Home Care Marketing & Sales Solutions by ASN
Dawn Fiala, Lisa Marsolais, Annette Ziegler, and Valerie VanBooven RN BSN provide insight into home care marketing strategies. They cover in-person, in-field sales and online marketing every other week. These podcast episodes are part of the Home Care Marketing Mastermind, sponsored by Approved Senior Network®. Find more information at https://ASNHomeCareMarketing.com
Home Care Marketing & Sales Solutions by ASN
Medicare’s GUIDE Model: A New Opportunity for Home Care Agencies Supporting Dementia Families
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Medicare is quietly rolling out something dementia families have begged for: ongoing support that doesn’t end when the appointment does. We sit down with Nancy Gillette, Chief Growth Officer at PocketRN, to explain the CMS GUIDE Model (Guiding an Improved Dementia Experience) in plain English, including what it pays for, how it’s delivered virtually by experienced RNs, and why it’s a true shift in dementia care, caregiver support, and aging in place.
We dig into eligibility and exclusions with the details that trip people up in real life: traditional Medicare Part A and B plus a dementia diagnosis is the baseline, all dementias qualify, and many people can still participate while receiving Medicaid services, veteran benefits, palliative care, or living in assisted living or memory care. We also cover the common deal-breakers like Medicare Advantage, hospice, PACE, and long-term nursing home residency, plus what paperwork typically works to prove the diagnosis.
Then we get into what GUIDE actually delivers across nine care domains, from comprehensive assessment and care planning to caregiver training, medication reconciliation, referral coordination, and ongoing monitoring designed to catch changes before they turn into an ER visit. Finally, we clarify the respite benefit everyone asks about: 72 hours per year for moderate to severe complexity, used in four-hour increments, on a July 1 to June 30 “use it or lose it” cycle, and how home care partners can get paid for required in-person safety visits and respite coverage.
If you support dementia clients or family caregivers, listen through to the Q&A and the real case stories about doors opening with discharge planners and senior living communities. Subscribe, share this with a colleague, and leave a review so more families can actually find these Medicare dementia care resources.
Visit our website at https://asnhomecaremarketing.com
Get Your 11 Free Home Care Marketing Guides: https://bit.ly/homecarerev
Welcome And Housekeeping
SPEAKER_02So welcome everybody to our GoCare Pro Mastermind. We are very excited for today's presentation. We're ever most of you know us, so we're just gonna skip through our intros because we want to get Nancy started here. So a little bit of housekeeping, keep your lines muted unless speaking, share stories, experience tips, ask questions. There is going to be a chat box. We're gonna have a question and answer period after, but if you do have questions, please put them in the chat and we will make sure that Nancy sees them. Tell us what you want to know. Again, as we always have, is we have one attendee that's attending this class, we'll receive a set of customized leave behinds for June, the fun leave behinds that we do. If you are interested in winning them, put yes in the chat box. We will let you know if you win. So put yes. Just if you do win, you got to make sure you send us pictures of yourself using them out in the field. So put yes in the chat. Okay. All right. Today's agenda, we are so excited. We have Nancy Gillette from Pocket R. Um, she's gonna tell you what Pocket R on is, and she is gonna speak on the Medicare Guide program. So excited. I've heard so much about it from many of you, and I'm really excited to learn more about it. She's gonna talk about the criteria, the expectations, the onboarding process, and then we're gonna have a QA. So very excited to have you. So welcome to guest Nancy Gillette. She's the chief growth officer at Pocket RN. She's been a healthcare executive with 20 plus years experience, so she knows what she's talking about. Proven leader in scaling organizations, innovation, operational excellence. She joined Pocket RN during a pivotal time in healthcare transformation. She focuses on aging in place solutions amid nursing workforce shortages, building a national network supporting the CMS Guide Initiative, advancing dementia care for patients and caregivers nationwide, driven by commitments to transform health care delivery. So welcome, Nancy. We are so excited to have you. Thanks, everybody. To learn. So here we go. Pocket RN Ritual Nursing Service.
