Miriam Allred (00:11)
Hey everyone, welcome back to the Home Care Strategy Lab. I'm your host Miriam Allred. It's great to be back with you. Today in the lab, I am joined by Jenna Morgenstern-Gaines, the co-founder and CEO of PocketRN I hope all of you have had the opportunity to meet her, rub shoulders with her at conferences, catch her on a webinar or a podcast. Jenna, welcome to the show.

Jenna Morgenstern-Gaines (00:32)
Thank you so much for having me, Miriam and thank you for everything that you do for the home care industry. I'm super, super excited to be here.

Miriam Allred (00:39)
⁓ sheesh. The pleasure is mine. I feel like we've kind of been on parallel journeys. We have both been in the industry for five or six years. Maybe you've been in it longer than I have, but I just feel like PocketRN and my journey have been kind of on this parallel track and we've known each other for a few years. So I'm excited to learn more. I think it's been a big couple of years for you and for your company. And I have people coming to me with questions about GUIDE And so I'm like, who better to have on the show than yourself? So we're going to unpack the GUIDE program. And you and I were talking before the conversation.

My audience is sophisticated. There's been a lot of awareness brought to this program over the last 12, 24 months. And so we're actually gonna unpack the common misunderstandings, the enrollment process, the market, the landscape. Like we're gonna give a couple layers deeper here, which I'm excited about. Before we do that, let's have you tell your story. For those that don't know you or know your background, kind of pre-home care, pre-pocket PocketRN, let's start there. Tell us your story.

Jenna Morgenstern-Gaines (01:34)
Fantastic. I'm excited. Thank you, Miriam. So just to briefly introduce myself, I'm Jenna, CEO, co-founder of PocketRN. And my background is mostly in the healthcare strategy and policy world. I started off my career here in DC trying to form public-private partnerships between policymakers and healthcare providers and Fortune 500 companies to support the sandwich generation of women, family caregivers who are caring for their aging adult parents as

as

as their young kids. And I love that work. And it became quite personal for me too around the same time, about 10 years ago or so now when I started to become a family caregiver to my mom. And I still am. And we've been through a journey together. And one thing that we've found, we've relied on over the course of her journey is really the amazing nurses in our family. So my aunt is nurse, my cousin's a nurse, my next door neighbor's a nurse.

and out of the goodness of their hearts, they just proactively check in on her on a regular basis. They're there at 11 p.m. on a Friday night when something comes up and we have questions. And they also have the most longitudinal data on her over time and the best relationship to help actually make change and support us through those moments. And so I've been very lucky, our family has been very lucky to have that kind of support from amazing nurses around us throughout this whole journey. And not to mention,

Mom also, we from time to time get amazing in-home care and services in the home that we need. And ⁓ that combination has been so helpful. And so, you know, when I left my previous job and life and went off to get my MBA at Stanford, I was part of the bio design program there. it's amazing program that brings together folks from across the university to try and address unmet medical needs. And I met my co-founder.

my co-founder, Dr. Sam Thomas, he's a doctor, but before he was a doctor, he was actually a home health aide living in the home of a man who needed overnight, round the clock care. And so the two of us were both very professionally and personally passionate about trying to help older adults and their families get the care that they need where they need it. And so, you we ultimately banded together to start PocketRN and to democratize what in many ways

family was very fortunate to have access to, which is what we call the nurse for life model. So all of our patients or clients and families on own placket are and get a dedicated specialized nurse who really becomes a care partner to them throughout their throughout their journey. And we work very closely and we've always worked very closely since our inception with home care to partner together to deliver the kind of services that families actually need in order to be able to stay healthy at home.

the support for activities of daily living, plus that kind of clinical wraparound nurse for life support. So that's a little bit about me and my background and sort of the journey that led us ultimately to PocketRN.

Miriam Allred (04:45)
I love it.

When you say you've been working on advocating and supporting the sandwich generation for the last 10 years, I'm curious where you think we are today. The sandwich generation, how far have we come? How far do we have to go? Are we doing better for this key sandwich generation right now?

Jenna Morgenstern-Gaines (04:55)
Yeah, great. ⁓

Yes.

Great question. 10 years ago, and I owe a debt of gratitude to folks who have been working on these issues for decades. But even 10 years ago, I think of Andrea Cohen, is one of the leaders of daughterhood and family caregiving policy writ large. I think of folks who have been trying to put family caregiving on the map, archangels, for years and decades now.

And, but even 10 years ago, it wasn't, it was, it wasn't sexy yet in the way that I think it is now today, at least kind of in the lexicon of, of most folks in the, in the healthcare world. And, you know, 10 years ago, we were all still working and I would say we are still working on ⁓ helping caregivers identify and see themselves as caregivers. I think you, if you look at any of the, of the studies and the research that groups like Archangels and others have done, you know, most often people, people will identify themselves not as a caregiver.

but as a daughter or as a spouse or as a neighbor and just doing what neighbors do for the people who are around them that need help. And so it's definitely been a journey, I would say, over the last 10 years to a point where now I think people understand more what that role means, where they understand what the role of being a parent means. But being a caregiver is something that is, I think, now finally sinking in for people. But policy and reimbursement

instructors and everything that kind of follows behind that is still playing catch up. That being said, the GUIDE program is really the first that we've seen that puts a specific focus on supporting the family caregiver. And I'm so grateful and so glad to see that Medicare is leading the way and recognizing that. often when Medicare takes the lead on things, others follow. So I think we're making progress, but there's definitely

there's still quite a bit of room to go.

Miriam Allred (07:08)
Yeah, that's a perfect transition into this GUIDE program. Let's do kind of a quick timeline of the history of events that have gotten us to where we are, because it's been a couple of years. When did the GUIDE program first launch? And talk a little bit about the early days, the evolution, the early adopters, what the program looked like, and then we'll kind of follow up to where we are today. But talk about kind of the early, when it started, what the early days were.

Jenna Morgenstern-Gaines (07:13)
this.

That's right.

Yes.

