Memory Care Experts Hopeful CMS GUIDE Model Will Aid Residents, Caregivers

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By Sloane Airey

Memory care experts are watching a new memory care model from the federal government in hopes it could help caregivers providing in-home help as well as existing communities and their residents.

The Centers for Medicare & Medicaid Services (CMS)’s new GUIDE model, announced earlier this year, aims to help dementia patients stay healthy and in their homes longer by offering caregiver training and support like a 24/7 hotline and respite. The model will also test out a new form of payment for participating providers who will be asked to coordinate care with each other for their patients.

Experts who spoke with Memory Care Business said the model offers hope for families, though the complexity of care dementia patients can require and the fact that there’s no cure for dementia mean results may be slow coming. James Lee, co-founder and CEO of memory care community Bella Groves, is one of several experts who told Senior Housing News this new model could still be a game-changer for the industry.

“I think the CMS GUIDE model will be a massive opportunity for operators to test a ‘senior living as a service’ business model where they evolve from a real-estate-centric business to a hub model,” he said.

‘There is a Disconnect’

For Kris Engskov, founder of Rippl Care, the GUIDE model is a validation of his own business model: Providing wraparound clinical and psychosocial care to patients with dementia. Rippl draws in the patient’s primary care provider and caregiver to keep dementia patients healthy and out of the ER, an approach Engskov said was learned from UCLA’s collaborative care program.


Engskov noted that CMS’s GUIDE model means the opportunity to study collaborative care models nationally for best practices. The government agency has also elected to run the program for an unusually long time of eight years, instead of its usual five. Some experts say that’s also an opportunity to implement recommended changes along the way.

“I think that’s another benefit to an eight-year program is you really can make some adjustments,” said Fred Bentley, director of ATI Advisory. “Just a little bit more nothing, nothing major, but some meaningful adjustments, and then really get a chance to see okay, we think we’ve perfected this model.”

A longer run time also gives interested parties time to figure out how to qualify for participating in the CMS model considering only providers who can bill Medicare Part B are eligible.

“What we’re finding is there is a disconnect between primary care physicians […] who would be would qualify for this participation, because they are billing Medicare Part B,” explained Bentley. “And then the whole constellation of, you know, memory care providers, Alzheimer’s groups, dementia care providers who are not in and of themselves, billing Part B services, but provide all that kind of wraparound support that’s needed.”

Lee of Bella Groves agreed that the adoption of the GUIDE model will likely start slowly. He believes adoption will follow the pattern of diffusion of innovations theory.

There will be 2.5% of operators –innovators in the space – that will figure out how to fire and then aim. Another 13.5% will follow closely behind as the early adopters and then the 35% of [the] early majority,” said Lee.

Still, Bentley from ATI believes that eight years signals a strong commitment from CMS, and may protect the program from Administration changes in Washington which can otherwise scrap program funding every four years. “It is sending a very clear signal to organizations that want to participate that this […] is not going away anytime soon,” he said.

‘A Giant Vacuum’

While the GUIDE model offers hope for more funding for some memory care providers, experts expect the industry’s longstanding care coordination and workforce development woes could still make implementing the model difficult.

Across America, there is, as Engskov from Rippl described, “a giant vacuum” where there should be enough dementia-trained clinicians to meet patient demands. “Frankly, I think we’re already very late […] in terms of being prepared for what’s coming,” he said of the GUIDE model’s timing. “But this certainly is, you know, welcomed and exciting.”

“The first boomers are going to turn 85 here in the next few years, and at 85, you have a one-in-three chance of having just Alzheimer’s, not even counting the other dementias,” said Engskov. “So we are going to see a significant wave for the next 25 years of boomers aging and getting these diseases in far higher volumes than they ever have.”

The other challenge awaiting CMS is how to coordinate care in order to pull off GUIDE’s promised collaborative model. “We have a very fragmented provider landscape, and especially […] when you start talking about kind of the nonmedical services that are essential to this guide model,” said Bentley. “So there’s a lot of coordination that has to happen.”

Lee agreed but noted that these increased coordination demands may open up opportunities in the next year for software companies that can develop products that allow different organizations to more easily team up.

Ultimately, the experts believe the GUIDE model is a big step in the right direction for memory care nationwide.

“Every memory care operator looking to evolve past their traditional brick and mortar offerings should examine the GUIDE Model,” said Lee from Bella Groves. “Helping unpaid caregivers to put their oxygen mask on first is a monumentally important mindset shift that all senior living providers can adopt.”

“I think CMS really helped us get the word out that this is now and urgent,” said Engskov, who noted the GUIDE model has already piqued the interest of payers and providers he works with.

A spokesperson for CMS declined to share the number of Letters of Interest the agency received so far, but noted that “the responses indicate strong initial interest from a variety of provider types and organizations.”

When asked in late October, CMS also did not supply the date when applications will open for organizations looking to participate in the GUIDE model this fall. Information on CMS’ budget for the program will be released in the agency’s upcoming Congressional Report, per the spokesperson.

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