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In the United States, there are approximately 6.9 million Americans over age 65 with dementia. And 11.5 million unpaid family caregivers, according to the Alzheimer’s Association.
A new program, the Guiding an Improved Dementia Experience (GUIDE) Model, was launched in July of 2024 by the Centers for Medicare and Medicaid Services (CMS). The GUIDE model was aims to improve the quality of care for individuals living with dementia by offering personalized support, caregiver resources, and better coordination of healthcare services. The purpose of the program is to help those with dementia and their families by providing them access to a system of free navigators -- dedicated professionals who have received required training in dementia, assessment, and care planning.
This program will run for a total of eight years according to the Centers for Medicare and Medicaid Services.
What Is The GUIDE Model
The GUIDE model is designed to improve care for individuals living with dementia by offering personalized support and resources. This program focuses on coordinating care between healthcare providers, caregivers, and patients, ensuring that everyone is on the same page.
Key Goals
Here are some key goals of the GUIDE model as listed on their website:
- Improve quality of life for people living with dementia by addressing their behavioral health and functional needs, coordinating their care for dementia and co-occurring conditions, and improving transitions between community, hospital, and post-acute settings.
- Reduce burden and strain on unpaid caregivers of people living with dementia by providing caregiver skills training, referrals to community-based social services and supports, 24/7 access to a support line, and respite services.
- Prevent or delay long-term nursing home care for as long as appropriate by supporting caregivers and enabling people living with dementia to remain safely in their homes for as long as possible.
Key Features
Some of the key features of the GUIDE model include
- Personalized Care Plans: The model helps create a care plan tailored to the patients by incorporating their goals, preferences and needs.
- Caregiver Support: Caregivers often feel overwhelmed by the responsibilities they face. The educational classes and resources provided help caregivers manage stress and help relieve the burden of caregiving.
- Care Navigators: A care navigator is a dedicated professional who helps guide patients and caregivers through the healthcare system. They help you get care and 24/7 access to a care team member or helpline to ask questions or get support. The navigators get 20 hours of training to help recipients sort through the confusing and cumbersome system of health care and long-term care in America, so they receive appropriate assistance.
- GUIDE Respite Services: GUIDE Respite Services can be provided so caregivers may take a break when they need to. Support comes from local in-home respite providers, adult day centers and nursing homes.
- Improved Access To Services: The model helps patients receive timely referrals to specialists to address other health concerns. The care navigator coordinates care with the specialist. This makes it easier to get the support needed without unnecessary delays.
Why GUIDE Matters
People who are caring for individuals with dementia often experience extreme stress both financially as well as mentally and physically. By focusing on personalized care, caregiver support, and coordination of services, the GUIDE model helps improve the quality of life for those living with dementia.
Eligibility
GUIDE participants are Medicare Part B enrolled providers and/or suppliers, with the exception of durable medical equipment (DME) and laboratory suppliers, who are eligible to bill for Medicare services and agree to meet the care delivery requirements of the GUIDE model. If the GUIDE participant can’t meet the GUIDE care delivery requirements alone, they can contract with other organizations to meet the care delivery requirements.
Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary.
Reimbursements
Medicare reimburses GUIDE participants for their services. It is between $65 to $390 a month, depending on the complexity of care for the person with dementia. But the medicare beneficiaries don’t have to pay anything at all.
According to Fortune, “Aside from dementia-care navigation, GUIDE participants can also provide free respite care valued at up to $2,500 for caregivers of people with moderate or severe dementia.”
Respite services provide short-term care for special needs folks to give their caregivers a break. Respite care can be scheduled for a few hours, days or even a few weeks. It can take place in the home, at an adult care center, or in a healthcare facility.
Finding a Care Navigator
People in Traditional Medicare, also called Original Medicare, can now look for GUIDE program participants in the database on the Centers for Medicare and Medicaid Services site or by calling Medicare’s toll-free number, 800-633-4227. At some point in the future, the Alzheimer’s Association plans to launch a searchable database online.
GUIDE is not available to people in nursing homes or hospice or with Medicare Advantage plans from private health insurers.
If you have further questions, you can reach out to the CMS GUIDE model team directly at GUIDEModelTeam@cms.hhs.gov.