Perfect. That sounds great. So we are in early 2026 now and the GUIDE program, the first sort of swirlings around the GUIDE program emerged in, in 2023. And those of us who were sort of following along, we're waiting for that application to come out. And it came out late 2023. You had to apply by early 2024, January, 2024. And it was a one and done application process. So if you applied and you got in,

you're

in, if you missed the application process, and you know, you can no longer become a participant in the GUIDE program, you can become a partner organization, but there are only a set number of participants that were selected for the program in early 2024, those announcements went out and the very first track, the established track under GUIDE went live actually in July of 2024. This was mostly for organizations that

were little bit older, more established, hospices, any hospitals that participated in the program. Those were the main.

types of organizations that went live in that first track for everyone else who was in the new track like PocketRN, we were in an implementation year. And so we were essentially running a pilot from July 2024 through to July 2025, which is when we PocketRN and everybody else in the new track officially went live and spent a lot of time preparing a lot of time and setting up partnerships and testing the models to make sure that the workflows worked and then officially went live.

in July 2025, which means that we're in about month eight or so officially of GUIDE and the uptake has been tremendous in just a very short amount of time. Now this is an eight year program total. So it will run now for an additional six-ish years. we are right at the beginning, but it feels like we've been a part of it for almost decades now. So that's a bit of the timeline just to level set, Miriam, for everyone.

Miriam Allred (09:33)
Thank

And you said it wasn't just, was maybe misunderstood. It was just home health partners, kind of the post-acute space that was involved in this, but you say hospitals. So the acute space as well. Talk about the involvement from the different organizations and why all of them need to be involved in this program.

Jenna Morgenstern-Gaines (09:49)
Yeah.

Great question. So let me level set by just providing some terminology that's specific to the GUIDE program. And I'll try my best to follow along with that throughout the podcast so that ⁓ I can stay consistent as well. So ⁓ GUIDE was ⁓ when they opened up the RFA, the request for applications for GUIDE, ⁓ there were a few criteria that you had to meet in order to apply to be a participant, which really means a

Provider under the GUIDE program most importantly you have to be a Medicare part B Provider in order to qualify for GUIDE you also have to be able to provide all the services There are nine care delivery domains under GUIDE but importantly you have to be a Medicare part B provider to be a participant in the GUIDE program so that means that if you're a Theoretically if you are a home health agency if you're a hospice if you're a hospital that also does part B if you're a telehealth provider anyone that is a

Medicare Part B provider can apply, could have applied and be, you know, and potentially be accepted into the, into the GUIDE program. Now that's the participant layer and the participants are set now. You now no longer can apply to be a participant in GUIDE, even if you would theoretically qualify. Now ⁓ there is a whole nother layer, which is the partner organizations. And GUIDE is very unique as well in how explicit it is around the importance of

partnership and collaboration in order to be able to deliver those nine care delivery domains. ⁓ most, what you and I in our world most often see ⁓ is that those partner organizations are often home care providers to deliver on the respite care delivery domain, which is one of the nine care delivery domains. Now, ⁓ home care partners are not the only organization that can serve as partner. In fact,

almost any organization that can add value in some way and contribute to those care delivery domains could hypothetically be a partner organization. So, you know, we also work with home health agencies that can help us deliver some of the home visits that are required under GUIDE. You you could be a, you could also be, we work with care management providers under GUIDE. We work with senior living facilities that deliver respite. We work with adult day. ⁓

providers that deliver respite. So there's a lot of...

flexibility and freedom to structure the program so long as you're meeting the requirements in order to fulfill those nine care delivery domains between the participant, the provider organization, and the partner organizations that we work with. And we'll talk about this more, but we work with a wide, wide range of partner organizations. Home care happens to be ⁓ the greatest in number and volume because of that respite care requirement.

Miriam Allred (12:55)
Yeah, so let's clarify the misunderstanding right here. Some owners might be like scratching their head like, wait, how are home care companies still participating in the program? Explain the layers here. PocketRN was an early participant and you all are Medicare Part B certified. And now you partner with home care companies. Explain that hierarchy so that people understand where they still fit in.

Jenna Morgenstern-Gaines (13:10)
That's right.

That's right. Yeah. So we pocket PocketRN are a Medicare part B provider and we're a participant in GUIDE parlance. ⁓ so we are one of the few hundred organizations that were accepted and applied to be a participant. We work with and contract with partner organizations that are often home care agencies and there's no time, ⁓ there's no expiration date on when partners can join us as part of our, our program. So,

We are working every day setting up with five, 10 new partner organizations, most often home care agencies. And the way that the partnership, sort of structure of that partnership works is we sign a contract with our home care agency partner. They do have to provide us with some information that we have to submit to Medicare for Medicare to review and do background checks and approve them as a partner organization. But that can happen anytime. That does take time as an important FYI for anyone.

who's interested in partnering, it can take 10 to 14 weeks to get approved by Medicare, but you're getting approved as a partner organization and you can do it at any time. It's that participant layer of Medicare Part B providers like PocketRN that is locked and that the partner orgs have to work with in order to be able to take part in GUIDE in some way.

Miriam Allred (14:37)
So the home care company doesn't have to be Medicare certified to engage with you all, but through you all, do they technically become Medicare certified through that process that you just highlighted?

Jenna Morgenstern-Gaines (14:44)
That's right.

you

Good question. So the answer is no, they don't become Medicare certified, but they become approved as a partner organization for GUIDE, which is a specific, a specific carve out or designation. It's not actual Medicare certification or enrollment. And, and they do not need to be per your point. They do not need to be Medicare certified. They do not need to be Medicare enrolled in Medicare. That's our job. That's us as the provider, as the participant, we are the organization that is accountable

to and enrolled in Medicare. Home care agencies simply have to provide us with some information on their agency and to fill out an organizational form that Medicare requires so that we can submit them to be approved as a partner. Doesn't make them Medicare certified, but they don't need to be Medicare certified in order to be a part of the program.

Miriam Allred (15:40)
Yes, small but important distinction. And that's why I wanted to clarify there. ⁓ You mentioned that process can take 10 to 14 weeks and you're talking about the home care company submitting information to you all that then rolls up to Medicare. Any extraneous information that one wouldn't expect as part of that process or is it all pretty standard information?

