The Power of the CMS GUIDE Model for Changing Dementia Care
Yesterday the Biden-Harris Administration along with the Centers for Medicare & Medicaid Services (CMS), introduced the Guiding an Improved Dementia Experience (GUIDE) Model. This model is designed to do 3 things really well:
- enhance the quality of life for individuals living with dementia
- alleviate the burden on unpaid caregivers
- enable people to remain in their homes and communities
The GUIDE Model comprises a comprehensive approach, including care coordination and management, caregiver education and support, and respite services. This innovative model will be tested by the Center for Medicare and Medicaid Innovation and comes from President Biden's April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers.
About 6.7 million Americans already have some form of dementia and by 2060 that number is expected to more than double! With the prevalence of the disease growing, the National Plan to Address Alzheimer's Disease was established in 2012. So this GUIDE model initiative is a really important outcome from that action.
What is the CMS GUIDE model?
Through this model, healthcare providers that normally care for people with dementia like neurologists, psychiatrists and gerontologists will receive payment for offering essential services like personalized assessments, care plans, and care coordination. People with dementia and their caregivers will have access to a care navigator who will help them access various services, including clinical care and non-clinical support like meals and transportation from community-based organizations. The model aims to improve access to resources for caregivers and strengthen the connection between healthcare and community-based services. It will also offer training programs for caregivers on best practices in dementia care and provide respite services, allowing caregivers to take short breaks while continuing to care for their loved ones at home.
Why is the GUIDE model for dementia care such a big deal?
Any large changes in healthcare (and maybe in America) have been initiated monetary incentives. CMS recognizes this power and only makes these kinds of changes when they are well researched and planned out. Which is part of the reason why this is huge! They are using their most powerful motivator to encourage health care organizations to create a collaborative care model that is unique and specific to providing excellent care for people with dementia AND their family caregivers.
That seems basic until you realize that the way nearly all payments from Medicare to healthcare providers are made is to reimburse them for services provided directly to the patient. Despite all the research that shows how important caregiver education, community based supports and living environment are in achieving excellent health outcomes, almost none of Medicare's dollars go to that.
In many cases, providing education and training directly to the patient is the ideal situation but when that patient has dementia it’s the people that care for them who really need the training. The problem is that the healthcare provider is only able to effectively bill for the time spent directly with the patient. The GUIDE model acknowledges that our general model of care doesn't serve people with dementia very well and encourages providers to create their own programs that have certain best practices as pillars and pays for that collaborative care.
Home Visits - The Game Changer
The amazing thing about the GUIDE model is that it starts with a home visit! So much of healthcare is forced into the four walls of a hospital or a clinic even though all the change needs to happen in four walls of our homes to see a difference in health outcomes. This is so very important for helping families accommodate for the changes that come with a diagnosis of dementia. Starting in the home sets the foundation for everything else and it is transformative!
This part is not news - lots of great programs operate this way but they rely on each organization finding philanthropic funding to facilitate this or they require private pay from the family. Now, these collaborative programs can apply for funding direct from Medicare.
Occupational Therapists are Key for Implementing the GUIDE Model
Occupational Therapists (OTs) are the best partners for completing that home visit. In the definition of OT it states:
Occupational therapy services are provided for habilitation, rehabilitation, and promotion of health and wellness for clients with disability- and non–disability-related needs.
We are the professional embodiment of the GUIDE model! Our whole purpose is to use our skills to promote health and wellness. If you're getting lost in all the jargon, read that definition how I see it as relating to dementia care:
Occupational therapy services are provided for habilitation (learning), rehabilitation (re-learning), and promotion of health and wellness for clients with disability (dementia)- and non–disability-related (their caregivers') needs.
The core of what we do IS client centered, integrated care. When you start at the home, you realize there are so many ways we can affect change or promote well being besides only prescribing medications. OTs are experts at that! A small example is using a red plate and cup for meals. It's a proven way to increase how much is eaten specifically for someone with advancing dementia by about 25% because the attention grabbing red color helps with focusing on the food. A typical medical model approach might go directly to prescribing an appetite stimulant. But having one less pill to try to get a person to take and a few less cues needed to keep the person eating can significantly reduce the burden and stress on caregivers. See the difference?
The point is...
I could really go on and on as to how implementing the GUIDE Model will be amazing for families and people with dementia who end up in these programs over the next 8 years. If you want to talk more about it with me I'd love to - connect here!
But I want us to see how the success of these GUIDE model programs across the country will set the precedent for doing this for other types of conditions and eventually create the systematic change we so desperately need in healthcare.
If you are interested in applying for funding for your program for dementia care connect with me on how the resources at AskSAMIE can support your program implementation.