GUIDE Companion

AI Powered GUIDE Companion: Confidence and Connection Across the Dementia Journey

GUIDE Companion aligns health systems, community centers, adult day programs, and families around one shared experience.

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A hand stops a row of falling wooden dominoes.

GUIDE Companion

“Dementia care is not just about services; it’s about giving families a way forward together.”

— GUIDE Program Director, Community & Health System Partner

Family, navigator, and clinician reviewing GUIDE Companion together

GUIDE Companion brings health systems, community centers, adult day programs, and families onto the same page—literally. Built on the genusPlatform and powered by RiverStar’s behavioral health and SDOH intelligence, it ensures the right person reaches out at the right time with exactly the right support.

Most dementia support programs scatter families across disconnected resources: paper handouts that get lost, portal logins they can’t remember, phone numbers that go to voicemail, and community services they didn’t know existed. GUIDE Companion replaces that fragmentation with a single, intelligent layer that sits above your existing EHR, GUIDE registry, and community systems.

Families receive clear, jargon-free guidance plus direct connections to local resources. Nurse practitioners gain structured, billable touchpoints backed by smart prompts and auto-documentation. Community and clinical navigators gain clean pathways plus dashboards that prove their value to CMS, state agencies, and philanthropic funders.

Together, genusConnect and RiverStar bring the complete package: proven workflows, behavioral science, clinical documentation expertise, and technology infrastructure designed to make GUIDE programs sustainable—not just clinically effective, but operationally efficient and financially viable for the long term.

60 Seconds to Connection: Text GUIDE to 211‑411

Imagine a nurse practitioner, social worker, or community navigator simply saying: “Text GUIDE to 211‑411*.” Within 60 seconds, the family’s phone becomes a personalized GUIDE Companion wall—no app download, no login, no complex portal navigation.

Interactive tiles guide families through what GUIDE means, who their care team is, how respite and adult day programs work, and exactly how to reach a navigator when they need help.

Behind every tile lives sophisticated intelligence. RiverStar’s behavioral health and SDOH risk models work quietly in the background to identify needs, prioritize outreach, and surface the right next steps at the right time.

genusAI orchestrates natural conversation, seamless language translation, comprehensive accessibility features, and personalized recommendations—all designed to meet families exactly where they are in the journey.

This isn’t just information delivery; it’s an intelligent companion that gently guides families toward safer routines, timely medical visits, community connection, and the confidence to navigate what can feel like an overwhelming diagnosis.

Every interaction is captured, every question answered, every concern logged—creating a continuous thread of support that keeps everyone aligned.

* Message and data rates may apply. Message frequency varies. Text STOP to opt out, HELP for help. See Terms for details.

Experience GUIDE Within 24 Hours: Your Branded Preview

GUIDE Companion can go from concept to hands-on exploration in as little as 24 hours. We set up a fully branded preview where health system leadership, GUIDE program teams, and community partners can click, test, and explore, with no risk to production systems and no interruption to clinical workflows.

This isn’t a generic demo—it’s your GUIDE Companion, wearing your brand, speaking to your community’s needs, and ready for real evaluation by the people who will use it every day.

The preview creates a safe space for innovation: test messaging with families, explore dashboard views with navigators, rehearse billing workflows with finance, and align expectations across clinical and community stakeholders.

We’ve learned that the best implementations emerge from grassroots input. The preview invites nurses, social workers, community center staff, and family advisors to contribute ideas early—building ownership and enthusiasm before launch.

Navigate the family-facing GUIDE Companion wall with all interactive tiles and AI chat
Explore nurse practitioner and navigator dashboards with real workflow simulations
Walk through Adult Day Companion activity logs and family summary views
Review how AI-assisted conversations are captured, summarized, tagged, and routed to the right team members
Test multilingual support, accessibility features, and mobile responsiveness
Experiment with Care Codes (a code you scan or a link you tap) and onboarding sequences

Open GUIDE Companion preview (opens in a new tab)

Built on Years of “Being There”—Refined by Real Families

GUIDE Companion isn’t a startup experiment. It’s the result of years of work across hospital discharge programs, community partnerships, adult day pilot projects, and thousands of caregiver conversations. It’s built on the same proven platform that powers Discharge Companion, now expanded to support the longer, more emotionally complex arc of dementia and chronic care.