Jenna Morgenstern-Gaines (16:01)
great question. So, and just to walk you through the steps, when we're partnering with a home care agency, there are really two things that we have to do. So we've designed a partner organization agreement and a contract together, which outlines the stipulations under GUIDE for providing respite care. And the second is that the agency has to fill out what's called

an organization form. And that form asks for several different pieces of information about their location, about their zip code, about ⁓ who is the, what's the ownership structure of that agency. And there are, are some sensitive pieces of information that it asks for. And so we have a secure form that we use for people to submit that information and then provide it up to, to Medicare. And, and there is, I will say, you know, there's, and Medicare always wants

to get enough information in order to be able to run a background check. And it does take time, but we don't tend to find that any agency or organization gets rejected. The only reason that their application might get sent back for review is because there was a typo in their name, or there was a typo in, you know, if they have a license number, they put in the wrong, you know, the wrong four instead of a five. So sometimes that can sus, that can shoot you back into the beginning of the site.

where you have to go back through that 10 to 14 weeks of approval. So it's really important. And what I would emphasize is to double check, cross your T's and I's when you're filling out that form, make sure it's accurate so that you can get it approved as quickly as possible. the 10 to 14 weeks comes from when we submit that. So as soon as we get the form, we submit it right away to Medicare. Medicare does the background check, does the review. That's what can take 10 to 14 weeks. And then once we get that approval back,

they can start delivering services. And again, it's a decent amount of time, but this is an eight year program. And so once you're in, you're in and you're set for the next six, seven years, however many are left in the program. But it does take some time. And I do think that's the most important thing that we try to set expectations around is we can't really affect that timeline very much because it is a separate third party background check that Medicare runs.

Miriam Allred (18:20)
Okay,

so let's talk about the what's next. So the company comes to you, they get that piece solved, then what? There's the clients, there are these dementia clients out there and they have to enroll into the program. the family and the individual enroll? Does the home care company enroll or does PocketRN enroll the individual? Then there's the individual enrollment process, explain that.

Jenna Morgenstern-Gaines (18:47)
Totally. Great question. So, let me take a step back to and sort of walk through.

who the GUIDE program is for. And that will also help illuminate how that activation process or enrollment process works for, for patients and families. So ⁓ patients who are suffering or clients who are suffering from dementia and their families, their loved ones are the target audience for GUIDE who are receiving the GUIDE services. And they have to, the patient, the individual has to have a dementia diagnosis in order to be enrolled into the program.

⁓ And they have to be on Medicare A and B so traditional Medicare. They cannot be on Medicare Advantage now and if you're a a home care agency, you may not know this you may not know whether you're your your client is a Medicare is on Medicare Advantage is on traditional Medicare and honestly, sometimes the families don't know and this is a confusing process for for families to navigate themselves. and so that just the eligibility criteria are important.

There

are couple other exclusion ⁓ criteria. So you can't actively be on hospice and receiving GUIDE services. You can't be in a PACE program, but you can be, you can be receiving Medicaid services. You can be receiving services from the VA. So all of the GUIDE services, so long as you're on traditional Medicare and you have dementia are additive to the VA, to Medicaid. It's not intended to replace any of those additional services that they might be receiving. So just to give you a picture of,

of who's kind of eligible here for the program. Now at.

Miriam Allred (20:31)
And let

me ask one question on that. You say they have to be on Medicare A and B. Can you just high level explain like the nuances to both?

Jenna Morgenstern-Gaines (20:40)
Yes. So usually, usually you would be on, if you're over 65 and you're enrolling in Medicare, your traditional Medicare, you're usually going to be on A and B. So A is for inpatient care and services. Any service you get in the hospital, you get in the emergency department. B is for outpatient. So that might be an outpatient clinic, could be an outpatient wound care clinic. It could be home health. And usually you're at least going to be eligible for both and enroll in both. It's when you,

you get Medicare Advantage that you're then you're getting C and D as well. And so, know, under, under, in most cases, we're not finding that folks are enrolled in A but not B or B but not A. It's, it's fairly uncommon. And so the best way to know is if you have a red, white and blue.

care card, which is actually a piece of paper. ⁓ It's more like a business card than it is ⁓ a plastic card. And that has a Medicare ID number on it. And we, PocketRN will run eligibility based on the Medicare ID number. the families don't even necessarily need to know for sure. If they're interested in the program and they want to see if they're eligible, we will run the ID number through our EMR and through our EHR. And that will tell us what

whether

they are eligible or not, whether they have A and B or not. And if they're missing a piece, you know, can, if they're eligible to get it. So it is a bit of a nuance, but it's unusual that they wouldn't have A and B. The more common issue is that they are on Medicare Advantage when they think they're on traditional Medicare. And that red, white and blue Medicare card and that number is what we use to verify that. And we can take care of that. So they don't need to go through the whole process of trying to confirm or figure that out.

Miriam Allred (22:29)
Perfect answer. Those were all the sub questions that I had and you nailed that. So then, okay, let's talk about then the process. Does this a client find the agency? Does the agency find the client? Does PocketRN source the clients? Like where are these right fit clients coming from?

Jenna Morgenstern-Gaines (22:33)
Yeah.

Yeah.

The answer to the short answer to that question is all of those directions and more. So it goes, it goes all ways. But to sort of give you the, maybe the 80-20 rule of what we see most often these days is two tracks. So one is ⁓ we might be working with a home care agency and that home care agency might say, we have...

20, 25, 30 clients that we're already serving that have dementia and that we believe have traditional Medicare. you run, they are interested in the program. Can you run eligibility and then take them through the enrollment process, which also is not overnight. And we can dive into that more deeply, but it requires, there has to be a welcome call, a comprehensive assessment. We've got to gather documentation, submit that all to Medicare and then Medicare has to, again, approve. It doesn't take the 10 to 14 weeks that it takes a partner to be approved, but that

that

all does take some time. But before I go down too deep there, the agency might come to us and say, okay, we've got these 20, 25, 30 clients that seem to be eligible and are interested in the program. We then walk them through the enrollment process. And if they want that, presumably, that agency to be their respite care provider, because they're already engaged with that agency, they probably love their caregiver and they love the care that they receive, then once that agency is

as a partner organization, which usually has already happened. And once that patient and family are enrolled in the program, then they start receiving GUIDE services, which includes our Nurse for Life, includes caregiver education from Nevvon daughterhood peer support groups, all sorts of great services and care. And they can start receiving the respite care, which their home care agency that they're already working with can then deliver. And so there's a two track process, both the partner has

to be approved, the patient and family need to be approved. And then once they're enrolled and aligned to the GUIDE program, they can start receiving those services. So that's one path that happens quite often. The other path is, and this is one of the reasons why it's so important to get involved in GUIDE if you aren't already. The other path is that we have patients and families coming to us, us PocketRN all day long, calling us, emailing us.

wanting to get enrolled into the GUIDE program because they need the support really, really badly. And Medicare did something amazing, which is at the end of the year and the beginning of this year, they sent out letters to every potentially eligible beneficiary in the country. And on those letters, they had contact information for PocketRN or any other participants that could have served them.

believe

that about roughly a million letters went out to people with pocket RNs contact information on it. And every day they're calling and asking to get signed up for GUIDE. So once a patient or family called, maybe they're in Denver, Colorado, or maybe they're in Wyoming or wherever they might be. We then look at the list of partners that we have in that partner organizations that we have in that geography. And we have a round robin system so that it's fair and consistent where we work through a list.

