STATEN ISLAND, N.Y. — Staten Islanders diagnosed with or caring for a loved one with dementia have the opportunity to receive assistance through an eight-year pilot Medicare initiative designed to provide clinical, care coordination, crisis support, counseling and respite services.
Advanced Memory Group in Rossville is participating in the nationwide initiative, called Guiding an Improved Dementia Experience, or GUIDE, which offers families managing a dementia diagnosis care coordination, and caregiver support services.
The GUIDE model is designed to enhance the quality of life for individuals living with dementia and to reduce caregiver burden. Families will receive a care navigator, knowledgeable about all resources available, including clinical and support services.
The Medicare Services-led program aims to aid overwhelmed caregivers and help individuals remain in their home and community with dignity and independence.
Patient navigators are assigned to families. They coordinate medical, social, and community-based services. They also develop care plans and provide 24-hour crisis support, the likes of which Medicare recipients have not seen prior to the program’s inception in 2024, said Dr. Adam Smith, of Richmond Behavioral Associates, Graniteville, a clinical team providing diagnosis and ongoing psychiatric care through the program.
They also develop and implement personalized care plans and train caregivers, he said.
“This GUIDE program is meant to provide extra support for the families, gathering resources and case management for them so that their loved ones will be able to stay in the communities longer,’’ said Smith. ”For these families, there really (weren’t) dedicated providers and case workers to help manage the trajectory of this illness. When they get super frustrated, because they don’t have the resources, they have to opt for nursing homes.”
The program addresses all causes of dementia, including dementia related to stroke or Parkinson’s Disease. “It isn’t just for Alzheimer’s patients,’’ he said.
Ann Marie Selfridge, administrative director of Advanced Memory Group and founder of a local community adult dementia program, said the response in the first year to having patient navigators has been one of overwhelming relief.
“They’re calling them on the daily, getting resources,’’ Selfridge said. ”That patient navigator is in intermediary and relieves so much of the stress on the caregiver.”
What’s new is that Medicare doesn’t typically cover case management, not typically Alzheimer’s care and definitely not respite, she said, adding: “Medicare is testing out how can we give this benefit so (patients) can get some improved health in their homes and keep their families out of hospital facilities.”
The GUIDE model
At a glance, the GUIDE program provides:
In-home support services, including respite care and personal assistance.Adult day program access, providing structured therapeutic, social, and recreational programming. Care coordination and counseling to address medical, emotional, and social needs.Caregiver support services, designed to ease caregiver strain and improve well-being.24/7 access to assistance for crisis support.Additional respite services, promoting independence and providing essential relief for caregivers.
Advanced Memory Group is collaborating with Smith and Dr. Mark DiBuono, of Richmond Behavioral Associates, Graniteville, to provide the memory care.
Participating families may receive a $2,563 Medicare-funded respite benefit to support the cost of approved respite services provided.
This benefit is exclusively applied toward authorized Medicare-covered respite services and renews on an annual basis.
The pilot program has room for new families, Smith said. Those interested should call 347-621-6174 or email advancedmemorygroup@protonme.