SPEAKER_00Thank you so much for having me today. And thank you all for taking time out of your very busy schedule. I completely understand
Why PocketRN Exists
SPEAKER_00how busy it is out there. So I'd love to start a little bit. As they mentioned, I am Nancy Gillette. I'm the growth officer at Pocket RN. I've met some of you in person, but many of you, we might be LinkedIn friends, or maybe this is our first time getting to know each other. So the one thing I want you to know about my background, thank you for the kind introduction, Anne, is that I actually, as you can see, come from the provider space. So I have spent the better part of my career working in Medicare certified home health and always having private pay caregiving and private pay nursing. And I started off my career very, I would say, as a family caregiver when I was in high school. My grandmother had to move out of her home and live with us. And it was all hands on deck. We didn't have any money, so we couldn't afford any care. And so it was everyone doing their part to support grandma and her aging journey. And so I feel like I've been in this space as long as I can remember. And I so appreciate all the hard work that you all do. And I'm so excited about the guide model, which stands for guiding an improved dementia experience. So I was very lucky in my career to leave the provider side after close to three decades and find Pocket RN. And who is Pocket RN? Pocket RN is a company that was formed out of the biodesign program at Stanford University with the goal of closing the gap between home and health care. They found me, again, because I had the lens of medical and non-medical nursing, particularly in the home. And so I've been a senior advisor for Pocket RN since the very early days and joined full-time close to four years ago now. And really, coming from our experiences as family caregivers, a great many of us are in the sandwich generation. I have an aging father-in-law who has very level six dementia. And I have a 17-year-old athletic daughter who is on a national travel team. And so between building this company, being a mom, being a daughter-in-law, dealing with caregiving at all facets, we've all really relied on the nurses in our pocket to support us. And I always tell people the second I have a hangnail, I'm calling my best friend who is a nurse. And if I have a rash, I'm calling my friend who's a nurse. Anytime anything goes wrong, she's take a Benadryl and chill out. But the first call is always to the nurses that are in the pocket. And so we as a team and the founders of Pocket RN really saw how important the nurses in their ecosystem were. And we wanted to democratize the access to a nurse in your pocket because not everybody has a best friend that's a nurse, right? But if you do have them, I'm sure you're all shaking your heads that you call them whenever something goes wrong with you or your family or your kids. And so that's really the history behind us at Pocket RN, really drawing from all of our own personal but professional experiences. And as we had already been really trying to build this company and fill the gaps in healthcare, because as a team, we always say healthcare is the millions of little moments in between scheduled appointments and visits. It's the stuff that happens in the middle of the night and on the weekends when everyone else isn't really available. This guide model of care fell into our lap and we all looked at each other and said, boy, this looks a whole lot like what we've already been building. And now Medicare is going to pay for some of these services. So that was a very exciting opportunity and time for us. And we were very happy to be one of the chosen providers for the guide model. Annette, can you maybe go to the next slide? This is just a quick overview of the people that are on the leadership team with me. And the biggest call out I always like to make for my home care partners that are on this call is really around two people that are on this team with me that are they're all very important. But the first is our co-founder, Dr. Sam Thomas. So before he became an internal medicine physician, he was a caregiver, a CNA who took care of a man that had musculospinal atrophy. So I don't know about you, I've met hundreds of thousands of doctors in my life, and most of them don't even know the difference between home health and home care. Sam has lived it and then decided to go on to medical school. So that's pretty cool. And so he creates a lot of our protocols. And then our CEO, Jenna, she's a family caregiver for her mom. And Jenna lives very close to the hill in DC. So we're on Capitol Hill quite a bit. We were advocating for the home care industry two weeks ago with HCAOA. We were all there. But her mom lives in the Boston area, close to me. And so she's a across state lines caregiver, like a great many of us. And so definitely dealing with all of the challenges. So we all really, in some capacity, this is a personal mission. It's not just a it's not just a billing code for us. It's really a personal mission to not only move home care into the center of the ecosystem of healthcare, but to really support families and to fill all of those gaps that we all have unfortunately experienced in our own personal lives. Next slide, please. What we built was a national network of nurses. So the most important thing you need to know here is that we have nurses in all 50 states. They are US-based humans that are working virtually. But the coolest thing about our nursing workforce is that on average, these nurses have 10 years plus of experience. So these are highly vetted, highly experienced nurses. They all have the dementia training that they need to work in the space with guide. These are nurses that would probably be really hard for individual franchisees to hire just because of the cost to hire nurses and the experience level that these people have. But we really have been able to create a very highly desirable workforce by allowing nurses to work how and where and doing what they want to do instead of being told what to do. And so we've never had to spend a dime recruiting. And like I said, we have uh lots of hundred thousands of nurses that work for us at Pocket R and. So that's pretty cool. Many of them are W-2s that are FTEs, but we also again create flexible work environments. So some people work nights and weekends, some people have two days a week that they don't work at the hospital and they pick up those hours with us. So really trying to meet nurses where they're at. Next slide, please. So, what is this guide model of care? Again, guide stands for Guiding an Improved Dementia Experience. It is a no-cost, comprehensive program
GUIDE Model Overview And Tracks