⁓ to reach out to those agencies and see if they could partner with us for this specific patient and family. And for those families, a lot of the time, that's the first time they're receiving home care. so that is the other direction, and that is growing every single day. And every day we're working with our home care agency partners across the country to help support these new families that are coming to us out of the blue for the first time.

Miriam Allred (26:40)
Super interesting, especially that second path I was gonna ask, how are these families coming to you? But good on Medicare to actually supply that information to these people en masse via letters. I think that's interesting and amazing. Talking about the first path that is more traditional, the more common approach, a lot of these home care providers are private pay and there's a lot of private pay.

Jenna Morgenstern-Gaines (26:44)
Yes.

Miriam Allred (27:04)
dementia clients and families out there. The path that you mentioned is that the client is already engaged in Medicare part A and part B, and so that's kind of the natural easy fit. But speak to dementia private pay clients. What is the path and the process for them?

Jenna Morgenstern-Gaines (27:21)
Yeah, that's in some ways it's exactly the same. So, know, when you're a home care agency owner and you've got, let's say, you you're a franchise in, you know, Cleveland, Ohio, and you've got 100 clients on your your census on your and that you're serving. ⁓ You probably have 60 to 70 percent of your patients or clients probably have dementia. ⁓ And let's say you're all private pay.

doesn't matter, it'd be all private pay and of that, probably around...

50 to 60 % have traditional Medicare. The country splits even kind of traditional Medicare to Medicare Advantage, but in private pay context, we find that skews a little bit more to traditional Medicare, that A and B versus Medicare Advantage. So if you've got 100 clients and you're doing private pay, you've probably got 30, 40 that today would qualify for GUIDE because they have dementia and because they have traditional Medicare A and B.

contact. I mean, that often is in many ways one of the most common paths where an owner or the operations manager for a given franchise or agency will say, I have this population of patients, they have dementia and I believe they have traditional Medicare A and B and pocket around, can you please help me verify that? And they're interested in the program. And for most of those clients,

they're receiving, they might be receiving a lot of care already, but they usually need more home care. And so for those clients, what we most commonly see is that maybe they're getting 40 hours of care a week already and the family will use the GUIDE respite care allocation to increase their hours. So maybe they'll go from 40 to 44 and maintain that for as long as they can until the, know, until the allocation runs out, which means that they're getting an extra four hours of care a week that they might need.

is getting paid by us to deliver that respite care. Now, some like to use the respite care all at once. Maybe they're going to a family wedding over the weekend. This happened with one of our families. And they want to use 72 hours over the course of Friday, Saturday, and Sunday to be able to have that experience as a family. And so there's flexibility in how that respite care gets used. But private pay, dementia clients, extremely common. ⁓

in a given agency with 100 clients, you're probably going to find that 30 or 40 qualify right off the bat for that, for GUIDE and for that additional rest of care.

Miriam Allred (30:06)
So let me make sure I understand this because it feels to me like there's like a gap here. So that private pay client has Medicare, but they're not taking advantage. There's no payment for any of their home care by Medicare at that point in time. Like they have it, but they're not utilizing it. Is that a gap in the home care agency's knowledge or is that a gap in the family's knowledge? It just feels like there's like a gap here.

Jenna Morgenstern-Gaines (30:33)
Good question. So GUIDE is the only way that today, traditional Medicare, Medicare A and B will pay for home care. up until year and a half ago, ⁓ traditional Medicare, Medicare A and B, ⁓ if you were, know, your private pay client, with dementia or otherwise,

you couldn't tap into Medicare to get reimbursed or to get an allocation of home care hours. This is brand new under the GUIDE program. up until a year and a half ago or so, you might've had traditional Medicare, Medicare A and B, but you couldn't get home care paid for, so you paid for it privately. You pay for it out of pocket if you can afford it, which most people cannot, ⁓ but some can. And that's the backbone of the

the private pay home care industry. under the GUIDE program, if you're enrolled in GUIDE, you can get an allocation of home care and that allocation you can't tap into unless you are enrolled in the GUIDE program with a participant like pocket PocketRN and the organization that delivers that respite care, that home care has to be a partner organization to pocket PocketRN or another participant under the GUIDE program.

So there is a gap in the sense that up until a year, a year and a half ago, you couldn't get home care paid for by Medicare. This is brand new, but now you can. And then there's definitely a knowledge gap. People are just not aware of this yet, but they're becoming aware, rapidly becoming aware. So does that make sense, Miriam? Does that help?

Miriam Allred (32:12)
Absolutely,

exactly. Exactly what my misunderstanding was thinking that maybe there's others that have that misunderstanding, but that makes perfect sense. There was no way to utilize your Medicare for home care until the GUIDE program. And now it's the only way in which you can utilize your Medicare benefit. So you're talking about respite care. You're talking about these kind of supplemental home care hours. Spell out exactly what the client, the family gets.

Jenna Morgenstern-Gaines (32:22)
Exactly.

Yes.

Yes.

Miriam Allred (32:39)
once everything is established, like what specifically do they get?

Jenna Morgenstern-Gaines (32:43)
Totally. there's, and before I go into that too, Miriam, one thing that might be helpful for your audience too, because it can get confusing, the different payer sources, you have, you've got Medicare, traditional Medicare, which is what we just talked about under, under the GUIDE program. You've got Medicare Advantage, which is a a different payer structure. And under Medicare Advantage,

At times, you can utilize supplemental benefits for home care. Now, that's a totally different population than what we're talking about, because if you have Medicare Advantage, you're not eligible for GUIDE, at least not today, although that might change in the future. And then there's next.

