Burgdorf Julia G, Freedman Vicki A, Wolff Jennifer L
Center for Home Care Policy & Research, VNS Health, New York, New York, USA.
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Alzheimers Dement. 2025 Mar;21(3):e70013. doi: 10.1002/alz.70013.
Medicare's new Guiding an Improved Dementia Experience (GUIDE) model funds integrated dementia care and related caregiver supports for community-living persons with dementia (PwD). Caregiver strain is a factor in provider payment and performance.
We examined national survey data on community-living PwD and their caregivers to identify which caregivers would receive support under GUIDE and characterize caregiver strain and use of supportive services.
Half of GUIDE-eligible PwD received care from multiple caregivers and high strain was common even among caregivers considered "low-complexity" under GUIDE. Use of role-related training, respite care, and support groups were low (11%, 18%, and 4%, respectively) and did not vary with caregiver strain.
Caregiver identification and assessment standards under GUIDE may overlook a significant number of caregivers. To maximize impact, innovative models like GUIDE should align caregiver engagement and services with the unique realities of care networks for PwD.
Half of GUIDE-eligible persons with dementia have multiple caregivers. 32% of caregivers for community-living PwD report high strain. 11% of caregivers for community-living PwD received training and 18% used respite care.
医疗保险的新型“改善痴呆症体验指南”（GUIDE）模式为社区生活的痴呆症患者（PwD）提供综合痴呆症护理及相关照料者支持资金。照料者压力是提供者支付和绩效的一个因素。
我们研究了关于社区生活的痴呆症患者及其照料者的全国调查数据，以确定哪些照料者将在GUIDE模式下获得支持，并描述照料者压力及支持性服务的使用情况。
符合GUIDE模式资格的痴呆症患者中有一半接受了多位照料者的护理，即使在GUIDE模式下被认为“低复杂程度”的照料者中，高压力情况也很常见。与角色相关的培训、喘息服务和支持小组的使用率较低（分别为11%、18%和4%），且与照料者压力无关。
GUIDE模式下的照料者识别和评估标准可能会忽视大量照料者。为了使影响最大化，像GUIDE这样的创新模式应使照料者参与度和服务与痴呆症患者护理网络的独特现实情况相匹配。
符合GUIDE模式资格的痴呆症患者中有一半有多位照料者。32%的社区生活痴呆症患者的照料者报告有高压力。11%的社区生活痴呆症患者的照料者接受了培训，18%的照料者使用了喘息服务。
