Guiding an Improved Dementia Experience (GUIDE) Model Overview Factsheet
Guiding an Improved Dementia Experience (GUIDE) Model Overview Factsheet
MODEL PURPOSE
Dementia takes a toll on not just the people living with the disease but also on their loved ones and caregivers in a way that almost no other illness does. About 6.7 million Americans currently live with Alzheimer’s disease or another form of dementia, a number that is projected to grow by nearly 14 million by 2060. To help address the unique needs of this population, the GUIDE Model aims to:
Improve quality of life for people living with dementia by addressing their behavioral health and functional needs, coordinating their care for dementia and co-occurring conditions, and improving transitions between community, hospital, and post-acute settings.
Reduce burden and strain on unpaid caregivers of people living with dementia by providing caregiver skills training, referrals to community-based social services and supports, 24/7 access to a support line, and respite services.
Prevent or delay long-term nursing home care for as long as appropriate by supporting caregivers and enabling people living with dementia to remain safely in their homes for as long as possible.
CARE DELIVERY APPROACH
The model will promote improved dementia care by defining and requiring a comprehensive, standardized care delivery approach that will include the following:
Standardized set of services for beneficiaries and their unpaid caregivers.
An interdisciplinary care team to deliver these services
A training requirement for care navigators who are part of the care team.
The interdisciplinary care team will deliver services by creating and maintaining a personcentered care plan, which will include details on the beneficiary’s goals, strengths, and needs; comprehensive assessment results; and recommendations for service providers and community-based social services and supports.
CARE COORDINATION
The care plan will identify the beneficiary’s primary care provider and specialists and outline the care coordination services needed to help manage the beneficiary’s dementia and co-occurring conditions.
CAREGIVER SERVICES
Participants will assess and address caregiver needs and include the caregiver as part of the care team as appropriate. Caregiver services
will include ongoing monitoring and support via 24/7 access to a support line.