfelt thank you needs to be extended to all service users and providers for their unwavering support, and to the dedicated Hospital Staff for their continued hard work. Their commitment and efforts make a profound difference in the lives of many, ensuring that Monaghan Hospital remains a place of care, compassion, and inclusivity.

3 Outcomes / Benefits

1. The main achievement of this initiative is the comprehensive improvements made that directly benefit older people, both patients and visitors.
   Upon entering the hospital, visitors will immediately notice the new ramped access leading to the hospital car park, offering a step-free route for older adults. Age Friendly signage is prominently displayed at the front, including designated Age Friendly parking spaces.
   Inside the hospital, new seating designed with older people in mind has been installed, the change machine has been repositioned for wheelchair accessibility, signage has been updated, and bathrooms have been refurbished. The “Dementia Garden” is currently being developed and will provide a valuable space for patients and their families.
   While substantial progress has been made, the embedding of an Age Friendly culture among staff ensures that enhancements will continue well into the future.
2. The second outcome has been the positive relationships which Monaghan Hospital staff have made with the local stakeholders. The Walkability Audit was completed by two teams which included members of the Monaghan Older People’s Council, the local Disability Network / National Council for the Blind and a local Women’s Group – Blayney Blades, Parents toddlers and Babies.

   At the Age Friendly Award Ceremony: All stakeholders involved in the walkability study along with representation from all hospital disciplines were present when the hospital achieved Age Friendly Status in February and continue to provide helpful advice and feedback..

   The Site Manager & Business Manager of Monaghan Hospital, Lynda McGrory, became part of the Older Persons Council, Age Friendly Alliance and continues to make a huge contribution. There have been a number of smaller projects completed with other stakeholders and contributions, for example, to the Guide to Services for Older People in Monaghan.

3. The lasting outcome of this initiative is the ongoing integration of an Age Friendly culture among the management and staff at Monaghan Hospital, which will provide long-term benefits for patients and visitors alike. Recently, staff completed Age Friendly Communications training to further support this commitment.
   The project has seen significant impact on:
    Patient centred approach to care
    Potentially reduce average length of stay
    Known to help with the reduction in medication usage / Potential reduction in medication cost
    Can reduce their length of stay in Hospital / accelerate Recovery
    Potential reduction in Risk
    Improve Physical Health & Well-Being
    Happier Service Users
    Potential Reduction in Staff Absenteeism
    Financial saving
    Building a culture of awareness
    Assist in meeting KPI’s
   This culture has inspired new projects and plans, including the recent renaming of wards with local names to aid dementia patients through reminiscence therapy.
   On May 19th, 2025, the ground-breaking ceremony for the new Dementia Garden took place. This significant addition to the hospital is scheduled for completion before the end of the summer. The garden will further demonstrate Monaghan Hospital’s dedication to inclusivity in every development, embracing the philosophy: “If you design for the young, you exclude the old, but if you design for the old, you include everyone.”
   Future developments include creating a pedestrian pathway connecting the front and rear of the hospital, along with additional Age Friendly parking spaces.