Over Jessie Waks’ 17 years at Bluestone Physician Services, a Stillwater-based clinic, she has noticed a trend: The number of patients or patients’ families choosing to receive care at senior living communities has gone up. So has the number of senior living communities.

Despite those increases, dementia care continues to present a considerable challenge to physicians, Waks says, including those at Bluestone, which provides primary care to patients in assisted living and group home settings and counts memory care among its key services

“It’s not uncommon for a patient to make it through the entire medical system, and get even all the way to memory care, and not have had a provider sit down with them and explain what dementia is, what to expect, what will happen as the disease progresses,” says Waks, who is senior vice president and head of primary care.

Waks says clinicians often lack the bandwidth for such attention, and patients’ families end up taking on major responsibilities, even for patients in assisted living communities. Families of dementia patients also face difficulty navigating the complex health care system, and dementia care tends to require more—and more constant—attention than traditional health care can offer.

In the United States, there are 6.7 million people with some form of dementia, and the number of U.S. dementia patients is projected to grow by nearly 14 million by 2060—an unsettling statistic linked to lengthening lifespans, as dementia mostly affects older people.

In July 2024, the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid, attempted to address these concerns and improve dementia care by launching an eight-year Guiding an Improved Dementia Experience (GUIDE) program. Bluestone was selected as a participant by CMS the following August. It began offering GUIDE services in July 2025.

The program allocates “care navigators” to assist physicians with care for eligible and enrolled patients. It also provides up to $2,500 in respite benefits, which tap caregivers to temporarily relieve unpaid providers, such as family members.

The goal is to allow patients to stay in their communities longer and to make the caregiver workload more efficient, Waks says. She did not disclose how much funding GUIDE has provided Bluestone but noted, “[GUIDE] gave us another revenue stream to hire additional care team members and fill some of the gaps that even we aren’t able to meet just within primary care.” The newly added staff is 20, including care navigators.

“So now we have more staff to be able to deploy to the patient’s bedside, in addition to the primary care provider who is servicing the building,” says Waks.

With GUIDE’s assistance, Waks says, Bluestone’s primary care providers—the physicians, nurse practitioners, and physician assistants—can focus on medication and clinical work. Meanwhile, GUIDE care navigators sometimes go into patients’ homes, supporting staff and patients’ families while helping patients who may be experiencing increased anxiety or restlessness.

“Bringing a patient with dementia out of their home can cause increased confusion and chaos for them and really disrupt their lives,” Waks says, adding, “We know that [home] is the best place for chronically ill patients, specifically [those] who have dementia. Our goal is to keep them home as much as possible.”

Medicare spending cuts are anticipated from the Trump administration’s One Big Beautiful Bill Act, signed July 2025. The bill is projected to slash Medicare by $536 billion over the coming decade.

While Waks is unsure of how that would affect the GUIDE program, she says the program’s support is critical “for patients like ours, who often cost the system quite a lot.”

Bluestone’s crew totals about 600 employees. They work for about 18,000 patients in primary care, spread across 600 assisted living and group homes within the Minnesota market. Outside Minnesota, Bluestone also has a presence in Wisconsin and Florida.