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Our Old Uncle Sam is Back!
On July 1, 2024, the Centers for Medicare & Medicaid Services (CMS) Innovation Center launched a model program:
OBJECTIVES
GUIDE recognizes that “Alzheimer’s disease and related dementias are devastating conditions for a person and their family and caregivers. Often, a family member finds themself in a new, unexpected role as a caregiver supporting the person living with dementia.”
GUIDE is a voluntary nationwide model program to “support people with dementia and their unpaid caregivers”, such as a relative or unpaid nonrelative who helps with activities of daily living. Support comes in the form of Care Navigators, Nurse Practitioners, support groups, education, and referrals to community resources.
“In focusing on comprehensive, coordinated dementia care, GUIDE aims to improve quality of life for people with dementia, reduce strain on their unpaid caregivers, and enable people with dementia to remain in their homes and communities.”
WHAT GUIDE DOES:
The model fosters the development of Dementia Care Programs (numbering 331 in July 2025 ) “to serve hundreds of thousands of people with Medicare nationwide.” GUIDE provides participating organizations with “a new Medicare payment for delivering a comprehensive package of care coordination and management, caregiver education, and certain respite services.” It also integrates with CMS’ efforts to cover drugs that slow the progression of Alzheimer’s disease.
The GUIDE Model standard approach to care includes 24/7 access to a support line, as well as caregiver training, education, and support services. “This approach will allow people with dementia to remain safely in their homes for longer by preventing or delaying nursing home placement and improve quality of life for both people with dementia and their unpaid caregivers.“ Under the model, participating organizations will assign people with dementia and their caregivers to a Care Navigator to help them access GUIDE and non-GUIDE services and supports, including assistance like meals and transportation through community-based organizations. “Unpaid caregivers will be connected to evidence-based education and support, such as training programs on best practices for caring for a loved one with dementia. Model participants will also help caregivers access respite services, which enable them to take temporary breaks from their caregiving responsibilities.”
WHAT ARE THE GUIDE MODEL ELIGIBILITY REQUIREMENTS?
“A beneficiary is eligible to receive services under the GUIDE Model if they meet the following criteria:
Has dementia, as confirmed by attestation from a clinician on the GUIDE Participant’s GUIDE Practitioner Roster;
Is enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs) and has Medicare as their primary payer;
Has not elected the Medicare hospice benefit, and;
Is not a long-term nursing home resident.”
MY PERSONAL IMPRESSIONS:
(I have no personal, professional, or financial conflicts of interest to declare.)
In becoming personally familiar with the program, my observations include:
Consistently very high-quality personnel, responsiveness, and interactions.
Thorough intake evaluation of the client’s physical, emotional, and medical circumstances and existing caregiving strengths and weaknesses.
A detailed and personalized written Care Plan including safety and enrichment.
Monthly Care Navigator in-home conferences and re-assessments.
An early and consistent emphasis on caretaker education.
Access to group-based and individual caretaker supports.
I am the primary care giver for my 66 yo ex husband who I was married to for 40 years who was diagnosed with early onset dementia he now is in the middle to late stage dementia . I had to divorce him so the state could take care of him since he left us in financial ruins. We lost EVERYTHING. I was fortunate to get him into the pace program for the last 2 years. So could work to support us. I now want him to be home with me. I will quit my job. And thought I could get paid to take care of him. He is declining
quickly. I tried to get the ihss and was told that he has a high share of cost and I would not make anything to take care of him. I have tried to se if this could be waved, because of this sad situation and I gave up because I was told no.
He has medi-cal and Medicare. I’m not sure he needs the Medicare if he has mdi-cal. I don’t understand this and no one can explain it to me.
Any help would be greatly appreciated.
I was told that