Medicare covers at-home nursing care for dementia patients for the first time this year

After an initial pilot program, Medicare has introduced a new model for treating patients with dementia this year.

The Guiding an Improved Dementia Experience Model, called GUIDE, is a voluntary program that covers the cost of at-home nursing care. The goal is to offer respite for caregivers and trained care for patients.

It “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 and communities,” according to Medicare, the federal health insurance program for Americans age 65 or older.

This is the first time Medicareis paying for at-home care for dementia patients.

Paul Lallanilla, the owner of Right at Home Pasco, has been helping patients enroll in the program. His business provides at-home care for seniors and adults with disabilities.

Lallanilla said that with more Americans living longer, Medicare is facing ballooning costs from dementia care. GUIDE is one way to find some financial relief, said Lallanilla.

GUIDE covers up to 70 hours of at-home nursing care for qualifying dementia patients per year. Patients can enroll only if they are covered by Medicare, not including a third-party Medicare Advantage plan. While those living in assisted living facilities are not eligible for GUIDE, if patients are discharged, they can apply.

After patients submit an application, it can sometimes take weeks to get approved, said Lallanilla.

Companies like Lallanilla’s contract with Medicare to provide the GUIDE at-home care services. There are more than 300 GUIDE partner organizations this year, which can be found on a map on the Centers for Medicare & Medicaid Services website.

Caregivers are typically family members or friends of patients who step up to help them as they struggle with dementia, said Lallanilla. They are unpaid and often dedicate most of their time to helping their loved one, often at the cost of their own well-being.

“We see that a lot. We see the spouse of someone with Alzheimer’s, you can go into the house, they look like they’re in worse shape than the person with Alzheimer’s because they’re not taking care of themselves,” said Lallanilla.

One of the biggest strengths of the GUIDE model, said Lallanilla, was how it provided relief for these patient caregivers. If they are afraid to leave their loved one alone to go the the grocery store or run an errand, Lallinalla’s company can send a trained nurse to their home and Medicare will pay for it.

GUIDE also provides caregivers with a licensed nurse to call in case of emergencies and training on how to care for their loved ones.

Rhonda Richards, the director of government affairs at the AARP, welcomes the training.

“We just put out a new study last week that showed that family caregivers too often are not getting training on these kind of things. In one case, it’s 11%, in another case, it’s 22%,” said Richards.

With the benefit of being able to keep the patient at home, it will improve the quality of life for many who otherwise would have to transition to nursing home care, Lallanilla said.

He said the program has already been making a difference in the Tampa Bay area.

“From the reports I’ve seen,” Lallinalla said, “The caregivers are doing better.”