U.S. Department of Health and Human Services Announces Medicare Dementia Care Model

Dementia© siriwannapatphotos / Canva

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), recently announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services. The GUIDE Model will be tested by the Center for Medicare and Medicaid Innovation and is a key deliverable from President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers, as well as key goals of the National Plan to Address Alzheimer’s Disease (National Plan).

“HHS continues to innovate to help Americans living with dementia and their unpaid caregivers. Our new GUIDE Model has the potential to improve the quality of life for people with dementia and alleviate the significant strain on our families,” said HHS Secretary Xavier Becerra. “We are proud to take these steps to deliver on the President’s promise to increase care coordination and improve access to services and supports for our families.”

“While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities. Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden,” said CMS Administrator Chiquita Brooks-LaSure. “We know that Black, Hispanic, and Asian Americans, Native Hawaiian, and Pacific Islander populations have been particularly disadvantaged in receiving dementia care. The GUIDE Model will provide new resources and greater access to specialty dementia care in underserved populations and communities.”

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Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations.

The model is also designed to enhance access to the assistance and resources caregivers need, Goal 3 of the National Plan: Expand Supports for People with Alzheimer’s Disease and Related Dementias and Their Families. Evidence-based models of support for caregivers of people with dementia and dementia-capable community-based providers have been expanded over the last decade through investments in research and services by HHS and others. The model will provide a link between the clinical health care system and community-based providers to help people with dementia and their caregivers access education and support, such as training programs on best practices for caring for a loved one living with dementia. Model participants will also help caregivers access respite services, which enable them to take temporary breaks from their caregiving responsibilities. Respite has been found to help caregivers continue to care for their loved ones at home, preventing or delaying the need for facility care.

“As millions of Americans already know, dementia can devastate people and their families in many ways. The GUIDE Model aims to mitigate the significant challenges of coordinating and managing health care and community-based supports and improve quality of life for patients and caregivers alike,” said CMS Deputy Administrator and Innovation Center Director Liz Fowler. “By offering caregiver support, respite services, and improved access to community-based supports, the GUIDE Model aims to keep people living with dementia safer and in their homes longer.”

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The GUIDE Model also supports the Biden-Harris Administration’s goal of advancing health equity for underserved communities. Black and Hispanic, and Asian Americans, Native Hawaiian, and Pacific Islander populations have a higher prevalence of dementia, are less likely to receive a diagnosis, and have more unmet needs. These populations are also more likely to experience high caregiving demands and spend more of their family assets on dementia care. By providing financial and technical assistance for developing new dementia care programs targeted to underserved areas, this model aims to improve the health outcomes and caregiving experience of Black, Hispanic, and Asian Americans, Native Hawaiian, and Pacific Islander individuals and their families through increased access to specialty dementia care.

CMS will release the application for GUIDE, a voluntary, nationwide model, in Fall 2023. Prior to the application release, interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023. The model will run for eight years beginning July 1, 2024.

For additional information, CMS has developed a GUIDE Model Fact Sheet or visit the GUIDE Model webpage.

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