When the Centers for Medicare & Medicaid Services (CMS) first announced the Guiding an Improved Dementia Experience (GUIDE) Model in late July, there was excitement and an eagerness to learn more from home-based care providers.
The goal of the model, according to CMS, is to “support people living with dementia and their unpaid caregivers.”
Even before the GUIDE model was released, researchers with the Washington, D.C.-based ATI Advisory started to do a deep dive into what dementia care looked like in the U.S.
Through a partnership with the Rosalynn Carter Institute for Caregivers (RCI), ATI began writing a white paper that detailed what a dementia care model would look like. Less than three months into their research, the GUIDE model was released.
“We were really pleased to see that, a lot of what we had pulled out as being critical components, were mirrored in the GUIDE model,” Madeleine Howard, a senior analyst with ATI Advisory, told Home Health Care News. “The piece that comes most immediately to mind is this respite component.”
This is one of the first tests of caregiver support within the Medicare fee-for-service program, Howard said.
The GUIDE Model could be a way for the entire country to view dementia care differently moving forward.
“I also think that CMS has an opportunity to use its data and its resources to evaluate this program in a different way than other researchers have been able to do,” Tina Hansen Pickett, managing director of ATI Advisory’s Medicare innovation practice, told HHCN. “We know many of the dementia caregivers themselves are also on Medicare, so both the care recipient and the caregiver — generally — will be on the same kind of insurance. There’s an opportunity to try and link the impact and the services provided under the GUIDE model to what’s happening with the beneficiary living with dementia, as well as the health outcomes of the caregiver too.”
ATI Advisory believes caregivers should receive support when they’re providing at-home care, but also afterward.
“We understand that there’s caregiver burden, even after the transition to long-term care,” Pickett said. “Having there be an ability for that caregiver support to continue — even after a transition to long-term care if that’s what the family chooses is the best option — is a really important component. Trying to shine a light on the realities that caregivers are facing in this system and making further tweaks in the model is one of our main aims and key takeaways.”
Other than opening access to dementia care for providers and patients, Howard and her colleagues are particularly excited about the support included in the GUIDE model for respite care.
The GUIDE model includes a “comprehensive package of care coordination and care management, caregiver education, and support and respite services,” CMS said.
Respite care is a primary service for many home care providers across the country.
Under the GUIDE model, certain people living with dementia and their caregiver will be eligible for up to $2,500 in respite services annually.
“One of the care delivery requirements is to make that respite available either in their facility at an adult day center or in the patient’s home,” Howard said. “That’s an immediate opportunity for home-based care providers to engage, to partner and to be one of those providers caregivers can call and bring into their home and allow them to leave their loved one safely with a trained provider.”
Some providers also have an opportunity to participate as part of a network with the GUIDE model.
Providers like Enhabit Inc. (NYSE: EHAB), Lifespark and DispatchHealth have all told HHCN they are strongly considering participating in the model and are keeping a close eye on how it’s rolled out.
“Certainly on the respite services, but there’s a lot of other services that these organizations provide that could be useful to an entity that’s participating in the GUIDE model, writ large, to help plug in and provide services in the person’s home,” Pickett said. “And to connect to services that are necessary to best support that caregiver that are outside of the typical Medicare fee-for-service guard rails — which we know are still limited within the home care space compared to the need that is experienced out there.”
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