Structured Family Caregiving vs. Personal Support Services

Mike Sizemore
Mike Sizemore

This conversation looks at the differences between structured family caregiving and personal support services. It covers who is eligible, what families need to think about, and common misconceptions. Givers Director of Administration, Mike Sizemore, shares insights on caregiver responsibilities, the application process, and why it's important to understand the details of each program.

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Episode Extras

Published:
February 11, 2025

Transcript

Katie Wilkinson (00:02)
For family caregivers that might not know the difference, can you just start with like a high level overview of the difference between structured family caregiving and personal support services?

Mike Sizemore (00:18)
Sure, well, I think, I guess one of the biggest things is that they are, they're really kind of one and the same in that you are caring for someone in their home. And that's the big similarity between the two. The difference is personal support is the one that has been around for years and years and years. And it has always been described as having an aide coming into the home and caring for someone there. Up until probably

late 2019, 2020, right around the time that COVID hit, that caregiver was always a non-family member. In fact, most states did not allow family to do any of the caregiving. So that was a big difference. Another thing is that with PSS, it's defined as a certain number of hours for a certain number of days. Whereas,

structured family is basically it's a 24 hour period. But the threshold is five hours a day, seven days a week. With PSS, can be as few as maybe two to three hours a day, three days a week, up to as much as four hours a day, say even five or six days a week. But the care being given in the home is going to be pretty much the same.

Katie Wilkinson (01:43)
And can you talk about what kind of care is being given in the home? Like what are the responsibilities of a family caregiver or of an aide? And you started to touch on it. Sounds like it's pretty similar, but if there's any differences between the types of care that might be provided under each program.

Mike Sizemore (01:52)
Yeah, right. So again, what we're talking about are activities of daily living. So whether you're coming into the home as a caregiver or you're living there with them, what you're doing are going to be traditionally the same kinds of things. You're helping them to get up out of bed and ambulate. They're going to the bathroom. They're getting a shower. They're brushing their teeth. They're putting their clothes on. You as the caregiver on either side of these,

are also involved with some light housekeeping that could include dusting and vacuuming, washing clothes, and then meal prep would be the other thing. Now, one thing that is different about PSS is that meal prep can be a part of it, but because they're on PSS, they can also have meals delivered to the home. So that's one difference there. But again, most of the rest of it is pretty much the same.

Katie Wilkinson (02:51)
Okay, awesome. If a caregiver or family is trying to decide between PSS and SFC, what are some of the key considerations they should look at?

Mike Sizemore (03:02)
Sure, yeah. I think the major difference in the two is that if the member, the person who's receiving the care, does not want someone living in the home with them, maybe there's still that level of independence that they have, or the caregiver does want to provide the care, but they don't want to live with the member. Maybe they have another job and this is something they can do on their off hours.

maybe they're in school full time, and again, this is something that they can do on off hours, then that allows them a lot more flexibility. With structured family, they have to live in the home, and that is the only work that they can do. But with PSS, there is the flexibility of living where you want to, but you can live with them if you would prefer. And then you only have a fixed number of hours during the day.

that you'll be caring for them and then if you have a job or school or other things then you can be fully involved in that as well.

Katie Wilkinson (03:59)
Awesome. You started to talk a little bit about eligibility specifically for the caregiver. Can you talk just largely about eligibility? I think this can be confusing for any Medicaid program. About the general requirements between SFC and PSS, specifically in Georgia.

Mike Sizemore (04:15)
Yeah, sure. Yeah. So if we're talking specifically about Georgia, as far as eligibility goes for the member, again, they both have to meet what we call nursing home level of care. So in other words, what that means is that they require a certain amount of care that if they cannot get it in their home setting, then a move to some sort of institutional care does exist at that point.

Another thing that is different about the two is that with personal support services, you can be in PMAL status, which means that your Medicaid is pending. You're not actually on Medicaid yet, but it is pending and you can actually begin to receive services in the home prior to having your Medicaid approved, which again, depending on primarily your financial status,

That could be something that would take maybe three to six months for them to actually be approved and move over to where care can begin on the structured family side, but with PSS, it can begin much, much sooner.