Miriam Allred (33:24)
Really quickly,

really quickly, Medicare is a national program, Medicare Advantage is a state program, do I have that right even?

Jenna Morgenstern-Gaines (33:31)
Great question.

Medicaid, which was the third one, the third pillar here, most often filters through the states. so more of it is more of a state program and every state can be different. So Medicare, Medicare Advantage.

both national but Medicare Advantage plans can differ and they're diverse, they are structured in a different way. And if you are receiving Medicare Advantage, it's usually being delivered through what you might more commonly see as a commercial payer like Blue Cross Blue Shield or Humana or United in some cases. so ⁓ if you've got a card that says blue and you're over 65 and you have Medicare of some kind and it says Blue Cross Blue Shield

It says it might be an indicator that you have Medicare Advantage. Always good to double check and run things through the eligibility checks, but that's kind of what it looks and feels like a little bit under Medicare Advantage. Now Medicaid, which is traditionally for low income individuals, is a state program and you can get home care under certain Medicaid.

waiver programs and Medicaid's under a lot of pressure right now. so that might, that certain things are changing under Medicaid, but we work with agencies that do a lot of work in the Medicaid space, but they have dual eligible. So that means folks that are both Medicaid and Medicare, and they're eligible for both. So they're over 65 and they're low income. And in that case, they can get both services. They can get their Medicaid services and they can get their traditional Medicare services. So Medicaid is the one that sometimes leads to some confusion because

the people might mix up Medicare and Medicaid and the benefits and the programs, the home care programs that are out there today. So let me just pause there, Miriam, and see if that makes sense. And then we can go into your great question about the services that families receive.

Miriam Allred (35:24)
That was great. That was perfect, like high level simple of the three different payers. Because again, there's just so much confusion here. And that is the mystery that home care companies have to understand through and through to then be able to go out and educate their family and client population. And so there's just all these nuances. So that was really well said. So yes, back to the original question, which is Medicare, the GUIDE program, what does it provide?

Jenna Morgenstern-Gaines (35:32)
Thanks

it.

Great

question. Yeah. So, take a step back.

The GUIDE program is an innovative model for supporting patients or clients and their families at through their dementia journey. And it intends to provide comprehensive services, particularly for the family caregiver. And because the family caregiver, as you know, is the one who is often shouldering the financial, emotional, physical burden of responsibility of caring for ⁓ their loved one. And the whole goal of GUIDE is

is to keep dementia patients and their caregivers and their families healthy at home for longer. And in so doing, improve quality of care and reduce total cost of care. And so it's a very unique program because it's focused on the family caregiver, because it's focused on continuity over a long period of time and filling gaps, and because it's focused on care at home and for the first time, reimbursing for home care, for the first time, you know, making sure that the home is the center of care where all the little things

happen in the little moments in between. That's when where health care ⁓ really exists. So to answer your question about what do you actually receive once you're enrolled in the program. There are nine care delivery domains that are a part of the GUIDE program. And I do think it's important to focus on this for a minute because often the GUIDE program gets kind of chalked up to respite care. But there are a lot of different components of the program that are hugely valuable and need to

together in concert in order to keep that family healthy at home. So I won't go through all of them, but in order to be a GUIDE participant, you have to be able to deliver between you and your partner organizations on those nine domains. And that includes an assessment at the beginning, care planning, includes care coordination, it includes medication management, 24-7 access, it includes caregiver education, it includes coordination of community resources, and it includes, of course, respite care.

So there's a lot that goes into it. And at the center of that model is what's called your care navigator under GUIDE. And at pocket PocketRN, your care navigator is at your nurse for life. So this is a dedicated nurse who becomes a part of your family and is matched to you based on your specific needs. And that nurse for life is checking in on you on a regular basis, usually on a monthly basis, but it can vary depending on the severity of your, of your dementia. They're helping.

you with practical strategies to manage ⁓ evolving changes in behavior and symptoms of ⁓ dementia. And they're trying to see around corners too and get ahead of issues before they become big, big problems. And so that care navigator, that nurse for life is at the center of everything. And it is really kind of the rock for patients and families in this program. in addition to that, they also get access to their care team.

24 7. And so if some if they have a question or something comes up, they can always reach out to the broader care team at pocket PocketRN or to any participant that that they're and that they're working with. They also get care caregiver education. And one of the unique things about pocket PocketRN and our model is that ⁓ we have a very close partnership with a nivan that has amazing family caregiver training and content. Sometimes when you're a you know, a tired family caregiver, you get home from

long day. You don't want to, you have a question, but you don't want to talk to someone and you just want to watch a short video about how do I manage sundowning for my loved one. And that's where that education comes in handy. They also get access to peer support groups via Daughterhood, which is an amazing organization. So you can get together with other family caregivers and learn from each other and support each other. And there's a whole other library of resources that we provide as part of our program. So games,

that inspire connection like memory lane games, vivid pics, medically tailored meals like Cook Unity. Everyone needs something different. And so our goal is just to provide a set of resources so that no caregiver ever has to Google anything ever again. ⁓ And that families can have that quality time back together that they need and enjoy the good days and be prepared for the bad days. Now that's everything else ⁓ except home care and respite care, which I will dive more into the weeds on.

So the respite care piece is a vital component and it's a huge milestone that Medicare is reimbursing for home care. Traditional Medicare is reimbursing for home care for the first time. It is a testament to all of the amazing work and impact that the home care industry has day in, day out that we all know about on keeping patients and families healthy at home. So the respite care allocation, it essentially serves as a break.

as a break for family caregivers. It's not intended to be wholesale home care all the time. And so you get an allocation of about 72 hours of respite care a year as a family. And so you get to decide as a family how you want that to be used. That being said, you work with your home care agency to come to some sort of agreement on what works for you and your agency. Now, the home care allocation, the respite care allocation,

does have to be delivered in four hour increments of care. And so it's not a one hour here, one hour there. And there are some guardrails, which really helps in many cases the agencies to be able to manage their time. But it could be used, as I mentioned before, all over a weekend. It could be used for four hours a week for as long as the allocation lasts for. People use it differently depending on what their specific needs are. And a lot of the time,

is

an existing client, as we talked about before, maybe private pay client, and that has Medicare, and they have 40 hours a week and they want more. And so they increase the 40 to the 44 hours a week, or they use it all in a given a busy month for the family. And so that respite care is actually, it's a tremendous lifesaver for so many families that are just trying to make ends meet and trying to care for their loved ones and need that.

bit of a break. And so that's kind of the nitty-gritty of the services and what you get under GUIDE and a little bit deeper into the respite care piece.

