Medicare’s GUIDE Program: How it Helps Senior Living (Part One)
By Jim Nelson | October 23, 2024
At the recent executive event in San Diego that we put on with our sister company, HEALTHTAC, a panel was held on the topic of dementia. During that panel, Cognitive Care Management President/CEO Brian Browne discussed a new Medicare program called GUIDE (available to anybody on Medicare Part B), which he calls a “boon” to the senior living profession.
With Alzheimer’s disease being the sixth leading cause of death in the United States, and dementia in all its forms being the No. 1 feared disease for people over 60, this continues to be a huge topic for senior living.
With all that in mind, I had a long conversation with Browne, during which we dove much deeper into some of the things he shared with the operators at our event.
This is part one of our two-part conversation.
SENIOR LIVING NEWS: Tell me about Cognitive Care, Management and what you do there.
BRIAN BROWNE: I’m a nutritional neuroscientist. I worked for one of the largest neurodegenerative research institutions, in a basic medicine, a clinical medicine, and a preventative medicine aspect for over 15 years and headed up a department. I realized that I had the tools to build a better mousetrap due to the fact that there were so many underserved people in that continuum. This led me to start Cognitive Care Management as a way to look at nonpharmacological approaches to risk reduction for Alzheimer’s, related dementias, cognitive decline, chronic disease, and abnormal aging. That’s a mouthful, but as people age the No. 1 concern or pain point is their cognition. Alzheimer’s disease is the No. 1 most feared disease for people over the age of 60. The way that we even get into a discussion about your cognitive health is typically some type of adverse event has happened, or an adult child comes home for Christmas and realizes that mom and dad aren’t the same as they were. But we’re addressing it in a reactive sense; something has started this discussion, some untoward event or a dramatic reduction in the quality of life and state of health from one point to another has caused this. So, part of what I wanted to do in this space was to be able to work proactively, to educate people and have them come in and look at their current risk stratification for chronic disease, cognitive decline, Alzheimer’s, dementia, create a plan for them and case manage them longitudinally to reduce their risk for these things. My day-to-day consists of seeing patients and families, creating some baseline measurements, objective measures when we first start off, and then subsequently managing them to make sure that we’re controlling all of their stratified risks. The data and the literature is robust, and The Lancet just came out with an article summarizing that we can reduce Alzheimer’s and related dementias, in essence, by over 50 percent by basically what I’ve been doing in my clinic for a while now: managing these risk factors. The literature supports the ability to do this, but very few people are in this space. Most people are in the reactive space because our healthcare system is based on a reactive healthcare model. So, when we’re looking at this particular pain point, there are very few places to turn to. That’s my day job, managing those things, I also do a lot of speaking around the country which gives a voice to what we’re looking at in the aging process.
SLN: Taking a non-pharmacological approach is such a huge factor.
BB: Everything that we put in our body has to be accounted for — we have to understand everything affects our bodies and brains — and there is a myriad of side effects for every single pharmacological thing that we put into our body that oftentimes confound the thing that we’re actually trying to help and cure. One of the things then, in my evaluation I do with my patients/clients, is look for what we call pseudodementias — things that mask themselves like dementia but are not true dementias. Those things are reversible. One of the leading reversible pseudodementias is drug interactions and drug reactions. When you take a myriad of pharmacological agents, they don’t play well together a lot of the times. We oftentimes see symptoms of cognitive decline as a byproduct of a number of unreconciled pharmacological agents that people are taking for a myriad of things that all of their physicians are not aware of. We end up with this cognitive decline that people think is a dementia process, but actually isn’t.
SLN: What age would you like to start seeing people in your practice and, by and large, what age do you actually start seeing people?
BB: Great question. We start to see the abnormal pathology of Alzheimer’s-like changes in the brain start at 40, but this disease is such that until you become symptomatic you don’t know specifically that these brain changes are happening. So, what’s happened is that reactive point, like I mentioned before, where we start to see the symptoms but by that time there’s been a lot of pathology, neurodegeneration that has made you symptomatic. The gold standard would be to start your risk-reduction strategy at age 40 — that’s where I would love to start to tinker with people and to keep them in the lowest stratified risk. Now, when do people typically come in? I really start to people, en masse average, probably in their early 60s or just right at retirement. I would love to see people at 40, but right before or right at retirement is when they typically come in because they realize they don’t want dementia to be part of their retirement expectations.
SLN: If a 65-year-old comes to you, it seems like the best you could do at that point is tell them about all the things they’ve been doing for the last 25 years that they shouldn’t have been doing. Is that true, or can you still help them?
BB: That’s untrue, because of epigenetics, in terms of our ability to affect our epigenome by the things that we do and don’t do. There is still a plasticity available so we can start to affect changes for your future. The minute that you start something positive is the minute that you start to extend on the back end. So, inactivity is your worst friend. Eighty-year-olds come to me and we create a plan for them to be robust for the years that they have left and continue to reduce their risk for chronic disease and abnormal aging and dementia. We can have you living a better quality of life the sooner that we start — the earlier the better — but there’s not a wrong age.
SLN: At our recent event in San Diego, you said to a room full of operators that “we have this vast disconnect of [residents] entrusting thousands of dollars a month to live with you, but you’re not addressing their needs of quality of life. There needs to be a marrying of what they’re looking for — turning their lives over to you to be managed — and the fact that we’re doing our best to improve quality of life.” To dive a little deeper into that, what would that marrying of look like?
BB: As people turn their lives over for residential living to senior living communities, people are doing it under the auspices that the senior living community is creating an atmosphere where they will have a robust quality of life and continuum of care with the latest and greatest innovations that will allow them to prosper physically, mentally, emotionally, etc. What has typically happened is senior living communities have invested in the built environment — opulent carpet, beautiful entryways, really gorgeous amenities, even made-to-order meals. They’ve invested in that aspect, which is eye candy, and we all see these wonderful facilities, right? Because they’re charging in excess of over $10,000 a month for people to live in these places it has to match that. And the disconnect is people who are entrusting these communities to care for them are assuming on the other end, it’s not just the opulent setting that is part of the infrastructure, they [assume that staff] are actually trained in dementia care and they are actually having an infrastructure of activities and lifestyle that are built in disease-reducing sentiments. There is an expectation, the same way that when I, let’s say, go to an amusement park that, “When I get on a ride you guys have tested everything. It’s going to be the safest experience, and I can just let go and have a good time, that I don’t have to worry if you have great security here, that I don’t have to worry about my kids running around here and being afraid of whatever, that you’ve taken care of that stuff, because I’ve paid this huge entry fee to come in here to be entertained.” There’s that expectation. And this is where that disconnect happens: It’s assumed, but is it actually happening? And what are the metrics to say that is actually happening? That disconnect can be overcome when these senior living communities adopt such metrics and adopt a way and a platform for everybody to win in that aspect.
[Look for part two of my conversation with Brian Browne soon]