Every detail reflects hard-won lessons from the field. Drawing on carePhysics principles, genusAI capabilities, and RiverStar’s behavioral health and SDOH expertise, GUIDE Companion embeds hundreds of deliberate design choices into the experience.

You’ll find accessible layouts that work for aging eyes and trembling hands. Supportive, validating tone that reduces fear and shame. Behavioral nudges calibrated to encourage action without overwhelming. Caregiver-friendly explanations that replace medical jargon with plain language. Multilingual pathways that honor cultural context.

All of this serves one foundational promise: to be there. Not just at a crisis moment or a single discharge, but throughout the entire journey—from diagnosis through care transitions, family stress points, community connections, and the daily reality of living with dementia.

GUIDE Companion understands that families don’t need more information dumps. They need a steady, intelligent presence that knows where they are, anticipates what they’ll need next, and helps them find their footing—day by day, conversation by conversation.

The Real Risk? Waiting for Perfect

Here’s the uncomfortable truth: dementia cases are accelerating, GUIDE enrollment windows are shrinking, clinician shortages are worsening, and community capacity is stretched to breaking. Organizations that wait for the “perfect” comprehensive solution often find themselves years behind—watching caregivers burn out, community centers close, and reimbursement opportunities pass by.

GUIDE Companion offers a different path: start learning today in a preview that touches no production system, prove value with a focused pilot, then scale systematically into a sustainable, community-anchored program that grows alongside your capacity.

The traditional approach—build consensus for years, issue RFPs, negotiate contracts, implement in phases, train staff, hope for adoption—takes so long that the landscape shifts underneath you. By the time you launch, the workforce has changed, the technology has evolved, and families have already found workarounds.

GUIDE Companion inverts that timeline. Within 24 hours, your stakeholders are inside a working environment, experiencing the actual interface, testing real workflows, and having concrete conversations about what works and what needs adjustment.

This “test-first, commit-second” approach dramatically reduces implementation risk while accelerating organizational learning. You discover friction points early when they’re easy to fix. You build internal champions who’ve actually used the system. You gather evidence from your own teams before making financial commitments.

The families in your GUIDE program can’t wait for organizational perfection. They need support now—this week, this month—while they’re still willing to engage, before crisis forces reactive decisions, while community relationships can still be nurtured. GUIDE Companion helps you meet that urgency with confidence rather than chaos.

Caregiver sitting with an older adult while planning GUIDE support

Maximize Efficiency and Morale with the GUIDE Companion

Streamlined Workload for NPs & Navigators

Fewer repetitive questions: GUIDE Companion handles common questions about dementia, safety, respite, and logistics, freeing NPs to focus on clinical judgment and complex decisions.
Structured, documentable touches: Each call or chat is time-stamped and tagged to GUIDE workflows, helping support documentation for Medicare programs where applicable (e.g., CCM, CHI, TCM) without adding late-night charting.
Clear pathways: Navigators—both clinical and community—see simple “next step” flows: connect to Adult Day Companion, schedule a check-in, flag a respite request, or link to an Area Agency on Aging.

Billing-ready summaries:

NPs can review AI-drafted summaries of calls and quickly edit or approve.
Time and topics are aligned to configured billing frameworks so finance and compliance teams have clean data to work with.

Revenue sharing with community partners:

GUIDE Companion can help track where NPs and clinics share revenue with community centers or AAAs supporting navigation and respite.
Transparent, sustainable funding models keep community-based partners at the table.

Integrated views:

Adult day, home support, and community programs can enter brief notes so NPs understand what is happening between visits.
Shared context allows more precise, empathetic conversations.

Elevated Staff Morale and Caregiver Engagement

Reduced repetition: Fewer “same five questions” calls; more time for meaningful coaching around stress, safety, and planning.
Behaviorally informed scripts: Conversation prompts based on carePhysics encourage calm, validating, and de-escalating communication, reducing conflict and emotional burnout.
Immediate feedback loops: Short caregiver feedback tiles after calls give quick insight into what is working and what needs adjustment.

Illustrative scenario – Enhancing GUIDE Contact

A GUIDE NP shares the text-to-join code before a call so the family opens the same Companion wall.
During the call, the NP uses a GUIDE Playbook: check caregiver stress, review daily routine, discuss adult day options, confirm safety.
After the call, the family receives a recap and a link to request respite or a navigator follow-up; the NP’s time and topics flow into GUIDE documentation.

