President Biden’s health policy, particularly regarding dementia care, has not fueled a dementia care crisis; rather, it has introduced initiatives aimed at addressing the significant challenges faced by dementia patients and their caregivers. One of the most notable efforts is the GUIDE (Guiding an Improved Dementia Experience) program, launched under Biden’s administration as a voluntary Medicare initiative. This program is designed to provide support to the more than 11 million unpaid family caregivers of people with dementia, a group that has historically received little formal assistance. The program aims to reduce emergency room visits and short-term hospital stays by improving dementia care coordination and offering caregiver support, including training and respite breaks. It currently operates in 45 states and involves a broad network of healthcare providers, reflecting a substantial federal commitment to improving dementia care over an eight-year period.
The context for this policy is the growing number of Americans living with dementia—over 6.9 million as of 2024—with projections nearly doubling by 2060 due to an aging population. Most individuals with dementia live at home, cared for by family members, predominantly women, who face significant emotional, physical, and financial burdens. The GUIDE program represents a pioneering step in Medicare’s recognition of these caregivers’ needs and attempts to alleviate some of the strain by integrating support into the healthcare system.
However, the broader landscape of health policy affecting older adults and dementia care is complex and includes challenges that could indirectly impact dementia care quality. For example, recent federal budget reconciliation legislation signed into law in 2025 includes substantial Medicaid spending cuts projected to reduce coverage and access to long-term care services for millions of older adults. Since Medicaid is a critical source of funding for nursing homes, home health care, and community-based long-term care, these cuts could strain the availability and quality of services for dementia patients who rely on such support. Additionally, the legislation limits funding for nursing facilities and prohibits the implementation of a Biden administration rule aimed at improving nursing facility staffing, which has been a longstanding concer