SPEAKER_00for dementia patients, their families, and their caregivers. And the whole goal of the program is to keep clients safer and longer in their homes. We at PocketRN deliver this model of care virtually with our expert registered nurses. And as I mentioned, we are in all 50 states. And again, there is no co-pays, there is no deductibles, there is no out-of-pocket expenses to the patients and families, there is no cost for you as a provider to work with us. It is a hundred percent free. I love free money. I don't know about you, but I always tell people if you don't want free money, you can always give it to me because I love free money. So this program is really exciting. Next slide, please. For us at Pocket RN, it's a seven-year demonstration project. There were two tracks to this program. So you may have heard about the established track and the new track. The established track was for providers that had been in business for more than five years, that had been servicing more than 500 dementia care clients. A lot of your hospitals and medical centers fell into that bucket and they went live July 1 of 2024. The rest of us fell into the second track, which was for providers that didn't have 500 dementia patients or hadn't been in business for five years. We have passed the five-year hurdle now, but at the time when we applied, we had not. So we fell into the newer track. So we just went live with Medicare July 1 of 2025. So we're not even one full year into this program. Lots of cool things to share with you about what we've seen, a lot of really promising results coming out of this program. And again, there is about 327 of us who are guide provider participants that can actually build this code. You're either in or you're out. They're never adding anybody else. So that's a question that I get all the time. The RFP came out, people applied, they were awarded this designation, and that's it. So there I hear people all the time say, Oh, I'm gonna apply to be a provider for guide. They can't. They can be a partner organization of people like Pocket RN, and I think you just mentioned a hospital system in St. Louis, who's a guide provider, but there are no more providers being added to that roster. And I always recommend if you want to find out who the providers are, you can Google CMMI guide, and you'll it'll bring you right to the CMS Innovation Center, and you can actually see the list of who's providing this level of care across the country or in their geographies. So it's really exciting because it Medicare is recognizing, really for the first time ever, that there is a need for more care for dementia patients and families, that they need more support, that there's a better way to, over a longer period of time, in a longitudinal way, really be able to support these individuals. And we see it as a humongous opportunity. If you've ever heard me speak before, I use the term seismic shift in home care because it is really the first time that Medicare is even acknowledging that home care and healthcare could be really said in the same sentence. And we're definitely seeing these outcomes proving that home care is a major solution that needs to be considered as and really home care is moving not just from the outside of the healthcare ecosystem, but into the center of the healthcare and ecosystem, because what you all do every day is supporting individuals in all of the hours and minutes in between visits and appointments. And really, there's a lot of time there that there's no one else there besides the home care agency. We're really excited about the better outcomes that we're seeing and the ways that we can support these families. Next slide, please. So people always ask, well, how do you, how are you eligible? Unlike other programs, this is super easy. So it is traditional red, white, and blue Medicare. If you've seen the red, white, and blue Medicare
Who Qualifies And Who Doesn’t
SPEAKER_00card, everyone who's 65 and older is eligible for traditional Medicare. And so if they have not waived their traditional Medicare benefits and they have Medicare A and B and a dementia diagnosis, that's all we need. All dementias qualify. So if you have Lewy bodyvascular, if you have Alzheimer's dementia, all of the above, it all is fine. We don't even need to know what kind of dementia you have technically. We just need to have a dementia diagnosis, which can come from a discharge summary, it can come from a physician visit, it can come from primary care. Sometimes the families have this paperwork at home because they've been given it from someone, but that's really all we need. And to know that they have Medicare A and B. They can be duly eligible. And what I mean by that is that you might have some of you might be Medicaid provider agencies and you're billing Medicaid for some of your services. A lot of times, people that have Medicaid, which is a state, fed a state program, they also have Medicare, which is a federal program. So we call those duly eligibles. And so it doesn't, in many cases, it does not exclude you from getting your Medicaid services under home care. You can also be a veteran. A lot of veterans also have traditional Medicare A and B. And so they can be getting veteran services through your home care agency and also qualify for a guide. You can live in an independent living, an assisted living, a memory care community, or your private home and still qualify for this program. And you can also be getting palliative care benefits. So those people are all eligible for this program. What you can't be, though, is on a Medicare advantage. And unfortunately, some of these companies have done a really good job marketing to people and they think they have traditional Medicare and they don't. When we check the eligibility, we unfortunately find out they have an advantage plan. And we tend to be the bearer of bad news because they didn't know. So that with that is one thing that we have definitely seen happen quite a bit. They cannot be on hospice. So palliative care is A-OK, but the second they roll to hospice, that becomes an exclusion to this program. You cannot be enrolled in a program all-encompassing care for the elderly or a PACE program because really they're already taking your Medicare and Medicaid benefits and rolling them into one program. So those individuals are excluded. And you cannot live long-term care in a nursing home. Now, many of you know that you have a client that maybe had a hip or knee surgery or they had heart surgery and they go to the hospital and they discharge and they go to subacute rehab. That's A-OK. But they can't be there for more than 100 days enrolled long-term care. If they roll as a long-term care resident, then they are considered a long-term nursing home resident and then they no longer qualify for guide. But those subacute rehab stays are totally fine. And so you see, it's pretty easy to qualify for this program. Unlike home health, we don't even need an order. We coordinate when we get these referrals, we check eligibility, and then we schedule the visit with the family. If you can go to the next slide, I'll talk about all of the care delivery domains in the program. So we check the eligibility and then we do a welcome call. And then when we do the welcome
The Nine Care Domains Explained
