Thoughts on Guiding an Improved Dementia Experience (GUIDE)

It is wonderful that the Centers for Medicare & Medicaid Services (CMS) is finally moving to address the critical role of family caregiving in the restructuring of healthcare delivery with the new GUIDE Model.

Overwhelmingly, persons suffering from chronic serious illnesses will be cared for at home going forward. There simply are not enough institutional beds to meet exploding demand.

According to the largest association in the US representing long term care and post-acute care providers (AHCA/NCAL), there are roughly 1.2 million nursing home beds today. Over 70 million boomers will ‘age out’ over the next couple of decades. The CDC reported just 1.6 million beds in licensed US nursing homes as of 2020.

As of 2023, an estimated 6.7 million Americans aged 65 and older have Alzheimer’s disease or related dementias. A mere 18% of assisted living communities have a dementia care unit, wing, or floor (Alzheimer’s Association).

A National Institute on Aging funded research study found that facilities that specialize in dementia care may provide better outcomes (Health Affairs, 2023).

This math simply does not work. We must also take into account the shortage of healthcare workers and the fact that COVID-19 caused many familles to become skittish about nursing home care.

While I applaud the GUIDE pilot, the number of those diagnosed with Alzheimer’s disease and related dementias is expected to skyrocket in coming years. The fact is that most Alzheimer’s sufferers will be cared for at home and family caregivers will in fact be the coordinators of care for them.

We should welcome all new innovative approaches to this aging crisis. The GUIDE Model is a commendable start and perhaps there will be more novel approaches, new technology, or a cure for Alzheimers that has not yet emerged.

I remain hopeful.



More Information on the GUIDE Model: