Amedisys is proud to partner with the Centers for Medicare and Medicaid Services (CMS) in delivering its Guiding an Improved Dementia Experience (GUIDE) Model to patients diagnosed with dementia and their caregivers in the middle Tennessee and greater Nashville area.
What Are the Goals of the GUIDE Model?
CMS has three goals to improve how healthcare providers treat dementia:
- Improve dementia patients' quality of life by coordinating care with other co-occurring conditions.
- Relieve unpaid caregivers by offering skills training and referrals to community-based social services and respite care services.
- Reduce the need for long-term nursing home care by empowering patients and caregivers to stay where they most want to be for as long as possible - at home.
What You Can Expect
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Comprehensive In-Home Assessment
One of our care navigators will make an in-home visit to perform a full assessment, including a medication review, safety evaluation and development of a care plan.
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Care Navigation Team
These dementia care experts will provide regular visits, 24/7support, monitor patient care and refer patients to essential services. We’ll also coordinate with primary care doctors and specialists as needed.
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Caregiver Support and Education
We will provide family caregivers with dementia specific education, skill-building and one-on-one support.
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Respite Care Services
We provide caregivers temporary relief through a predetermined amount of in-home respite care at no cost to patients or their families.
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24/7 Support Line
You will have around-the-clock access to our care navigation team by calling our dedicated phone number for any assistance and guidance.
Who is Eligible for the GUIDE Model?
Medicare fee-for-service beneficiaries, including those dually eligible for Medicare and Medicaid, who have dementia are eligible for the program if they meet the following criteria:
- They have a clinically attested diagnosis of dementia
- They are enrolled in Medicare Parts A and B as their primary payer, but not in Medicare Advantage, including Special Needs Plans and PACE.
- They are not currently enrolled in the Medicare hospice benefit.
- They are not residing in a long-term nursing facility.
These services come at no additional cost to eligible beneficiaries, and it is covered 100% by Medicare. However, there could be referrals to external services that may be billed to Medicare and require an out-of-pocket payment.
Frequently Asked Questions
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Does this program replace my PCP/specialists?
No. This program is designed to complement, not replace, your existing care. We offer care management and caregiver support, and we’ll coordinate with your doctors as needed.
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How does this program help people with dementia?
It helps manage common challenges through caregiver education, regular check-ins, care planning, coordination with doctors and referrals. The program aims to improve health outcomes and quality of life, allowing individuals to stay in their homes longer.
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How does the program help caregivers?
Caregivers receive meaningful support, including access to a Care Navigator, educational resources, and respite services to help ease the challenges of caring for a loved one.
To connect with an Amedisys team member about this program, please call 615-622-7901, email GUIDE@Amedisys.com or fill out the form below.
