Getting Your GUIDE: An Introduction To The New Medicare GUIDE Model (Guiding An Improved Dementia Experience) By Dr. Marc Rothman

By Dr. Marc Rothman

What is GUIDE? 

I’m often asked a question that has started coming up more and more from families and caregivers: 

“What is this new Medicare GUIDE program I’m hearing about for dementia care?” 

For many families caring for someone with Alzheimer’s disease or another form of dementia, the healthcare system has historically offered very little coordinated support for the day-to-day realities of living with the disease at home. 

The new Medicare GUIDE Model (Guiding an Improved Dementia Experience) is designed to begin changing that. 

Why the GUIDE Model Matters 

Traditionally, Medicare has paid for specific healthcare services such as hospitalizations, doctor visits, rehabilitation after a hospital stay, and hospice care near the end of life. 

But dementia care does not fit neatly into those categories. 

Families dealing with Alzheimer’s or other forms of dementia often face daily challenges that extend far beyond the doctor’s office. They may need help navigating behavioral changes, planning for safety at home, coordinating care providers, or simply understanding what the next stage of the illness may bring. 

Until now, most of that work has fallen on caregivers themselves. 

The GUIDE Model is designed to fill that gap by providing ongoing guidance and support throughout the dementia journey, not just during medical visits or emergencies. 

What the GUIDE Model Provides

At its core, the program gives families access to a dedicated care team that helps them navigate dementia care over time. 

One of the central features of the program is a care navigator, often a nurse or social worker, who becomes a consistent point of contact for the family. Instead of trying to piece together information from multiple providers, families have someone they can turn to for guidance. 

Participants in the program typically receive: 

A dedicated care navigator 

This professional works directly with the family to help coordinate care, answer questions, and connect them with appropriate resources. 

24/7 access to guidance 

Dementia related challenges rarely happen at convenient times. Families can reach out whenever issues arise, whether it is a behavioral change, safety concern, or care decision. 

Regular check-ins 

Monthly check-ins help ensure that changes in the patient’s condition are addressed early and that caregivers feel supported as circumstances evolve. 

A personalized care plan 

Rather than reacting only to today’s challenges, care teams work with families to anticipate future needs and plan ahead. 

Expert guidance on important decisions 

Families can receive advice on topics such as transitions in care, evaluating living arrangements, and ensuring that caregivers entering the home are well-qualified. 

Support near the end of life 

As dementia progresses, families often face difficult decisions. Having expert guidance during this time can make an enormous difference. 

The program may also include a respite benefit of up to approximately $2,500 per year to help cover respite services for caregivers. Even short breaks can be incredibly valuable for family members providing daily care. 

Who Is Eligible for the GUIDE Model? 

Another question I hear frequently is: How do I know if my family member qualifies for this program?

First, the individual must have a diagnosis of dementia. This may include Alzheimer’s disease, Lewy body dementia, vascular dementia, frontotemporal dementia, Parkinson ’s-related dementia, or other forms of the condition. 

That may sound straightforward, but in reality, many people with memory loss struggle to receive a clear diagnosis. For families facing that challenge, clinicians experienced in dementia care can help guide the evaluation process. 

Second, the individual must be enrolled in traditional Medicare, Part A and Part B. At this time, the program does not include Medicare Advantage plans. 

There are a few additional limitations. Individuals currently enrolled in hospice care cannot participate in GUIDE at the same time, and those living permanently in a nursing home are not eligible. However, someone who temporarily enters a nursing facility for rehabilitation after a hospital stay can still qualify once they return home. 

People who are eligible for both Medicare and Medicaid may also participate in the GUIDE Model unless they are enrolled in certain specialized Medicare programs. 

Because each situation is unique, the easiest way for families to determine eligibility is through a brief screening process with a participating provider. 

What Enrollment Looks Like 

In many cases, determining eligibility takes only a few minutes through a simple screening questionnaire. 

Families can learn more by visiting https://www.marcrothmanmd.com, where there is a link to resources about the program and information about dementia care. 

Another option is to visit https://www.lizzycare.com, where families can complete a quick eligibility check that typically takes about five minutes. 

Patients and families get access to GUIDE through a certified GUIDE participant, like Lizzy Care. Lizzy Care is active in NY, NJ, CT, Chicago, Louisville, and Jacksonville. Other GUIDE programs are in various areas. The CMS website has a list that can be referred to to find participants in your area.

Once a patient is confirmed to meet the program’s requirements, enrollment itself usually happens fairly quickly. In many cases, it takes about a week, though occasionally it may take a bit longer.

After enrollment, Medicare determines whether the individual qualifies for the respite benefit that helps support caregivers at home. 

From there, the care team begins working with the family to create a care plan and establish regular communication. 

Supporting Both Patients and Caregivers 

One of the most important goals of the GUIDE Model is to support not only the person living with dementia but also the caregivers who make it possible for that individual to remain at home. 

Family caregivers often shoulder enormous responsibility. They coordinate appointments, manage medications, ensure safety, and respond to behavioral changes. 

Many caregivers wonder constantly whether they are making the right decisions. 

Programs like GUIDE are designed to give families something they have often lacked: a team they can rely on for expert guidance throughout the journey. 

When caregivers feel supported and informed, people living with dementia are more likely to remain safe, comfortable, and engaged in their homes and communities. 

For those of you who prefer, take a look here at Dr. Rothman’s video presentation regarding this new GUIDE program.

Dr. Marc Rothman has dedicated his professional career to helping older adults. As CEO of Lizzy Care, a full-service dementia care management company, Dr. Rothman draws from his years as a practicing physician and physician executive to design programs that deliver care more safely and effectively. Dr. Rothman is also the founder of Dementia Spring Foundation, a 501(c)(3) nonprofit that supports artists and innovators who are telling new stories of dementia, curating programs engaging those living with dementia, and harnessing creativity to foster community and hope.