Andwell's GUIDE program tailors dementia support for Maine families
Andwell Health Partners is among nearly 400 organizations selected nationwide to participate in the new Medicare GUIDE Model. The program will support people living with dementia and their caregivers through coordinated clinical and community-based services. Submitted photo
FARMINGTON — Andwell Health Partners is preparing to support more than 450 people living with dementia and their caregivers during the first year of participation in the new Medicare GUIDE [Guiding an Improved Dementia Experience] model, according to Michelle Stebbins, RN, BSN, MS, the program’s manager.
Rather than integrating existing care management programs into the new dementia care model, Andwell built upon them. “Andwell Health Partners’ existing care management programs are not necessarily integrated into the GUIDE model, rather they influenced the design of the GUIDE model,” said Stebbins. “Tapping into the expertise of seasoned clinicians, workflows, and policies from Andwell’s existing care management programs reduced the need to ‘start from scratch,’ allowing the interdisciplinary team responsible for launching the GUIDE model to take the extra time needed to determine how best to customize the program.”
If patients need additional services, Stebbins said, “GUIDE staff will coordinate with the patient’s primary or specialty care provider for clinical referrals.”
For caregivers, respite services will be provided in the home through Andwell’s CareGivers service line. “Respite will be provided in four-hour blocks, services will include support with activities of daily living, light housekeeping, meal preparation, and companionship,” Stebbins said. “Andwell’s GUIDE staff will be working with caregivers to understand that respite isn’t just for those ‘must do’ tasks, but for self-care.”
She emphasized the long-term nature of dementia and the critical role caregivers play in helping patients remain at home: “The health and well-being of caregivers plays a critical role in the person with dementia’s ability to remain in their home for as long as they desire or are able.”
To build broader support networks, Andwell is “partnering with Alzheimer’s Association, Maine Chapter for support with 24/7 access to education and support, caregiver education and support groups,” Stebbins said. “An integral part of the GUIDE program is resource coordination; so GUIDE staff are actively leveraging the connections and resources of colleagues to build a resource repository that will leverage our communities’ existing resources. Examples include food banks, transportation, financial aid, home modifications and more.”
Outreach efforts include mass mailings to community-based organizations, including “primary and specialty care practices, police/EMS departments, assisted and independent living facilities, insurance brokers, adult day programs, housing authorities, social service and senior advocacy organizations,” she said.
Training opportunities for caregivers will be personalized. “Training will be personalized to the needs of the caregiver, their situation, and learning preference,” said Stebbins, listing topics such as advance care planning, communication, environmental safety, self-care, anticipatory grief, and disease progression. “Andwell anticipates offering monthly education with varying subject matter experts from the community.”
In addition, group-based education will be available through the Alzheimer’s Association. “Courses are offered on demand, in person, or live virtually,” Stebbins said. A full listing is available at alz.org/maine/education-programs.
For more information about the GUIDE program, visit andwell.org or call 207-777-7740.
