GUIDE Dementia Care Program
(Supported by Comfort Keepers in partnership with Lower Cape Fear Life Care and PocketRN)
What is the GUIDE Program?
The GUIDE Program—“Guiding an Improved Dementia Experience”—is a CMS-sponsored initiative that provides specialized support for people living with dementia and their caregivers. The goal is to deliver coordinated, dementia-focused care that improves quality of life for families while reducing stress on caregivers.
Comfort Keepers is proud to be a partner in making the GUIDE model available to our community, working closely with both Lower Cape Fear Life Care and PocketRN.
Our Partners in GUIDE Care
🌿 Lower Cape Fear Life Care
Lower Cape Fear Life Care brings decades of experience serving individuals with advanced illnesses and dementia in our region. Through their LifeCare Memory Partners program, families gain access to:
Dementia-focused education and caregiver support
Referrals to local community resources
Guidance navigating care transitions and long-term planning
Compassionate, in-person support tailored to family needs
One-on-one caregiver coaching and support
Paid respite care hours (up to 72 hours/year for qualifying families)
💻 PocketRN
PocketRN provides the clinical infrastructure for GUIDE, connecting families to dementia-trained nurses virtually, 24/7. Their GUIDE Program includes:
A dedicated nurse for regular phone or video check-ins
24/7 access to an interdisciplinary dementia-trained care team
Medication review and care coordination across providers
One-on-one caregiver coaching and support
Paid respite care hours (up to 72 hours/year for qualifying families)
PocketRN ensures that no matter the time of day, help is always just a call or video chat away.
What Participants Receive (Covered by Medicare)
Eligible participants and their caregivers can access services at no cost, including:
Ongoing dementia-trained nurse support
Care coordination across health care providers and community resources
Education, coaching, and stress-reduction strategies for caregivers
Covered respite care hours for family caregivers
Eligibility
To participate in the GUIDE program:
The person must have dementia (or be diagnosed through assessment)
Be enrolled in Traditional Medicare Parts A & B
Reside at home or in an assisted living setting (not long-term skilled nursing)
(Note: Medicare Advantage plans and hospice are not currently eligible.)
Why This Matters
Dementia care is often fragmented. The GUIDE program changes that by creating a central point of support for individuals and caregivers. With Lower Cape Fear Life Care providing local, in-person support and PocketRN offering 24/7 clinical care, families benefit from a full circle of services—coordinated through Comfort Keepers.
Together, we help ensure those living with dementia experience care with dignity, safety, and compassion, while caregivers feel supported and less alone.
Learn More or Enroll
Visit PocketRN GUIDE Program
Contact Comfort Keepers of Wilmington to discuss eligibility, referrals, or program enrollment.