Caregiver Stress Check-In

Family question: “I feel like I’m burning out—what can I do this week?”

Companion support: GUIDE Companion walks through a short stress self-check, offers simple coping ideas, and nudges the caregiver to schedule a navigation call or referral to respite/Adult Day Companion.

Adult Day Daily Summary

Family question: “I just want to know how Dad did today.”

Companion support: Adult Day Companion notes summarize highlights—participation, meals, walks, and safety—with options to ask follow-up questions or flag concerns.

Safety at Home

Family question: “How do I make the house safer now that Mom is wandering?”

Companion support: Families receive a checklist tailored to dementia safety, links to local resources, and a suggestion to schedule an NP or navigator call for added guidance.

Respite & Funding Answers

Family question: “Is there any help to get me a break once a week?”

Companion support: Tiles present respite options, explain eligibility in plain language, and allow the family to request a navigator call to walk through funding.

Neighbor & Volunteer Support

Family question: “Our neighbors want to help. What’s safe to ask them to do?”

Companion support: GUIDE Companion suggests appropriate tasks, offers boundary guidance, and can generate a “How to help” message the family can share.

GUIDE Companion Supports Families Across the Dementia Journey

Empowering Families with Knowledge and Confidence

Plain-language explanations turn terms like “behavioral symptoms,” “respite,” and “adult day” into familiar concepts.
Stepwise guidance walks families through “What to do this week,” “Preparing for a visit,” and “When to call for help.”
Confidence to ask better questions means visits with NPs and navigators become richer and more productive.

Accessibility options—large fonts, high-contrast modes, audio playback, and multilingual support.
An optional care notebook lets families bookmark key tiles and topics to revisit or share during family meetings.

Guidance to Essential Resources, Supported by Research

Connects families to GUIDE program materials, dementia education, and local community resources such as AAAs, memory cafés, and caregiver support groups.
Aligns with evidence on caregiver support, burden reduction, and community-based dementia services (with deeper references available on the genusConnect Research page).
Encourages adherence to care plans: follow-up appointments, medication routines, safety actions, and respite use.

Comprehensive Support Through Adult Day & Respite Companion

Adult day and respite are core to keeping people at home safely. The Adult Day Companion mode lets centers record key activities and share family-friendly summaries.

Daily snapshots for families (“Today Dad joined exercise, laughed during music, ate well, and walked with staff.”).
Flags for mood changes, falls, or concerning behavior that can trigger NP or navigator outreach.
Evidence to support respite requests and document value to funders and GUIDE evaluators.

Strengthening the Community Care Ecosystem

GUIDE Companion is the connective tissue between hospitals, clinics, AAAs, community centers, adult day programs, and families. It turns isolated efforts into a coordinated ecosystem.

Multilingual, Multichannel Communication

More than 50 language support options help diverse families understand GUIDE resources.
Video, text, and audio options let caregivers engage on the go or late at night.
Accessibility features are designed to meet or exceed 508 requirements.

Building Partnerships for Preventive and Community-Based Care

Highlights local partners—AAAs, memory centers, faith communities, transportation, mental health, nutrition, legal, and financial counseling—for easy discovery and contact.
Encourages shared campaigns such as falls prevention month, caregiver appreciation, and safety checks with tiles across GUIDE walls.
Provides feedback data to community partners so they can see usage and impact.

Use Case – Enhancing Resource Connectivity and Feedback

A caregiver filters for an adult day program with transportation and bilingual staff, watches a brief tour video, and requests an introduction call.

They add the center’s contact to their phone, and the interaction feeds real-time feedback dashboards for health systems and community partners.

Insights show what is working and where new partners or resources are needed.

Transportation coordination between clinics, AAAs, and community vans.
Warm handoffs to counseling, food support, and caregiver mental health resources.
Volunteer visitation campaigns framed around dementia-friendly tasks.

Your Branded Preview: Test Drive With Your Brand, Team, and Community

Inclusive Two-Channel Preview

Family-facing channel simulates the GUIDE Companion that caregivers see, including Adult Day Companion views.
Professional channel gives NPs, social workers, navigators, and community leaders dashboards, playbooks, and reporting to explore.
Both paths carry your branding so the experience feels real without touching production systems.

