Remaining in the Community: GUIDE seeks to empower people living with dementia to remain safely in their homes and communities for as long as possible, delaying facility placement.

Caregiver Support: GUIDE reduces burden on caregivers that provide unpaid caregiving services by providing skills training, 24/7 access to a care team, and access to respite care services.

GUIDE attempts to help delay facility placement as long as possible. The GUIDE Program is designed to help keep the referred safe at home and to provide support to prevent caregiver burnout.

Refer individuals who meet these basic criteria:

• Suspected or confirmed dementia diagnosis.
• Living at home (not in a nursing home or most appropriate for a skilled nursing facility).
• Has an unpaid caregiver (family/friend who provides some caregiving that is unpaid).
• Enrolled in Traditional Medicare (Part A & B). If unsure, you can still refer and the GUIDE team will determine.
• Note: Prioritize those where caregiver burnout seems high or safety is a concern.

The GUIDE Respite benefit can provide an up to $2,563 annual Respite allowance for direct caregiver relief. Eligible participants with moderate to severe dementia who have an unpaid caregiver can receive a yearly benefit that pays for temporary relief services. While all enrolled participants get access to care navigators, 24/7 support lines, and caregiver training, the financial respite benefit is restricted based on two major factors: 1) Moderate or Severe Dementia Diagnosis, 2) Unpaid Caregiving is taking place. The Respite benefit can be used for:

• In-home personal care services
• Adult day center programs
• Temporary facility-based stays

* The respite benefit is not paid to the Referred person or their caregivers.  Instead, the Respite benefit is provided by Kern County Aging & Adult Services (KCAASD) GUIDE Program-officially authorized contracted providers. 

GUIDE Intake & Assessment: In the GUIDE Dementia Program, the Area Agency on Aging, KCAASD, conducts the participant, caregiver, and home assessments to create a comprehensive care plan.

Once a referral is received, the KCAASD GUIDE team performs three critical evaluations:

1. Participant Assessment: Evaluating cognitive and functional needs.
2. Caregiver Assessment: Measuring stress, health, and support gaps.
3. Home Safety Inspection: Identifying risks and recommending modifications.

The official KCAASD GUIDE Program Referral Form is available by clicking here: GUIDE Referral Form.  Please ensure the following sections are accurate:

• GUIDE Referral Name & Medicare ID
• Caregiver Contact Information
• Reason for referring person to GUIDE Program

To receive a copy of your GUIDE Referral submission, please fill out the “Email Address” field at the bottom of the GUIDE Referral Form before submitting it. 

The Referral Submission Protocol is shown below:

A.   Complete the GUIDE Referral Form and submit the form. To receive an emailed copy of your GUIDE Referral submission, fill-out the “Email Address” field at the bottom of the GUIDE Referral Form before submitting.

B.   Wait to receive a copy/confirmation of your referral submission via email, if applicable

C.   Referral Complete. The GUIDE Program takes over from here, scheduling three assessments (Referred, Caregiver, and Home Safety Assessment). 

• Validate Medicare Status: Ensure the participant has Traditional Medicare, not a Medicare Advantage plan (Part C plan), not on Hospice, and not in a PACE program.
• Confirm Home Setting: GUIDE is only for those living in the community, not those already in skilled nursing or heading into the higher level of care. Room & Board is acceptable referral.
• Caregiver Engagement: Can mention to caregivers the up to $2,563 annual respite services benefit; as many may be unaware of this benefit.
• Timely Submissions: Referral errors are minimized when the Referral Form is completed immediately after identifying the GUIDE Referral.

*A quick tip: tell the person to be referred and their caregiver about the respite services benefit. It helps them understand how the program can help them and the caregiver.

• Acknowledge the refusal without pressure.
• Clarify the reason for refusing if the caregiver is willing to speak about it (time, stigma, cost, mistrust, not understanding the program?).
• Offer a brief explanation of what the GUIDE Program could provide for the person with dementia and their caregiver.
• Revisit later if the situation changes.

• Contact KCAASD GUIDE Program:
  • aasdguide@kerncounty.com, or
  • Call 661-868-1000 and ask to speak with a GUIDE Program team member.