For 2026, CMS judges GUIDE dementia programs on five measures covering medications, quality of life, caregiver impact, cost, and nursing-home stays. Families using Original Medicare can use those five measures as a 2026 action checklist for joining a program and tracking support.
The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary national dementia-care program that pays participating programs a monthly fee. CMS says in its blog post on clearing the path for dementia care that the model launched July 1, 2024 and runs through June 30, 2032. The 2026 performance year runs July 1, 2026 through June 30, 2027.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the official guidance from CMS — Use this primary source to verify the official guidance.
- Read the official guidance from CMS — Use this primary source to verify the official guidance.
Table of Contents
- Does GUIDE cover your family?
- What services should you expect?
- What are the five 2026 quality measures?
- How do 2026 scores affect payment and respite?
- Your 2026 action checklist
Does GUIDE cover your family?
GUIDE serves community-dwelling Medicare fee-for-service patients with clinician-confirmed dementia. They must have Parts A and B with Medicare as primary payer.
This affects families using Original Medicare. The National Association of ACOs explains in its overview of GUIDE eligibility that Medicare Advantage including Special Needs Plans, PACE enrollees, hospice electors, and long-term nursing-home residents are excluded. Those families cannot join even with dementia.
- Use Original Medicare with Parts A and B and Medicare as primary payer
- Have clinician-confirmed dementia and live in the community
- Do not have Medicare Advantage, PACE, hospice election, or long-term nursing-home residence
What services should you expect?
CMS lists in its GUIDE Model page five required supports: a care navigator, comprehensive assessment with home visit and written care plan, care coordination, 24/7 clinician access, and caregiver education plus respite. The navigator is your point person. The assessment builds the plan for home needs.
Ask for the written care plan, the 24/7 phone number, and the caregiver training schedule at enrollment. If your loved one has moderate-to-severe dementia, ask about respite eligibility. Keep those contacts on the refrigerator and in your phone.
What are the five 2026 quality measures?
CMS states in its 2026 GUIDE performance manual that it judges participants on five measures in four domains. They are high-risk medications in older adults, patient quality of life, caregiver impact, total per-capita cost, and long-term nursing-home stays. Each measure reflects safety, daily life, or avoidable facility use.
For 2026, quality of life is called Quality of Life for Patients Living with Dementia and uses PROMIS-10. Caregiver burden is called Caregiver-Reported Impact in Dementia and uses the 22-item Zarit interview. Expect the program to ask about symptoms, daily function, mood, and caregiver strain. Those answers directly feed its 2026 score.
How do 2026 scores affect payment and respite?
The July 2026 to June 2027 year is the first year all five measures adjust the monthly payment. CMS details in its payment methodology paper an adjustment from minus 3.5 percent to plus 10 percent. A higher score means a higher program payment.
Eligible families with moderate-to-severe dementia can receive up to $2,625 in provider-paid respite at $0 cost-sharing. Respite gives the caregiver short-term relief while the program pays the provider. Ask whether your stage qualifies and how to schedule hours.
Your 2026 action checklist
Confirm eligibility, then choose a GUIDE program and request its navigator, assessment date, and home visit. Ask how it reviews high-risk medications, tracks quality of life, and supports caregivers.
Request the written care plan and 24/7 access number in writing. Bring your medication list and primary caregiver to that first assessment visit.
- Confirm Original Medicare, Parts A and B, community residence, and dementia diagnosis
- Ask about medication review, PROMIS-10 and Zarit surveys, cost help, and nursing-home prevention
- Schedule caregiver training, confirm respite amount, and book relief dates early
- Save the navigator name, care plan, and 24/7 number where all caregivers can find them
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