Miriam Allred (42:32)
Fantastic. I'm just like absorbing all of this in real time. Let's paint all of that into a picture with an example. Can we do that just to make sure we understand how all of this fits together and what it really looks like in application? So let's start with like the start of care of a client. So say the home care company is working with PocketRN, everything's in place, the care navigator, the client, the start of care.

Jenna Morgenstern-Gaines (42:41)
short. ⁓

Yes.

Miriam Allred (42:59)
Can we kind of walk through, I don't know, maybe like the first 30 days or even the first 90 days, who owns what and what all of like the key components, like milestones are.

Jenna Morgenstern-Gaines (43:02)
Yeah, sure.

Absolutely. So I will walk through step by step how it works. So let's say, let's just start with the flow of ⁓ a family comes to us from a home care agency partner of ours. And then we can go the other way around, although it's not too much, not too much different. So the agency that we are working with, they will submit some basic information about that family to us through what's called a tracker.

where we need data points about the name of the patient, their date of birth, their Medicare ID number, which you can get just by taking a photo of that Medicare ID card or by typing in the ID number. Now, once we get that information, we can check eligibility for that family. So at that point, they've already had a discussion with the home care agency and the family about this program. They're excited.

They want to know, they want to confirm, okay, are we actually eligible? We'll run that Medicare ID number through our EHR to verify that they are indeed eligible. They do have Medicare A and B. Again, we can take care of all of that. And if they are eligible, then from there they'll do a welcome call. And that welcome call is with an intake specialist on the PocketRN team. It'll help kind of walk them through the program in a little bit more detail and get some of the initial information, some questionnaires that we need.

the family caregiver usually to participate in and to provide us with some information on to get them to get them started. Then they will have what's called a comprehensive assessment with a nurse who ultimately will become their nurse for life ⁓ and that comprehensive assessment is much more in depth. It can be a 90 minute meeting virtually and it's a virtual meeting sometimes sometimes ⁓ well almost always at one of the family or multiple

of the family caregivers will be present for that meeting alongside of the patient. The family caregivers might be in all different places. They might be in Boston and New York and DC, but they all can be on the HIPAA Compliance Zoom meeting together. The nurse will go through a lot of questions and some of them are a bit more sensitive. And so we try and really prepare people for these meetings. So they'll go through a background on their medical history. They'll ask the caregiver some questions. They'll do some cognitive assessments.

as part of that meeting. And based on that, we will package up all the information that we've gathered as well as documentation that we might need from the family. So we might need their power of attorney paperwork. We might need dementia diagnosis documentation. We gather all of that up and sometimes our agency partners are helping to nudge the family if they haven't sent us the POA paperwork. And so we're collaborating and communicating.

through that process. And the last piece of the puzzle that we need our, that our agency partners help us with is a home visit. Now, most, most families under the GUIDE program require a home visit in order to ensure that, that they are eligible for the program and for the respite care. Our home care agency partners are often going into the home for QA visits or supervisory visits. People will call them, call them different things.

doesn't need to be with a nurse, doesn't need to be with a clinician, it can be with a care coordinator, it can be with a case manager, everyone has different terminology. And so that regular visit that they're doing to the home anyway, ⁓ often on a 90 day basis cadence or sometimes more often, sometimes less often, that visit can satisfy the home visit requirement. And we ask that they provide us essentially with their latest ADL, IADL functional assessment that comes out of

that visit as supplemental documentation to provide to Medicare and we pay our agency partners for that visit into the home. And so we gather all that up, that gets submitted. It's a collaborative process as you can tell. It's not a referral handoff like, go pocket around, you go, you know, we do the vast majority of the work, but you know, it's not a one and done. There's close collaboration and communication. And once we submit it to Medicare, it doesn't take Medicare long to approve

approve.

It can be a matter of days before we get the thumbs up or thumbs down. It's almost always a thumbs up that they're approved. And once they get approved, we send out an authorization to both the letter, both to the family, letting them know that they're in and also to the agency. If the family came to us through an agency and that they're authorized to deliver the 72 hours of respite care so long as that is

what the family also wants because patient and family choice are at the center of everything under under GUIDE. so once those letters go out ⁓ and then from there the family will have their first visit with a nurse virtually in that first month and that'll be one of the very first ongoing monitoring touch points that they have with that care navigator and they can start getting all the other services as well. So they can start getting the respite care, they get caregiver education from Navon, they can get the peer support

groups from daughterhood and they can get you know and the medication management support that they need 24 7 access after that after that letter goes out and then we're on an ongoing cadence where we are we are this is a journey and we are we are slowly working with families over time to help them address their and meet their goals whatever that might be it might just be that they want their loved one you know to to smile again and be happy yeah more you know they want and they they want to be able to you know and ⁓

and care for their loved one, but also get a break themselves. And so it just depends on their goals and happy to share some, we've seen some amazing stories of dramatic changes in the families that we've been able to work with who otherwise would have been in a really tough situation. So anyway, I'm happy to go into detail there, but that's already a lot of information on that flow, how that works.

Miriam Allred (49:33)
Jenna, you're on fire. You are

so good. I'm so impressed right now. A couple of follow-up questions. Who is the key player on the home care agency side? Is it the care coordinator that is tightest with that care navigator on your team? Are those the two key players over this client?

Jenna Morgenstern-Gaines (49:38)
Yes.

Good question.

You know, great question. And I will say unsatisfyingly, it depends on the agency. We do find that it depends. the owner is if there's an owner or if there's a, you know, a general manager in the of the agency, you know, they tend to be the first touch point for contracting and for, you know, getting the partnership in place from there on. And there tend to be sometimes a couple of different office staff that we're coordinating with and the care corps.

coordinators are often or the one you maybe they're the client care services and Director or you know client care services manager for certain for certain for a cohort of clients and families They're often the ones that we are then communicating with as care go as care continues and and goes on over time now There is engagement with the professional caregiver on the ground as well. So, you know just to give you an example sometimes we

will have a visit and will notice something about the home that is valuable for the professional caregiver and the agency to know before they enter into the home again, or even if they're there in the moment. So there were times when we met with a family and they had cold and flu-like symptoms and turned out they had COVID. And we let the agency know right away, hey, ⁓ the family seems to be sick. You might not want to send the professional caregiver in there so that they, or you make sure they're full.