Positive Messaging and Strategic Discussions

Positions the preview as a safe space to experiment with AI, messaging, and workflows.
Encourages cross-functional conversations between clinical, community, finance, IT, and philanthropy teams.
Captures structured feedback that directly informs the production rollout.

Phase I – Internal GUIDE Leadership (1–2 weeks)

GUIDE program leads, NP champions, and community partners receive preview codes.
They explore content, test messaging, and identify quick wins for local adaptation.

Phase II – System-Wide Exploration (1–2 weeks)

Broader staff, navigators, and selected community centers participate.
Training tiles and sample calls show how GUIDE Companion fits daily work.

Phase III – Early Family & Community Adoption (1–2 weeks)

Selected clinics and community partners invite a small cohort of families to use the preview edition.
Messaging sets expectations that this is early access and that feedback is actively invited.

Open GUIDE Companion preview (opens in a new tab)

From Your Preview to a Live GUIDE Deployment

Fast transition: once workflows and content are tuned, the preview becomes a live GUIDE deployment in days, not months.
Brand continuity: visual branding, tone, and key messages carry over, reducing change shock for staff and families.
Turnkey but extensible: out-of-the-box GUIDE content is ready on day one, with options to add local materials, partner resources, and custom codes over time.

Supporting the Triple Aim in Healthcare plus 1

Refining the Family Experience

Makes GUIDE tangible and understandable, reducing confusion and fear.

Boosting Community and Population Health

Encourages early use of supports like adult day and respite, reducing avoidable crises and ED visits.

Streamlining System Efficiency

Automates common contacts, routinizes documentation, and aligns GUIDE programs with existing IT and EHR investments.

Reducing Clinician and Navigator Burnout (the “plus 1”)

Shifts work toward meaningful conversations rather than repetitive instructions.
Provides AI-assisted playbooks, positive reinforcement, and communication tools grounded in behavioral science.

Fostering Data-Driven Evolution

Engagement analytics, caregiver feedback, and community resource usage data inform continuous improvement and funding strategy.

GUIDE Companion: Grounded in Evidence and Real-World Practice

GUIDE Companion draws on research and experience in dementia care, caregiver support, community-based services, and AI-supported engagement. It builds on the same evidence base that informs the genusConnect platform and Discharge Companion, extending those principles into longitudinal dementia and complex care programs.

SMS and chat-based engagement for caregiver education and follow-through.
Evidence around adult day, respite, and community programs reducing caregiver burden and delaying institutionalization.
Behavioral-science approaches that support motivation, reduce anxiety, and improve comprehension.
Real-world lessons from discharge, community pilots, and navigator programs translated into configurable pathways.

Supporting research

Pricing: Choose Your Path to GUIDE Innovation

Preview Edition – Complimentary for Participating GUIDE Sites

A complimentary preview for health systems and community partners exploring GUIDE.

Standard branding and pre-configured GUIDE content paths included.
Ideal for rapid alignment before contracting.

Pilot & Early Deployment – Per-Member or Per-Encounter Models

Configurable pricing options (e.g., per GUIDE-enrolled member per month or per guided episode), plus customization and consulting as needed.

Designed to align with GUIDE funding streams and complementary Medicare programs.
Includes reporting packs that highlight impact for leadership and funders.

Customization & Expansion

Optional deeper integration with EHR, GUIDE registries, AAAs, and community networks.

Add branded Adult Day Companion, Area Agency Companion, and Volunteer Companion for your region.
Extend to additional service lines as GUIDE matures.

Our Story: Partnership in Action – From Discharge to GUIDE

GUIDE Companion was born at the intersection of two journeys: the evolution of the genusConnect platform—built on carePhysics, AI, and a decade of discharge and engagement work—and RiverStar’s deep experience in behavioral health workflows, SDOH data, and community-based care coordination.

Because of this partnership, we now bring to GUIDE:

211‑411 onboarding that links existing human workflows to modern AI in seconds.
PWA technology so families and staff can use GUIDE Companion without app stores or big IT projects.
genusCoach + RiverStar playbooks that support real-time coaching, documentation, and risk-aware follow-up.
A roadmap that looks ahead to IoT sensors and home robotics—integrating future signals into human-first guidance rather than overwhelming dashboards.

Our commitment is to walk alongside your teams and community partners—learning, adapting, and continually improving GUIDE Companion so it remains worthy of the families you serve.