SPEAKER_00call, we are actually scheduling the comprehensive assessment to be done with our nurse, with the primary family caregiver. The family caregivers have to attend at minimum the annual visit with our nurse or with the guide provider's clinician. And really, we hope that there is a minimum, at least a monthly touch point with these families, because that's really the way that we can see changes of condition, catch things before they get too far out of control. And so I think that as I've been really speaking about this program and talking to people about the awareness, I think a big part with home care agencies that would be very beneficial would be setting the expectation with the families that the more engagement that they have, the more likely we are to have even better outcomes and to support them. Because it's not just about respite. I know people always think the guide is synonymous with respite, and I understand why from a revenue standpoint, but the respite's the respite component, as you can see from this chart, is one of nine care delivery domains. And the other ones are equally as important but different. So the first thing that I saw when I looked at these nine care delivery domains as a former provider was care management. I said, this is care management for all. My wealthy clients paid for home care and all paid for care management, but not everyone can afford to do that. And so really this guide model of care has a lot of interesting facets that really are care management components. And we're not taking away from in-person care managers either, by the way. We love our in-person care managers, but there's only going to be a fraction of your patient population that can afford them. And we fill in gaps for those care navigators and care managers. So as you can see, the comprehensive assessment is the first step after the welcome call. And that family caregiver has to do two things in that annual assessment. The first is they have to complete the Xeric burden and they have to complete the promise. These are two standardized tests that are required by Medicare that are helping Medicare and our the guide providers really gauge how overwhelmed these family caregivers are. And that gives us a baseline of understanding of what's going on. So our nurse, it pocket our and our nurse completes the comprehensive assessment. We have the visit with the family, we get the Zarit and the Promise, and we send that all off to Medicare. Medicare typically is taking one to two days to review that information. And then they send us an alignment letter saying, yes, this individual is approved for the guide model of care. And yes, they qualify for respite, or no, they don't qualify for respite, or no, they don't qualify for the program. We'll talk a little bit more about respite in a minute, but to qualify for the respite, you have to be in the moderate to severe complexity of dementia with a family caregiver. Low complexity individuals can still benefit from all other eight care delivery domains. They just won't get the respite care until they get into that moderate to severe category, if that makes sense. The next thing that happens is care planning. So this is when our nurses are really working with the families and we're determining do you have your advanced directives? Do you have all of your beneficiary information? Do your beneficiary know what your wishes are? Do you want to live the rest of your days in your private home? Do you have the financial resources to do that? What would what does success in this program look like for you? It's really trying to start building that relationship with the families to understand what they need and really being that advocate for them starting very early on. It's also when we start talking about, okay, you did qualify for a respite. How do you want to use it? There's three categories. We're seeing the majority of our partners, our patients wanting to use our partners in home care. But we have had some requests for adult daycare because there are some people that are never going to be able to afford home care ever. And so adult daycare is a maybe a better option for them to get a little bit more time. But we have definitely seen that the majority of our clients are requesting home care because they just it's easier for them to have this care delivered in their home. Our team is available 24-7. We do not outsource this. So a patient or a family can reach out to Pocket RN. You can reach out to Pocket RN for any reason at any time 24-7, and you are going to speak to someone on our support team. A lot of times the calls that are coming in are something's going on with my mom and I don't really know what to do. Can I schedule an appointment with my nurse? And we schedule an appointment with the nurse, usually the next day or the day after. I will also mention that in our model of care, I really tried to replicate like what I did as a provider when I took care of medically fragile children. I had a lot of kids that I took care of that were traiked and vented. And they had the same nurse every day. Those nurses became an extension of the family. And something that I realized early on was that if the nurse that worked for my agency left to go work for a competitor, that family followed the nurse, right? Those relationships are not transferable. And so it wasn't my patient, it was that nurse's patient. And so we virtually wanted to have that continuity of care at Pocket RN. And we created the nurse for life model. So as long as these appointments are proactively scheduled, which I would say I don't know, 90, 95% of the time they are, that patient and family is going to work with that same Pocket RN nurse for their entire seven-year journey with us through the guide model, which has been amazing. So again, families are calling in, they're talking to support, they're scheduling appointments with their nurse, they want to ask their nurses questions. And that nurse really becomes a quarterback and a cheerleader, and it also becomes a collaborator with your in-person staff at your home care agencies so that we're working together to really support these families. We have ongoing monitoring and support. So these are what we're trying to have at least a monthly touch point with these patients and families. It's oftentimes in these visits that our nurses are recognizing changes of condition long before the families do. We're really holistically taking care of these individuals. So we're catching things, we're finding out all kinds of stuff. But that's been really great in terms of helping us reduce unnecessary hospitalizations. In terms of referral and support coordination, we have a very large network of resources for families. And so we wanted to be able to offer some of these services to families at a discounted rate. We didn't want any, we didn't want any credit for referrals. We just wanted families to use these kinds of services. And so we said offer discounts to families so they can use your stuff. So we have a partnership with a company called Tim Care, and they offer incontinence supplies that you can order online and they get discreetly delivered to your home. And these have been clinical. Created by physicians and clinically proven to reduce UTIs and infections. And they're offered at a discount. And they actually cost about the same as what you'd pick up at Costco. There's lots of white papers around how it's UTIs are a big problem with this patient population, right? So