PPE, know, whatever, whatever the protocol is and, and make sure to follow it. And likewise, there was a time when the rug was turned up. And if you're a virtual nurse on a zoom call, you unfortunately can't add, uh, you can't fix the rug. But if you know the professional caregiver is coming into the home, we can give the agency the heads up. Hey, like there's a safety, there's a safety hazard in the home. Can you tell the professional caregiver as soon as they get there to make sure to add, to fix the rug in the living room so that they don't accidentally trip and fall. Um, so things like that.

that are really important in order to be able to keep patients and families or clients and families safe and healthy that will be communicating about ad hoc as they come up.

Miriam Allred (52:02)
Where does that communication and information live? Because for one client, there's just this like mountain of information about their health and about all of this information that all parties are coming upon. You think of the home care agency, you know, they've got all this documented in their operating software. Do you all have a software that integrates with that? Where does the communication, like you just said, your care navigator comes on a piece of information that that caregiver needs to know. Where does that communication and information live?

Jenna Morgenstern-Gaines (52:10)
Yes.

Yes.

Yes.

Yeah, great question. ⁓ the short answer is the vast majority of our clinical documentation or all of our clinical documentation has to be in our EHR as a Medicare Part B provider. And actually there are certain stipulations even about what EHR you can, what kind of EHR you can and can't use as a Medicare Part B provider under GUIDE. So everything of clinical importance and ⁓ documentation

lives in our EHR. being said, there's so much real time communication and operational communication that also has clinical implications such as a rug being turned up, right? And so we also have our own, we have built our own HIPAA compliance software called, which is our pocket PocketRN web-based app. And our partners are operating within that, they get provisioned.

access to their own quote unquote clinic, which is for their agency, where we can communicate in real time and share information in a HIPAA compliant way and communicate about patient or client care. Now, if that being said, if a rub is turned up as an example, we can communicate that about that in the PocketRN platform. We're also just going to call the agency or email the agency and make sure that they get that information as soon as possible.

so that they can act on it and not have it be sitting in ⁓ their portal, which is valuable for information capture and for seeing data and trends over time. But if they need to know something that is important for patient or client care, then we want to make sure that they get that information right away. And so there's a software component, but there's also the operational integration between us. And because we've worked with Homecare, our whole

life as a company and we know that that life is crazy sometimes and we want to fit within their workflow and meet them where they are and so you know we do we don't and we don't want that ever to come at the expense of client care or patient care.

Miriam Allred (54:45)
Yeah, fantastic. Let's talk about the outcomes here, the implications for the home care companies. think between us, there's a lot of obvious benefits and advantages for the client and the family. think those are, we don't have to necessarily state and identify, but what burden are we removing from the home care office team? What gaps and problems and burdens are we solving for them with this program and with this partnership?

Jenna Morgenstern-Gaines (54:49)
Yes.

Yes. Yeah, there's, there's a lot to speak to here. So let me talk about, the longterm and then I'll bring it back to, kind of the short term and the day to day, you know, for the office staff. so, so big picture, why this is so important is because Medicare is basically for the first time recognizing the value of, of home care and paying for it and reimbursing for it. And that is, as I are, as I mentioned,

a huge milestone and it's an opportunity and it's an opportunity for us collectively to take advantage of and so ⁓ Long-term big picture the goal here is to be able to validate that the nurse for life model You know under the GUIDE program plus home care plus all the other maintenance services that come under GUIDE caregiver education, etc, etc ⁓ That that is the winning formula to keep patients and families healthy at home and the long

game for all of this is that we take that data and that validation back to Medicare and it's going to be evaluated formally and we also want to present our own data and our own outcomes so that home care can ultimately become a reimbursable benefit under Medicare, which would open up home care to the 50 million older adults today that need some form. mean, home care is a

essential to keeping patients or clients and families healthy at home. And so that is why this program is so important. It's not just about the short run. It's not just about the, you know, the extra hours of care. It's about

this becoming a peek into the future of what Medicare will be and how central home care will be to that that vision and journey and so long term ⁓ that is that is where that is you know the the big picture behind why GUIDE is is so important and the problems that the big market problem that ⁓ that it solves is that ⁓ you know currently there are only a few ways to get paid for home care it's private pay or it's Medicaid or it's VA this opens up the aperture to

tens of millions of people. So that's the big picture. the short term is, ⁓ would put it into, there's kind of two different buckets that I would put this into. there are some obvious short term business opportunities and growth opportunities for home care agencies. There's obviously under the respite care allocation, you can increase hours of care.

for existing clients. You can gain new clients like we talked about that are calling us, know, phone off the hook all day long. You can expand to new referral sources. So there are obvious business growth opportunities and we see that all day long. So we see our, you know, some of our best agency partners. We've got one that, you know, she was trying to get her foot in the door with a hospital, local hospital for a long time, you know, for years they had never taken a meeting with her. They finally did because of the GUIDE program and now she's receiving

and that was her foot in the door. And now she's receiving five referrals from them a day and not just for the GUIDE program, also for 24 seven care and for others. And so, you know, there's a tremendous opportunity to be able to serve new patients or clients to expand the amount of care that you're delivering to existing clients and to, grow the pie. And because there are so many folks in need and there are so many organizations that have, that have dementia patients and clients that, that know that they need additional support. But the, ⁓

other short-term thing that I think is really important and is it gets back, it gets behind the great question that you you've asked me in the past, Miriam, which is, you know, the why now? Why should, why should home care agencies move today ⁓ on GUIDE if they haven't already? And the reason for that is because what we've seen is that the best partner organizations, the best agencies under GUIDE, they actually become true heroes in their community.

out to their community and they're sharing the GUIDE program with hospitals, with senior living partners, with memory care facilities, and they've become the trusted go-to source on GUIDE. And they are seen as ⁓ a hero to not just their existing clients and families that are proactively, they're bringing them proactively these new set of services, but also to the whole community that recognizes this is a huge problem and there isn't enough care for patients and families struggling with dementia.

today and so those home care leaders have really become positioned as the experts in dementia care in their universe and that is a huge differentiator for them. ⁓ It means that when someone is a new client and they're deciding between Miriam's home care agency that's in GUIDE and Jenna's home care agency that's not in GUIDE.

