Medicare News: New Dementia Care Model Could Mean Breakthroughs for Medicare Beneficiaries Suffering From Cognitive Decline

The Latest CMS News Could Mean Big Things for Dementia Coverage Medicare

Dementia is a prevalent illness among the aging population in the United States, and it has many negative impacts on those with the disease and their loved ones. Approximately 6.7 million Americans are battling dementia, and 30 percent of their caregivers are age 65 or older. This article will review the basics of the new Medicare dementia care model, what it means for dementia care under Medicare, and how it can help those with dementia and their loved ones.

What is the GUIDE Model?

Although dementia is increasingly common among the older population, there has been a lack of consistent quality care for people with dementia and their unpaid caregivers. Striving to rectify the care inequity, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new Medicare dementia care model on July 31, 2023. The model is called the Guiding an Improved Dementia Experience Model (GUIDE). This updated care model aims to improve the quality of life for people with dementia and their caregivers, and is certainly good Medicare news.

The Five Goals of the GUIDE Model

The GUIDE model will tackle significant issues contributing to the inadequate care for people with dementia and their unpaid caregivers in the following five ways:

1. Defining a standardized approach to dementia care delivery for model participants
   – Includes staffing considerations, services for beneficiaries and unpaid caregivers, and quality standards
2. Providing an alternative payment methodology to model participants
   – Includes a monthly per-beneficiary payment to support a team-based collaborative care approach
3. Addressing unpaid caregiver needs
   – Includes caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers
4. Respite services
   – Includes 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 to give the unpaid caregiver temporary breaks from their caregiving responsibilities
5. Screening for health-related social needs
   – Includes screening beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs

How Does the GUIDE Model Help Dementia Care Under Medicare?

The GUIDE Model will help people with dementia by providing them with consistent quality care and improving their comfort in the following ways:

• The care model improves care for those with dementia through care coordination and management and caregiver education.
• The care model allows those with dementia to remain in their homes and communities, which delays or eliminates the need for nursing home placement.
• The care model reduces the poor outcomes that people with dementia regularly experience, such as:
  • • High hospitalization rates
    • Emergency department visits
    • Post-acute care utilization
    • High rates of depression
    • Behavioral and psychological symptoms of dementia
    • Poor management of other co-occurring conditions

The GUIDE Model will help the unpaid caregivers of people with dementia by providing them with training and support in the following ways:

• The care model will provide caregivers with a care navigator who will aid them in accessing services and support.
• The care model will give the caregivers evidence-based education on dementia care best practices.
• The care model will allow caregivers to take temporary breaks from providing care through respite services.
• The care model will reduce caregiver’s stress and depression, which will mitigate common poor outcomes for caregivers, such as:
  • • Increased risk for severe illness
    • Increased risk of hospitalization
    • Increased mortality risk

When Will the GUIDE Model Begin?

If this innovative approach to dementia care under Medicare interests you, you may be wondering when it will begin. The GUIDE Model will take effect starting on July 1, 2024. After its commencement, the new dementia care model will run for a total of eight years.

CMS will accept letters of interest for the GUIDE Model until September 15, 2023. In fall 2023, a request for applications for the GUIDE Model will be released.

Final Thoughts

The GUIDE Model aims to address common issues for people with dementia and their caregivers. Creating and establishing a higher standard of care for people with dementia and reducing the strain on unpaid caregivers may be the beginning of a promising future for all impacted by dementia.