we don't get any, we don't get anything for that, but we get better outcomes, which is what we're really excited about seeing. We work with a not-for-profit organization called Daughterhood that hosts circles weekly with some dementia care experts. It could be anything from taking away the keys to my mom's drinking too much and I don't know how to stop it to sundowning to the guilt of feeling like a family caregiver. And they have tons of awesome content. And families can join those for free. It's a not-for-profit, so they fundraise, and that's how they can afford to do all this cool stuff. And we love them. So we recommend that to families to join. And I'll give you a little aside bar, but we had a gentleman whose wife has dementia, and he was nervous because it was called daughterhood. And we're like, no, but it's family caregivers. And so he went and he said he joined a circle that was talking about journaling. And he used to be a writer and had stopped doing that because he was so overwhelmed taking care of his wife. And so he took this circle and he actually wrote his wife a song and then was playing it to her when he came when he came off of the class and he shared it with our nurses and said, I finally had an opportunity to find some of the joy of my own life back. And those are the kind of powerful stories that are coming from family caregivers. And that's just one small example. But anyway, I could go on for days about all the res resources that we have available for family caregivers, but we really wanted to create an ecosystem so that family caregivers didn't have to Google stuff anymore. I don't know about you, but when my families Googled things, they came back to me with 400 other things wrong with them that they didn't really have, and it made my life a nightmare. So I we don't want people searching broader Google. We want them to really be searching clinically vetted content. Which brings me to the next category: caregiver support and training. So caregiver education is a big part of this ecosystem that we have built. And when I was in an agency, I worked with a company called Nivon, N-A-V-V-O-N. And Nivon does paid agency caregiver competency training. But I had this crazy idea and said, hey, James, what if we turned this upside down on its head and we made family caregiver education for untrained, unpaid family caregivers? Let's do it. So we've created online training for family caregivers all around dementia. We have videos, we have clinically vetted content that the families can ask a question and it'll answer it the same way that one of my live human nurses would, so that they're not searching greater Google. We've had since July 1, this is a pretty significant number, we have had 3,000 family caregivers use this training that we have created and over 13,000 education hours. All free, all funded by this program. That's amazing. It really shows you how hungry families are for information and how they just really don't know where to turn. So we're really excited about that. In terms of medication management, I think that for most of you that really speaks for itself. But we're looking for things like do you have expired meds? Do you have bags of meds that you haven't even taken out of the closet? Do you have generic and brand names? Are you having any side effects of these medications? We have an example where I will give you that we had a patient in their 90s, and this patient was starting to rapidly decline really quickly. And the daughter was very upset about it and was literally considering putting this client on hospice for failure to thrive. She had been losing a lot of weight. We did the med reconciliation, and we had a physician that was not one of our physicians, one of the patients' physicians, had ordered Ozempic. And so this person was rapidly losing weight because they were on Ozempic and would have been put on hospice and got them off Ozempic, got that order discharged, our team did, and within three weeks had bounced back to being vibrant self, no hospice needed, living life. So we're finding lots of those kind of things when we do these med reconciliations. We also had another client that the family caregiver was afraid to do the injectable diabetes injection and the insulin injection, and they weren't doing it. And everyone thought they were doing it, and this client wasn't getting their much-needed insulin. And so we really avoided a crisis there by doing a lot of virtual teaching and coaching with the family. Care coordination. Sometimes these clients fall, they need physical therapy. Sometimes they need a specialist. Maybe we need a diabetes educator. Maybe we need a nutritionist. So we have a social work team that works alongside the nurses to really help make sure that the families have all the resources that they need. And then, of course, the last domain is the respite care. So what you can see here is that PocketRN's Nurse for Life is doing the majority of the heavy lifting here. And the only two things we don't do, our partners do. So the first is within that comprehensive assessment, one thing that has to happen within 60 days of the comprehensive assessment being completed is an in-person home safety bill. All you're getting is the IDL and ADL information on that client. Takes about 30 to 45 minutes. And we can't do that because we're virtual, has to be done in person in the home. So our home care partners do that for us. We pay you for that visit. And then the respite care is 72 hours per year times whatever the Medicare rate is. I think the base rate right now is $33 an hour times the 72 hours. And that timeline goes from July 1 to June 30th. Use it or lose it. So we're approaching a new cycle where all these clients who have used their respite last year are going to get another 72 hours in their quote unquote bank to use starting July 1. I'll go to the next slide, please. So again, it's moderate to severe complexity dementia. And the most important thing you need to know is that it is has to be scheduled and provided in four-hour blocks or four-hour
Respite Rules And Home Safety Visit
