GUIDE: The New Dementia Care Model

The Biden-Harris administration just announced an amazing new model for individuals with dementia and their caregivers. Currently, these individuals are often experiencing higher rates of hospitalization, mental struggles, and financial struggles. Caregivers are often overburdened and lack time to take care of themselves let alone their family members. Today we wanted to talk more about the program in preparation for when the applications go live in Fall of 2023.

How Does the Model Help?

GUIDE is an 8-year voluntary model that will be offered in all states and US territories. This is part of a preventative care model with the intent of improving the lives of people with dementia and their caregivers. The purpose of the model is to address the following issues within dementia care:

• Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for beneficiaries and their unpaid caregivers, and quality standards.

• Providing an alternative payment methodology to model participants – CMS will provide a monthly per-beneficiary payment to support a team-based collaborative care approach.

• Addressing unpaid caregiver needs – the model will aim to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers. 

• Respite services – CMS will pay model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver  temporary breaks from their caregiving responsibilities. 

• Screening for Health-Related Social Needs – model participants will be required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs.

All of the above is going to include person-center assessments from medical professionals, 24/7 access to a support line, care plans, assistance with coordination and more. All of this, to take the burden off unpaid caregivers and create a safer environment with preventative care.

With all this in mind we would also like to note there is a major focus in health equity. Dementia imposes significant financial, emotional, and logistical burdens on families. This is worsened for certain racial and ethnic groups. For example, black and hispanic populations have higher prevalence of dementia, but are less likely to receive a timely diagnosis. With this intent CMS will be offering a variety of financial and technical support to ensure participating individuals can develop their infrastructure, improve care capabilities, and participate successfully in the model.

If you would like to see a visual example please click here for one provided by CMS.

Eligibility Requirements

The eligibility requirements are listed here:

• Beneficiary has dementia, as confirmed by attestation from a clinician practicing within a GUIDE dementia care program (DCP).

• Enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs).

• Have Medicare as their primary payer.

• Not enrolled in Medicare hospice benefit.

• Not residing in a nursing home.

What’s next?

Right now, organizations are signing up for the model in order to provide the above care to people in their area. Applications will be open in Fall of 2023 so keep your eyes open! While you wait if you are looking for home modifications for you or your family our team is prepared to help. As we discovered above, being a caregiver can be an extremely stressful task. If some home modifications would improve your home situation please reach out!