Medicare’s GUIDE Program: How it Helps Senior Living (Part Two)

By Jim Nelson | October 28, 2024

In part two of my conversation with nutritional neuroscientist and Cognitive Care Management President/CEO Brian Browne, we get into the nuts and bolts of Medicare’s new program called GUIDE (available to anybody on Medicare Part B), which Browne calls a “boon” to the senior living profession.


SENIOR LIVING NEWS: What is the GUIDE program and what do memory care operators need to know about it?

BRIAN BROWNE: Dementia is the most expensive condition for those who participate in Medicare. They’ve tried many times to get their arms around it, but they now realize that they have to have a much more coordinated approach to managing dementia. The GUIDE program is that approach. It is an approach that allows people to be case managed at the earliest signs of cognitive decline. So, Medicare recipients are encouraged by their family physicians to get the annual Medicare wellness exam, which is included in their cognitive screening. Now, those family physicians, primary care physicians, should automatically provide a cognitive screening all the time. It really doesn’t happen most of the time, unfortunately. So, aging people and their families need to know that they need to request this. When we start to see people entering cognitive decline, usually a loved one, an adult child, or a spouse starts to notice these changes. The GUIDE program then triggers a full-on evaluation to see if it is what we call age-related normal cognitive decline or something more. If the evaluation uncovers early dementia, it triggers the GUIDE program to go on steroids. We assign them a navigator who is now responsible for walking them through a system that will allow resources to be distributed to that particular recipient and to their family member/caregiver. There’s education, services, and support that are triggered. There’s a path of medical care that’s triggered and designed to have better outcomes with an early Alzheimer’s diagnosis. So, the GUIDE program, from the inception of someone coming in and identifying themselves with cognitive decline, case manages them through the rest of the diagnosis. We’ve seen in the literature, when someone is case managed through the process the outcomes are better, the quality of life is better for both the person living with Alzheimer’s and their caregivers, their family members, all of those people. Now, we want to keep people functional and able to have a great quality of life without triggering into a memory care placement. And that’s important, because the longer we keep them on the other side, the less expensive it is for everybody, but the quality of life increases also. And when we use the economies of scale to the GUIDE program to manage these people, it’s a win-win for everybody. Medicare has crafted out these dollars so that it can happen, as opposed to when they used to get involved when something catastrophic happened. Someone would have a fall, someone would have an untoward event which would lead to a blow-up, basically. It would blow up the family, it would blow up everywhere, and we started to see the really expensive latent care, which would precipitate with a placement to memory care and all the things that start to get expensive. This way you short circuit that.

The second part of your question to senior living operators, how does this affect their business? This is a boon to their business, to be perfectly honest. This now allows people who are living in senior living communities and independent living and assisted living who have the earliest signs of cognitive decline to be case managed in perpetuity, which will allow them to stay and be as well as you can be while occupying the most financially advantageous aspects of senior living for those operators. It will keep them in independent living and in assisted living, not transfer them to memory care. So, this works in favor of every single senior living operator to say, “My people can be case managed? They can age in place in our community, and we can derive revenue from that, at no cost to us?” That’s where they should all be saying, “Sign me up for someone to manage my population so that we can keep them aging in place, healthy for as long as they can, in my senior living community.” It’s an absolute win for senior living communities, specifically those who are early adapters of this, to have people manage their populations.

SLN: So, if I am the executive director of a community, and I have a resident who my staff has said, “I think we need to have this person evaluated,” and the resident agrees, and their family agrees, the community itself pays nothing? The resident and the resident’s family pay nothing. Medicare Part B pays for the whole thing?

BB: Correct, yes.

SLN: That’s huge.

BB: It is huge. The second part is we have to normalize cognitive screening like we normalize cholesterol screening, blood pressure screening, and glucose testing. We need to normalize this because the earlier that we can see changes to thinking and cognition, the more tools we have in our toolkit to be able to reduce your risk or to stem the tide.

SLN: How do you fit into the equation?

BB: Medicare had an RFP (request for proposal) for providers to apply to get accepted into this program, so there’s only a circumscribed amount of GUIDE practitioners out there. My group is a virtual model of the GUIDE program. We were accepted into the GUIDE program so we can be everywhere and nowhere and administer this in any state in the U.S.; we’re one of the few that can do that. Others are brick-and-mortars that are attached to a geographic region.

SLN: What’s involved in a cognitive screening?

BB: We do what we call a history physical, we do a self-report evaluation, we take blood, we get all your biometrics, we test your cognition, we test other aspects as well that are connected with your cognition, and we get other points of data. We put it all in the mix and we are able to gauge how you’re aging. We can drill down from there and then we start to look at how we can intervene to create the best version of you that we can.