SPEAKER_00increments. So a family can't call you and say, I want to book six hours. They have to use four hours under guide. And if they really wanted six hours, then you would be able to work with them and say, I could do an additional two hours or six hours or whatever hours, private pay if you want, but the guide money has to be used in four-hour increments. So four, eight, twelve, and so on. And families can use this however they want. So that's a conversation when they're working with you that you can talk to them. If you have an eight-hour minimum, you need to let them know that up front. We don't do four-hour shifts and they can decide if they still want to work with you or not. But you do have a lot of flexibility in the conversations around your staffing to really be able to work with the family to make that happen. Again, everyone gets 72 hours a year, and it is that family caregiver. So the family caregiver, I always like to just say this too, does not have to live with the individual. Oftentimes they do, but they don't have to. It can be your children, it can be a neighbor, it could be someone from church, it can be a friend, but that person has to be the primary caregiver for the person with dementia, and they have to participate in those visits. So that's the number one thing. But we do have some neighbors that are pretty much taking care of their neighbor next door because they don't have any family. So we definitely see that. Next slide, please. So again, this is just a quick overview that it's 72 hours a year, mild, moderate, severe complexity, dementia, Medicare A and B, all dementias are included. Doesn't cost anything to anybody, and it's really whole person support. The program has just been amazing. We'd love to work with you if we're not already. Next slide. I think we're probably almost close to the end here. Oh, one more thing that's important. In terms of if you work with home health agencies or other physician groups, we do not impact those providers' billing. Again, there's very few of us that can bill this guide code. So, Medicare certified home health, if they're in there billing Medicare A, they're doing things like wound care and physical therapy and occupational therapy for the patient. A lot of what you can see from here with guide is support for that family caregiver. So we can both be in there working with these families at the same time. Primary care physicians can be doing other things like chronic care management, remote patient monitoring. They just can't build those codes and the guide code simultaneously, but we're usually the one building the guide code in that capacity. So we're definitely not interfering with other non-guide providers' work, which makes it a lot easier for all of us. Next slide, please. If you want to sign up, this is a webinar that goes over most of the things. We also host a every Thursday, three o'clock webinar to talk about the program, answer questions that
Partner Setup And Payment Flow
SPEAKER_00you have. We can always email you an invite to that. There is two things that are required if you want to work with any guide provider. The first is a partner roster request. Again, remember you all don't have to be Medicare certified. That's the coolest thing about this program. You work with us. We are the Medicare entities. We are the ones that do all Medicare compliance, billing, all that. And then when you become our partner, you basically become a subcontractor of each guide participant. And then the guide participant becomes a payer source and a referral source to you. So if you provide respite, you invoice the guide provider and then we pay you. With us, we don't take any of that money of the respite. It's 100% pass through. Medicare pays us a per member per month to manage that life. So that's how we get paid. And the respite money is just given to the home care agencies as they provide that care. They invoice us, we pay you. And then there is a contract that everyone assigns that just basically says we're not going to break the law. We're all going to do all the things that the program says. There's a BAA in there so we can share information with each other. And it's pretty easy to get going. The one thing I will say though is that the partner roster request can take 10 to 16 weeks for Medicare to approve you. They're basically background checking the agency owner to make sure that you're not on any of the fraud lists or that there's no compliance issues or that you're not, I'm just not saying I'm Nancy's home care and hanging a sign and saying I'm going to take care of all these people and not do it, which I think is actually pretty good for our industry right now, based on the news that we've been seeing lately. So they're just really doing their due diligence. But that's just a it's just a form with who your EI, who your owner is, their EIN, the agency, the social, and the zip codes that you cover.
SPEAKER_02Okay. All right. We have a couple questions. Let's see. Do you refer to agencies or let's say, do you refer agencies to provide the caregiver for a patient?
Referrals Case Studies And Marketing Plays
SPEAKER_02Do you refer to the system? Sometimes okay.
unknownOkay.
SPEAKER_00So sometimes we do when in December, for example, Medicare sent out these lists. Not lists, sorry. I just had a message that popped up and it made me say lists. Medicare sent out letters to individuals that had Medicare A and B in a dementia diagnosis and told them they qualified for this program. And at the bottom of the letter, it basically said, these are the guide providers that are covering your zip codes. And so families started calling us that day. Okay, I want to be in this program. So those a lot of those people had never had a single hour of home care or any services from anybody. And so then what we would do is we looked at our partner roster list and the zip code of the client, and we would determine who was under contract, and we would call those agencies and say, hey, we have a respite referral for guide. Do you want it? And they'd say yes or no, and then we'd go to the next person on the list. Especially as this program moves into years two, three, and four, we're gonna start seeing a whole lot more of that direct-to-consumer stuff coming into us. Word of mouth is definitely taking off in this program. So people that are already in the program are starting to tell their family and friends in other states that, hey, we work with Pocket R and we want to be in, we want to get my mom and this, my mother-in-law. We're seeing the father-in-law and my mother-in-law are in Texas is qualified for this program. Can we get them in this program? Many of these people have never had any care at all.
SPEAKER_02Nancy, I have a quick question before we go to the next. Do you have any case studies from home care agencies? Because it's not a lot of hours that they're getting, but it's something. Do you see a lot of clients they sign on through the guide program? Yeah, 30 to 40 percent. Okay, with more hours. With us.
SPEAKER_00And these are things that I will say that are just from us. I do a I just like I did a webinar earlier today and I talked about some of these outcomes. I had I had one agency that had been trying to get into a senior living community for years and couldn't get anywhere with the executive director, went in with the guide flyer, said they were partnered with Pocket RN, walked out with 300 weekly billable hours in one sales call. I have another lady in Texas. Her nickname for us is Pocket Money. She has gotten five 24-7 private pay referrals in six months from going to hospital systems and talking to discharge planners about guide and saying I'll take your Medicare patients that have dementia. And they've basically said to her, if you're gonna take these referrals, I'm gonna give you the good private pay ones too. And that's huge money. I mean, 168 hours a week times 40 bucks an hour, 50 bucks an hour is a lot of money at the end of the day. So we've definitely seen that. People are telling us that doors that have been slammed shut are being opened. People that wouldn't even talk to them are saying this is amazing and this program's huge, and I didn't even think there was a provider in my market.