Obviously they're going to go with Miriam because they're going to get additional hours of care that are paid for by Medicare. They're going to get a care navigator and they're going to get a partner that actually understands how important this is and how much, how in need they are ⁓ as they go through that dementia journey. it's a huge differentiator. It's a huge way to position yourself as a leader in your community in dementia. And that's what we're seeing from the best agency.

Miriam Allred (1:00:21)
Thank

Jenna Morgenstern-Gaines (1:00:50)
out there and now is the time because patients and families are now coming to agencies saying, hey, do you support the GUIDE program? Because if not, I might switch. I might go down to Miriam's agency down the street because she's offering GUIDE and you're not even if I've been with you for five, six, seven years, it's happening. And so now is the time to really be at the forefront of this and the cat's out of the bag a little bit already, but it's still not too late. It's still not too late.

Miriam Allred (1:01:17)
And I just want to put a plug in for what I shared with you before the show, is, a close friend of mine in the industry in Pennsylvania, an established home care company. said to him, what's on your radar for 2026? And he said, we're going in on GUIDE. We see the writings on the wall, the opportunities there. They are established processes through and through. he said, there's this growing demand and we want to have this opportunity to serve our clients in a different way.

and it's innovative and we want to be a part of the next wave of home care. And I just, on a personal note, I feel this sense of like hope in the country. We talk about our healthcare system and it feels broken and fragmented and it's really easy to get doom and gloom on healthcare in this country. But Jenna, you sharing all of this, I feel this sense of like hope, like our country is recognizing we need to take care of these patients and these families and long-term care and keeping people.

at home healthy and safe is the place that they want to be. And it's like, we want to be a part of this wave of health care and home care in this country. And so I just get excited. What an incredible opportunity. And PocketRN is leading the charge and making it easier and accessible for home care companies to be a part of this without putting the additional burden on them. know, home care companies, what they do best is taking care of these clients and these families. And you will take off kind of the manual back end burden.

and help them get out there and do what they do best. so I just, I think the world of you, Jenna, I am just so impressed with how much you shared today. I think this is super insightful for home care operators listening to this. I guess just in closing, obviously pocketrn.com, get there and get involved. Any other ⁓ advice for companies maybe on the fence considering, but not sure.

Jenna Morgenstern-Gaines (1:02:54)
Yeah.

sure.

Miriam Allred (1:03:03)
Like what would you say to them and why should they get involved and then how should they get in contact with you and your team?

Jenna Morgenstern-Gaines (1:03:08)
Totally. So I'll start with the tactical and I just couldn't agree more with the sense of hope that you conveyed, Miriam. So the super easy way, you can go to the website, pocketrn.com. can email sales@pocketrn.com which is the email. The email is served that we use to inquire about becoming a partner organization under GUIDE, and we will send you all the information that you need to get set up.

And, you know, I think if I could, you know, we've been able to cover, so your questions are so great, Miriam, and such a wide, you know, ranging discussion about, you know, the reasons to get involved and GUIDE. And I think the only one that I, you know, that is worth ⁓ doubling down on is what you just said, which is that it's really an opportunity to help people. And I, every, almost every home care operator that I come across, they got into this

business because they wanted to help people and they probably had a personal experience too that brought them there. And so, you know, it's the GUIDE program, I'll be honest, it's not perfect. It's great, but it's not perfect. And there are ups and downs and it's a new model. So things change. So you have to have, you have to have patience with the program and know that things are not always black and white and they can, they could change. But if you're motivated by the mission of it, then it's going to feel worth it. And what I find is most, you know, most, most,

operators that I come across, they're doing it for that reason. And I think the only last thing I could sort of leave with you and everyone is. ⁓

when everyone, you know this all too well, but you know, when you become a family caregiver for a loved one who's gotten a diagnosis of dementia, you're really alone. There is nobody outside prior to the GUIDE program, there was really nobody that was looking out for you and trying to be the expert in supporting you for the duration of this journey. And the only thing I've ever been able to compare this feeling to, knowing it myself,

you know how others experience it is. It's kind of like being a new kid in school, and you're joining a school for the first time. You don't know anyone. You don't know your schedule. You don't know how to get from one classroom to another, and you feel lost and you feel confused. And someone in your homeroom or your class or whatever, they reach out their hand and they say, let me help you. Let me show you how to get to your next class. Let me teach you. Let me show you which teacher you should go with over another. You can come sit with my friends.

at lunch, like I will be there for you ⁓ and I'll be your friend. And that's what Guide does and what PocketRN is fortunate to be able to do in partnership with Home Care for families. We actually have the opportunity to reach our hand out and see someone and say, hey, we've got the relevant knowledge to help you and walk alongside you for this journey. And we actually care. I think that's what's most motivating. And I'll just share one of our family caregivers said to us the other day.

⁓ that if we had never met you, we would be in a constant tailspin and we would be navigating this alone with no lifeline. And that means the world, because I can say it all day long, but when I hear it from a family caregiver, ⁓ you just feel and know that you're making an impact. I don't think there's anything more motivating than that. So anyway, that's what I would leave people with if they're on the fence, if they're thinking about it.

Miriam Allred (1:06:30)
Yeah.

Jenna Morgenstern-Gaines (1:06:47)
we're always happy to talk to people about the details and walk through the program. We're very passionate about it ourselves.

Miriam Allred (1:06:54)
Fantastic. And for what it's worth, every company that I've spoken to that is working firsthand with PocketRN, you all are a true resource to these home care companies. You just shared, you know, from the caregiver perspective, but I think a home care operator listening to this may think like, it's a lot of information. It sounds intense. Do we have the bandwidth to take this on? But you all are an incredible partner in taking the home care company through this journey so that they become the GUIDE expert. It's not all on PocketRN. It's actually the home care company.

the administrative team, all getting on board, all being educated, all becoming the experts on this program to then be that backbone support to the care staff out in the field. And so again, I just hear nothing but good things and you have delivered so incredibly on this show, Jenna. So thank you for joining me in the lab. We'll go ahead and wrap here, but highly recommend everyone connect with Jenna and the team, look into GUIDE and see if it's the right fit for your business.

Jenna Morgenstern-Gaines (1:07:47)
Thank you so much, Miriam. I really appreciate you having us.