Abstract: PURPOSE: To implement an Age-Friendly Health System (AFHS) in a Veterans Health Administration nursing home using shared decision-making and goal-concordant care, achieve Institute for Healthcare Improvement recognition, and assess patient perceptions of care. METHOD: This pilot study took place over 3 months and included 35 patients aged ≥65 years. Pre- and post-implementation chart reviews assessed documentation of the 4Ms (What Matters, Medication, Mentation, Mobility). After implementation, 12 patients completed the collaboRATE survey to evaluate shared decision-making and goal-concordant care. RESULTS: Documentation of all 4Ms improved. The collaboRATE top score was 83%, with a mean score of 3.94 of 4, indicating high levels of perceived shared decision-making. CONCLUSION: Implementing the AFHS 4Ms Framework in a nursing home setting is feasible and supports high-quality, person-centered care. Results suggest strong alignment with the 4Ms and what matters most to older adults.