SPEAKER_02Yeah, I think it's great. David, he said he's contacted you and he receives received the form to complete, but it says expired.
SPEAKER_00I'm not sure. Email us again. Uh we'll send it back to you again.
SPEAKER_02Yeah. David, maybe put the specific form, but he when he opens it up, it says it's expired. So I'm not sure. He will. He will. If he has a problem, let me know. I'll send I'll let Nancy know.
SPEAKER_00Yeah, it's just you can email us the emails on the screen right now. Actually, sales at Pocket RN. Just make sure that when you email us, you let us know that you're a home care agency or a home health agency or whatever you are. So we send you the right documents because they're different, and that's we'll send them out to you right away.
unknownOkay.
SPEAKER_02Oh, we have another question. Bobby, she was on an intake call with a prospective Medicare guide client and would love to speak with you further. Bobby, did you want to unmute your line? Do you have a quick question?
SPEAKER_01No, I have a lot of questions. So no, this is not the time for that. But yeah, the I'm pretty sure that this lady is eligible for the program and kind of just need next steps. And I know I missed a lot when I was on the phone with her. So, Nancy, if you could tell me the best way to just should I just email the sales?
SPEAKER_00No. So if you want to talk to someone about an actual patient referral, the best place to email is guide at pocketrn.com. Or you could call us and ask to speak to an intake specialist and they will connect you. So our intake team is trained to check eligibility, do all of the things and help you. And that phone number is 872-233-4490.
SPEAKER_01Okay, perfect. I'll do that.
SPEAKER_02Awesome. Thank you so much. Yeah, thank you. Perfect. Lisa just put that in the chat. I'm just thinking back, I think it's great that Medicare now covers something. I would think it would be smart to market to memory care facilities. How is that some place that people are marketing to? Okay.
SPEAKER_00It's huge because the thing is, senior living communities are a respite category. Okay. But there's a couple of challenges there. The first is that you cannot use the respite money to pay for your housing. So you can't say to the community, take $2,500 off my bill this month. It doesn't work that way. So what typically is happening is that home care agencies are coming into the senior living communities and providing the respite in the four-hour blocks. So we see a lot of families using this on the weekends when maybe the home, maybe the senior living community, memory care community is short-staffed. Because a lot of times when I've done it, I've been like, you have to hire a caregiver. We can we your mom needs more care than we can give you on the weekends, and families are doing that. So they can use that money towards that. So that's one way that's been wildly successful. And what ends up happening is once the caregivers are doing an awesome job in the memory care community, all the other clients are like, the families are like, I want to sign up for extra hours. I want to sign up for this service. And so we're seeing private pay coming from non-guide people in the building because you know how it is, once you're in.
SPEAKER_02We have Ruth just asked, living in a memory care does not preclude the guide program.
SPEAKER_00No, as long as it's not licensed as a skilled nursing memory care community.
unknownOkay.
SPEAKER_00And those are rare. That's going to be a high level of nursing care. Usually it's a wing within a subacute rehab facility that's more of a long-term secured area. But no, traditional memory cares are totally fine. Your bridges of the world are all fine.
SPEAKER_02Okay. We have another question. You said the billing has to be done in four-hour blocks. If a nurse's intake assessment doesn't take that long, is it still subtracting four hours for the onboarding process?
SPEAKER_00So you guys are not doing the comprehensive assessment. Our nurses are doing that. We're just asking you to do a home safety avail, and that is not a respite avail. That is a different avail. You shouldn't be like if you're in a regulated state and you have to send a nurse out there, then that is something that you'd have to do. But that does not come out of the respite money. The respite money is the caregiver money that comes after that. But when but in the nine care delivery domains, our nurses are creating that plan of care and doing that comprehensive assessment. We don't have agencies do that.
SPEAKER_02So for the asset when somebody has to go do the safe the agency has to do the safety assessment, that's not included in the hours. You pay them separately.
SPEAKER_00We pay them $100 to do that. And like I said, it should take 30 to 45 minutes max.
SPEAKER_03Okay.
SPEAKER_02All right, great. That's a great question. Yeah. I don't know, Lisa. Can you think of anything else? There's so much to know. I know, there's a lot. I know. I'm actually glad to learn a lot of this. Because I think I was one of those people that kind of thought, oh, it's rest, it's more of a respite type of situation. So it was good that you addressed that. Oh, there's another question. I am a Florida nurse registry that does not accept Medicare or Medicaid. Am I excluded?
