GUIDE Dementia Care Management

The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary nationwide model that aims to support people with dementia and their unpaid caregivers. The 8-year model, created by the Centers for Medicare and Medicaid Services (CMS), launched as a pilot on July 1, 2024 and is set to expand nationwide on July 1, 2025.

The GUIDE model focuses on comprehensive, coordinated dementia care and aims to improve quality of life for people with dementia, reduce strain on their unpaid caregivers, and enable people with dementia to remain in their homes an communities. It will achieve these goals through a comprehensive package of care coordination and care management, caregiver education and support, and respite services.

An individual is eligible if they meet all the following criteria:

• Enrolled in Medicare Parts A and B and Medicare is the primary payer
• Reside in the designated geographic area;
• Have an eligible dementia diagnosis;
• ARE NOT enrolled in a Medicare Advantage plan
• ARE NOT enrolled in a Program for All-Inclusive Care for the Elderly (PACE)
• ARE NOT enrolled in the hospice benefit; and
• ARE NOT residing in a long-term skilled nursing home. Assisted living or other congregate settings are allowed

GUIDE is designed to focus on the needs of the person living with dementia AND the needs of their unpaid caregivers.

• Comprehensive Assessment and Individualized Care Plan tailored to your needs and what matters to you.
• Support from a dedicated Care Navigator. Ongoing support and coaching from a trained local Care Navigator focused on your quality of life.
• Access to Respite Care at no cost. The GUIDE model covers up to $2500 worth of respite care per year for unpaid caregivers.
• Education on best practices in managing dementia – make day-to-day life easier.
• Become a more confident caregiver – education on dementia to develop knowledge, skills and confidence so you can provide the best care for your loved one now and in the future.
• Maintaining health and functioning. Most folks living with dementia are managing multiple chronic conditions. We work with you and your health providers to stay healthy and promote mobility, brain functioning, effective medication use, and what matters to you.
• Improve your relationships. Improve your relationship with your loved one by learning valuable ways to communicate with people with changing brains.
• Prepare for the future – People with dementia experience a loss of the ability to manage daily activities independently. We will help you learn about advanced directives and how to plan for life with dementia as early as possible so that you can share your values and what matters to you now and in the future.
• Staying Resilient – A focus on caregiver resilience and sense of well-being. Support for caregivers to manage stress and increase your ability to stay healthy, motivated, happy and better able to cope when things are challenging.

We want to hear from you! You can refer yourself for the GUIDE program or we can receive referrals from medical or helping professionals in the community. We are happy to discuss your situation and see if GUIDE can support you.

You can reach us at:

Email: GUIDE@mwvadultdaycenter.org
Phone : 603.356.4980 and ask for the GUIDE program
Fax: 603.452.0780, Attn: GUIDE
Mail: 987 East Main Street, Center Conway, NH, 03813 Attn: GUIDE

Or print out the referral form and mail or fax the form to us.