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The Guiding an Improved Dementia Experience (GUIDE) Model might be one of the biggest steps in the right direction for recent Medicare policy. The eight-year voluntary nationwide program was launched last year by the Centers for Medicare & Medicaid Services (CMS), with the goal of supporting individuals living with dementia, as well as their unpaid caregivers.
The program’s focus is more important than ever, with an estimated 6.7 million people living with dementia. This amount is expected to skyrocket to 14 million cases by 2060, according to data made available by CMS.
On top of that, more than 11 million U.S. adults are unpaid caregivers for an older adult living with a form of dementia. Plus, roughly 80% of seniors with Alzheimer’s disease and related dementias receive care in their homes, according to CDC data.
The GUIDE Model opens the door for Medicare payments for a combination of care coordination, care management, caregiver education and support, as well as respite services. It also opens the door for the home care industry to participate in Medicare, alongside clinical care providers and vendors. This is a major opportunity for home care providers to partner with Medicare-certified providers and expand the breadth of their businesses.
This week, I connected with the leader of a home care company that is an official GUIDE participant partner organization. He explained that home care agencies are a natural partner for GUIDE participants, due to their expertise in providing hands-on respite care directly in the home.
Home care providers that already specialize in dementia care may therefore be the first to be part of what could be a new renaissance for home care, one in which home care is reimbursable through Medicare and is highlighted for its importance as part of a value-based arrangement.
In this week’s exclusive members-only HHCN+ Update, I chart the future that the GUIDE model may have opened up for home care providers, including a seat at the Medicare table, and I offer analysis and key takeaways, including:
– The GUIDE model will lead to a new wave of partnerships that rely on home care’s expertise in keeping people safe in their homes.
– The success of these partnerships will demonstrate the value of non-medical home care in a new arena.
Right at Home, PocketRN and more creative collaborations
Medicare Part B-enrolled providers and/or suppliers are eligible to be GUIDE participants. These organizations are also allowed to bring on a partner that has been vetted by CMS, if they can’t meet the GUIDE care delivery requirements on their own.
GUIDE participants match seniors living with dementia with a “care navigator.” It’s this care navigator’s job to help these seniors gain access to services and supports, ranging from clinical to non-clinical services.
One partnership that has already emerged as an early GUIDE success story is the one between virtual nursing startup PocketRN and home care franchise company Right at Home. The former is a GUIDE participant and the latter is their partner organization.
When I spoke to Jenna Morgenstern-Gaines, CEO of PocketRN, earlier this month, she detailed some of the early wins that have resulted from teaming up with Right at Home for GUIDE.
“We’re seeing that patients and families are really getting to spend more quality time together, and they’re able to enjoy the little moments together,” Morgenstern-Gaines previously told me. “We’ve had numerous families be able to celebrate big milestones.”
PocketRN is not stopping after its partnership with Right at Home. Earlier this week, the company announced a partnership with Waco, Texas-based home care provider Cornerstone Caregiving to deliver care through the GUIDE model.
Other companies also see the benefits of GUIDE. Last year, Senior Helpers COO Mari Baxter identified GUIDE as a key opportunity for home-based care providers, due to the potential to strengthen care delivery by taking a team-based approach.
“Working with a direct participant benefits the clients and family caregiver by providing a team-based approach to care,” she previously told HHCN. “This ensures comprehensive care for the client and involves all parties in the process, maintaining consistency and quality. The GUIDE Model also introduces families and clients to home care, keeping them safer at home and reducing hospital admissions.”
Almost 400 home-based care companies are participating in GUIDE.
VNA Health System, Memory Care Home Solutions, CaringAtHome, Honest Home Health Services, Andwell Health Partners, Preferred Choice Home Healthcare, Providence Home Care and Hospice and Contessa Health are just some of the home-based care providers that are involved in the program.
During GUIDE’s eight-year run, we will see more partnerships like the one between PocketRN and Right at Home, setting the stage for home care providers to be a part of value-based care in a way the industry has not yet seen
Some home care companies have already narrowed in on dementia care — and may be particularly well equipped to join in on GUIDE..
Companies including Tender Rose Dementia Care Specialists, Pansy Homecare, Friendly Faces Senior Care and Full Bloom Memory Care have specialized in dementia care. I anticipate that these providers will be at the top of the list of home care companies that will announce future participation in GUIDE.
In my recent interview with Doug Robertson, senior director of government affairs at Right at Home, he pointed out that non-medical home care providers are well-positioned to take part in GUIDE because organizations like his are not burdened by the administrative overhead of Medicare, OASIS reporting or Medicare conditions of participation. Instead, they can fully focus on beefing up care delivery.
As the GUIDE model moves forward, I suspect that this aspect of home care will become increasingly attractive to potential partners and that home health providers will seek to find home care partners well-versed in providing dementia-specific care.
Home care performs on the main stage
Have you ever been to a music festival with multiple stages? If so, you know the drill. The larger artists occupy the main stages and headline the show. Meanwhile, the lesser-known, or mid-size artists, take the smaller stages and are stuck performing at times that may cause audiences to overlook them.
In the home-based care world, it can sometimes feel like non-medical home care is the indie artist giving a show-stopping performance on the small stage at a music festival.
At HHCN, my colleagues and I have reported on this dynamic over the years.
Participating in the Medicare program through GUIDE is one way I see home care providers moving from the small stage to the main stage.
Significantly, GUIDE is an additional Medicare benefit. It doesn’t take away from or conflict with home health or any other Medicare benefit that someone with dementia would receive.
And as Robertson noted during our interview, GUIDE marks the first time that traditional Medicare has reimbursed providers for care related to activities of daily living. This is a major development that allows home care providers to showcase their value in the Medicare space.
Value can mean anything from reducing falls and hospitalizations to serving as the eyes and ears in the home.
While it’s too early to say exactly how meaningful the GUIDE model will be for home care providers, I think that Medicare seriously engaging with non-medical home care isn’t off the table sometime in the future.
After all, while it might now seem like ancient history, it was less than a year ago that the Kamala Harris campaign proposed a Medicare home care benefit. Harris lost the election, but the factors behind the home care proposal – including the high cost of residential care options like senior living communities and the financial and emotional toll that caregiving is exacting on the “sandwich generation” – are still very much in play.
The Trump administration might never pursue this type of expansion of Medicare, but the current moves to slash Medicaid spending could eventually put an even greater premium on Medicare as the primary program to address the panoply of complex care needs for older adults. While it likely will take years, and perhaps another presidential election cycle (or two), the aging population and the need to contain costs could make it inevitable that personal home care becomes a Medicare benefit.
But the role that home care companies play in programs like GUIDE will help set the stage for such an expansion of benefits, so this model is a critical proving ground for their value proposition. And in order for home care companies to occupy a larger stage at the metaphorical health care festival, they not only need to prove their ability to keep costs in check and improve patient outcomes and satisfaction – they also need (and deserve) to see appropriate financial upside for their contributions to these care models, while having the confidence to also take on downside financial risk.
Fair apportionment of these financial rewards – and downside risk – not only creates necessary alignment across different provider types involved in frameworks like GUIDE, but should help home care providers invest in the technologies and other capabilities they need to play a larger part in the health care ecosystem and maximize their value.
So, while the GUIDE-related participation and enthusiasm of home care providers make this an exciting moment, I will be carefully watching how the program plays out in the years ahead. I believe that the stage has been set for success, and that home care providers will become a headline act not just in GUIDE but, increasingly, in the U.S. health care system as a whole.
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