SPEAKER_00No, you are not excluded. You are we work with lots of Florida registries, but there are things about a registry that are different than home care. So, number one, even though you're not the one sending the caregiver specifically, you we you do have to agree that when you are sending the caregiver, that you are making sure that your people are background checked and that they have the DCW training that's we can provide through Nivon that they can take. That takes two and a half hours approximately. But they but you do have to, there's a few things in the contract that is a registry as a non-home care entity that you have to do. No one that works with us has to be Medicare or Medicaid certified. That is what is the coolest thing about this program. In my 30 years, almost every intake call that I ever took, does Medicare pay for this? The answer was no. The answer now is that really all depends. Can you tell me more about your mom and dad? And do they have dementia? Do they have traditional Medicare? There's a new program. I'd love to tell you all about it. And people basically are getting to try your services for 72 hours paid for by the federal government. And if they love your caregiver and they can afford it, they're signing up for private pay hours. Every person that I have ever signed up in my 30 years, and I've signed up a lot of people into home care, every single family came back to me and said, Nancy, if I knew you were gonna make my life this much better, I would have done it sooner. But they have to experience that relief to actually get it. And they all say it. So now it's you know what? You can try our services from with Medicare, dollars, and see what you think. And then if they love you, they're gonna sign up. We're just seeing it over and over again.
SPEAKER_02I think it's fantastic. We have another question. So are our caregivers working technically onto your nurse for a packet RN? What state are you in? Ruth, what state are you in?
SPEAKER_03I'm in Florida. So do you I'm just really asking, you guys own the plan of care, like when we're there and hospice is there, hospice is primary, right? Or we own the dementia plan of care.
SPEAKER_00And when you guys are going in and you're doing your ADL stuff, you're typically creating, you're having them sign an agreement and you're having them, you're usually creating a plan of care that this is what we're gonna do for you during the respite time, right? So if we're gonna create, we're gonna do your meals, we're gonna be here eight hours. You guys are still typically creating that. And I know in Florida you have to have a nurse co-sign that. But again, if you're in Arizona and you don't have any regulations, then whoever in your office is getting those consent signs still gets it signed. You still have to follow all of the rules of your state in order to be in compliance with the home care legal bodies. But in terms of Medicare, we create the dementia plan of care. We own the patient in terms of the Medicare dollars. And it's if your patients are seeing their primary care physician and those docs are doing their things, we're doing our thing, and you're still doing the things you have to do to be in compliance for home care.
SPEAKER_03Okay. All right, thanks.
SPEAKER_02I have a question. I keep thinking of all these things. So it's a four-hour increment. Say a client wants four hours in the morning, but then they want an additional four hours in the evening. So then they would pay the privately for the four hours through our agency, right?
SPEAKER_00So if they still if they have the 72 hours and you're willing to let them split that up, then they could use the eight hours in the day because they're in two four-hour shifts. So that could be okay.
SPEAKER_02Okay. Okay, but if it was eight hours, then it's four hours.
SPEAKER_00If it's eight hours, you could still invoice us for eight hours until they exhaust the 72 hours, but they can't say to you, I want to schedule 10 hours.
SPEAKER_02Okay. Okay.
SPEAKER_00Does that make sense?
SPEAKER_02Yeah, yeah, that's neat. All right. Any other questions? Everybody's gonna get a replay of this of the program. You're gonna have the PDFs, all the contact information. I think it's wonderful. When I was in home care for years, we kept saying Medicare is. to start covering some Medicare and it's they're they finally are maybe it's only dementia. Hopefully it'll they'll start like you said seeing the need that they will start helping more Medicare patients with other services.
SPEAKER_00Yeah 72 hours isn't a game changer right and a respite rate of $34 or $33 is not a game changer at all. It's the first time they're even talking about you which is humongous and it's a massive opportunity. And so I think sometimes I run into people that are like my private pay rate's so much higher. I'm like, yes, I understand that. My private pay rate was too even 10 years ago. The fact of the matter is though we have an opportunity to move our industry into the center of the healthcare ecosystem to get these things to be paid for. And maybe maybe the outcomes the goal is that they pay for home care for more hours at a better rate because we know that even if I'm in there doing this and you're providing home care and home health is in there and even a home visiting physician and maybe even a hospice or palliative care, we're all together still cheaper than a half a day of hospitalization. It's just a different way of thinking really that all of us can collaborate to keep people out of the hospital. And it is a game changer. So I want you to think about the it's not about the respite dollars, it's the opportunity that we have in front of us as an industry. And the more data that we have from all of you in all 50 states with Pocket RN, we're collecting every ounce of this data. By the way, one last thing I'll share with you because I know this is a mastermind group and this is something I know you guys talk about. We have a human-centered design team that really works with patients and families and understands what's going on with this program. We are at a 91% net promoter score on this program 91 industry average if you're at 50 you're doing a good job. 91% of people that are in this program are massive fans of it and they're telling everybody.
SPEAKER_02Yeah we have another question and this is I think I talked to you about this before. How much does Medicare reimburse isn't it by state?
SPEAKER_00It is by state by zip code so when you send us an email we would send you the lookup tool and you can look it up in your market am I missing anything else?
SPEAKER_03Let's see is that by client zip code or office? Client zip code where they live good question.
SPEAKER_02Yeah great question Okay I think this is great. Nancy such great information thank you so much for having me
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