An Overview of GUIDE

Medicare’s New Dementia Care Coverage

Any family caregiver knows how challenging and lonely the role can be. Caring for someone with dementia can be even more so. Fortunately, the Centers for Medicare & Medicaid Services (CMS) is rolling out a program called the GUIDE Model, short for Guiding an Improved Dementia Experience.

The GUIDE Model is an eight-year, nationwide program for people enrolled in original Medicare Parts A and B. There is no cost-sharing for the services provided under the GUIDE Model. Medicare covers 100% of the expenses for care coordination and respite services, ensuring that financial barriers do not hinder access to essential support.

GUIDE’s services for those living with dementia and their caregivers include:

• Personalized care coordination through trained care navigators.
• Support for family caregivers, including education and respite services. (Caregivers can access up to $2,500 per year in respite care services, allowing them to take necessary breaks from caregiving duties.)
• Access to community resources like transportation and meal services.
• A 24/7 support hotline for urgent needs.
• A team-based approach with health care professionals who specialize in dementia care.

“The GUIDE program is like the middleman to help me with the daily challenges I face with my mother,” said Erica Krebs of Agoura Hills, California, in an article from AARP. “Speaking with personnel with the GUIDE program gives me and my sister suggestions that if we try this, it maybe will work better.”

The Right at Home – PocketRN Partnership

Right at Home is proud to offer GUIDE in certain markets through a strategic alliance with PocketRN, a leading provider of virtual nursing care. Through this alliance, PocketRN will assess the client’s condition, reimburse Right at Home for the home care agency role in the assessment process, and then Right at Home will provide the respite care allowance while PocketRN delivers the 24/7 hotline, nurse virtual check-ins, care coordination, medication management, and family caregiver dementia training.

PocketRN assigns a nurse to the beneficiary, which leads to a trustworthy relationship.

Seniors and Families Reaping Benefits of Early Success

Many families are already seeing the benefits of the GUIDE program. One such family already benefiting from this collaboration is Suzanne Taylor and her sister Donna Wardlow, 75, who lives with dementia in a memory care facility in Flower Mound, Texas. Donna, who previously underwent open-heart surgery and battles recurring UTIs, has experienced significant cognitive decline.

Before enrolling in the GUIDE Model, Suzanne, Donna’s primary family caregiver, frequently made trips from her home to manage Donna’s care, a 45-minute drive away. “I was having to go over there so much ... now someone’s coming regularly, and it gives me time to take care of other things,” said Suzanne.

Now, Donna receives weekly visits from A.P., a caregiver with Right at Home Lewisville. A.P. provides companionship, organizes Donna’s belongings, facilitates engagement activities, and gives Suzanne peace of mind. Despite Donna’s limited income from Social Security and Department of Veterans Affairs survivor benefits, Suzanne has found relief knowing the program is covered by Medicare.

“This was a godsend,” Suzanne said. “Programs like this don’t just help the person with dementia—they help the whole family.”

The CMS contracts with 390 partners, like PocketRN, across the U.S. to provide this care. Many Right at Home locations may be working with one of these partners, so reach out to your local Right at Home office to find out what’s available through GUIDE.

Who Is Eligible for the GUIDE Model?

To participate in the GUIDE Model, the CMS states that the person must:

• Have dementia, as confirmed by attestation from a clinician on the GUIDE Participant’s GUIDE Practitioner Roster;
• Be enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs) and have Medicare as their primary payer;
• Have not elected the Medicare hospice benefit; and
• Not be a long-term nursing home resident.

A Partnership in Dementia Care

The GUIDE Model represents a significant step forward in dementia care, offering structured support to those affected and their families. “The ultimate goal is that this works, saves Medicare money, improves the lives of people with dementia and their caregivers, and keeps people out of nursing homes,” said Los Angeles geriatrician David Reuben, M.D., in the AARP article.

If you or a loved one is navigating the challenges of dementia, consider exploring the GUIDE Model. It’s more than a program—it’s a partnership in care.

How Right at Home Can Help

At Right at Home, improving the quality of life for those we serve is more than just a motto; it is our mission. Providing care to families affected by dementia can have a profound impact on fulfilling this mission. Our dedicated caregivers are available to help. Use our office locator to contact the Right at Home office nearest you and ask for a free in-home consultation.