Harmony at Home Partners with PocketRN to Bring Medicare's GUIDE Program to East Tennessee
We are excited to announce a significant milestone for families navigating dementia care in East Tennessee: Harmony at Home has partnered with PocketRN to deliver the Medicare GUIDE Model — the Centers for Medicare & Medicaid Services' most ambitious investment in community-based dementia care to date.
What Is the Medicare GUIDE Model?
The GUIDE Model — Guiding an Improved Dementia Experience — is a voluntary care model developed by the CMS Innovation Center and launched in phases beginning July 2024, running through 2032. It was created to address a critical gap in traditional Medicare: the lack of coverage for coordinated, community-based dementia care.
According to CMS, the GUIDE Model provides Medicare beneficiaries diagnosed with dementia with a comprehensive package of services designed to help them remain in their homes and communities longer, while also supporting the health and wellbeing of their family caregivers.
The program covers:
- Care Navigation — a dedicated care navigator coordinates all aspects of your loved one's care, from medical appointments to community resources
- Caregiver Training — structured training in dementia care best practices, behavioral management, and self-care for family caregivers
- Respite Care — Medicare-covered respite services so family caregivers can take scheduled breaks
- 24/7 Caregiver Helpline — round-the-clock access to registered nurses who can answer questions and provide real-time guidance
All of these services are covered by Medicare — at no out-of-pocket cost to eligible beneficiaries.
Why This Partnership Matters for East Tennessee Families
Dementia caregiving is one of the most demanding roles a family member can take on. In East Tennessee, where many families live in rural or semi-rural communities with limited access to specialized dementia resources, the GUIDE Model represents a transformative opportunity.
The Alzheimer's Association estimates that over 6.7 million Americans are currently living with Alzheimer's disease, and Tennessee's aging population means our region carries a significant share of that burden. For years, families here have had few options beyond expensive memory care facilities or managing alone with minimal support.
Through our partnership with PocketRN, we're changing that.
PocketRN is a technology-enabled care coordination platform and CMS-approved GUIDE Model participant. Their platform connects patients and family caregivers with registered nurses around the clock via phone and video — providing the clinical guidance families need, especially during evenings and weekends when physician offices are closed.
Harmony at Home provides the in-home care component: our trained caregivers deliver hands-on respite services, activities of daily living support, and companionship for GUIDE-enrolled clients throughout Knoxville, Maryville, Oak Ridge, Crossville, Morristown, and the surrounding area.
Together, we form a complete care team — bringing the GUIDE Model to East Tennessee families who need it most.
Who Qualifies for the GUIDE Program?
To be eligible, beneficiaries must:
1. Be enrolled in traditional Medicare Part A and Part B (not a Medicare Advantage plan)
2. Have a formal dementia diagnosis from a physician
3. Be living in the community (not in a nursing facility or assisted living)
4. Have a caregiver willing to participate in the program
5. Reside in Harmony at Home's East Tennessee service area
If your loved one is enrolled in Medicare Advantage, they are not currently eligible for the GUIDE Model — but contact us to discuss other care options that may be available.
How the GUIDE Program Works in Practice
Once enrolled, a care navigator from our team — supported by PocketRN's platform — will conduct an initial assessment and create a personalized care plan. This plan is reviewed and updated regularly as your loved one's needs evolve.
Family caregivers gain access to the 24/7 PocketRN helpline, where registered nurses can provide guidance on managing behavioral symptoms, medication questions, safety concerns, and caregiver stress. Training sessions are scheduled to help caregivers build confidence and competence in their role.
Respite care visits from Harmony at Home's trained caregivers give family members scheduled breaks — whether for a few hours a week or several days — while ensuring their loved one continues to receive professional, compassionate care.
Why In-Home Dementia Care Is Better
Research consistently shows that people with Alzheimer's and other forms of dementia fare better in familiar home environments. Moving to a memory care facility can accelerate cognitive decline, increase anxiety and agitation, and undermine the sense of identity and continuity that familiar surroundings provide.
The GUIDE Model is built on this evidence. By funding in-home care coordination, caregiver training, and respite services, Medicare is investing in the proven effectiveness of home-based dementia support.
At Harmony at Home, we believe every person with dementia deserves to live with dignity, comfort, and purpose — in the home and community they know. Our GUIDE Program partnership with PocketRN is our commitment to making that possible for as many East Tennessee families as we can reach.
Next Steps: Find Out If Your Family Qualifies
If your loved one has been diagnosed with dementia and is enrolled in traditional Medicare, we encourage you to contact us for a free eligibility consultation. Our team will review your situation and walk you through the enrollment process step by step.
Call us at (865) 269-6345 or schedule a free assessment online.
You can also learn more about the GUIDE Program:
Harmony at Home is a locally owned, non-medical home care agency serving Knoxville, Maryville, Oak Ridge, Crossville, Sevierville, Morristown, and surrounding East Tennessee communities since 2009.