Katie Wilkinson (05:18)
Yeah, that's definitely a good thing to highlight and to be helpful.

Mike Sizemore (05:20)
Yeah, and as far as I'm sorry, as far

as the other things there, they are 18 or older and or 65 and older, and they're afraid frail and aging senior adult, or their person 18 between 18 and 64 with disabilities. And again, those two criteria the same free to program.

Check your eligibility for Structured Family Caregiving >> 

Katie Wilkinson (05:41)
Awesome. You've been working in Georgia Medicaid for a long time. You know a lot about the programs that are available under Georgia Medicaid. Are there any misconceptions you've heard or learned about of either of these programs that are worth clearing up for people or clarifying?

Mike Sizemore (05:59)
Hmm. I think that probably the biggest misconception is that a lot of times people don't understand on the structured family side that there's a lot of restriction to what they can and cannot do. But again, on the PSS side, as I stated earlier, there's a lot more freedom with

with where you live and other things you can do. But you can't just simply come and go and kind of work it as you want to. There are some other requirements. You do have to become the employee of the providing agency with PSS. So that means you are their employee on a part-time basis.

And that means instead of receiving the daily stipend that you do, which is a fixed amount per day under under structured family, and it is non taxable on the PSS side, you are their employee and therefore you are subject to matching taxes. You are relegated to an hourly rate of pay that is below what the state pays the agency on a per hour basis for that care. And you are required

to work within EVV or electronic verification, which means that there's a geo fence around the property where the person lives. You cannot clock in until you're inside the home. You have to report all of your notes there. And as soon as you leave, you are clocked out. So again, you have to make sure that you understand that those are some of the, if we want to call them restrictions, those would be part of what you have to look at there. Now,

Maybe another positive in this is that you're also covered because you're a W-2 employee of the agency You're also covered under their workers compensation plan, which in Georgia is sole sole remedy for folks that get injured at work So that does give you if you were injured in caring for someone then workers compensation would pay for any kind of doctors visits or rehabilitation that were related to that injury

Katie Wilkinson (08:08)
Yeah, those are really important distinctions to make between the two programs. Under structured family caregiving, for instance, at Givers, we provide eight hours of annual training to caregivers and 24-7, basically, caregiving coaching support is the same available under PSS programs.

Mike Sizemore (08:08)
Yeah, so the same thing is required there. There's a little more on the front end in that you have to go through a company orientation. Now that orientation could take an hour or two hours. But then you are required to have eight hours of additional training during the year and that happens every year. Now with PSS or personal support,

I believe I'm correct on this in Georgia, you are required to have your first aid card from the American Red Cross and you are required to also have a CPR card as well. Those are not required though we at Givers do make sure that first aid is one of the very first things that we do teach in our training program.

But under PSS, it is a requirement that you actually have been to those classes in person and have trained with a certified trainer for that.

Check your eligibility for Structured Family Caregiving >> 

Katie Wilkinson (09:19)
Okay, awesome. If someone's interested in applying for one of these programs, how do they do that? What's their first step?

Mike Sizemore (09:26)
Okay, again, both of these programs, the application process is identical, because what we have to understand is we will have a number of people that will come to us and say, hey, we would like to be a part of structured family care. And we'll take the application, we forward that on to the AAA, our Area Agency on Aging, who then turns it over to one of the case management companies.

their nurse goes out and then does a full blown assessment on that person. Where we look at the person, we look at the environment, we look at the needs that they have, but case management in their nurse in coordination with Alliant Healthcare, which is at the state level who reviews all of this, they're the ones that actually get to determine specifically what that member or that client is gonna receive. So even though they may think,

that they have a need for five hours or more, seven days a week. Once that nurse gets in and that information is then uploaded and verified by Alliant, they may come back and say, well, they do qualify for personal support, but not to the level of structured family. They only need four hours a day, four days a week, or even maybe say five hours a day, but only three days a week. So like I said, that combination can look a little different.

for each one, but the initial part of the process is the same. The evaluation may dictate that they go to one program versus the other.

Katie Wilkinson (10:57)
And if I'm hearing correctly, that evaluation might also give them the option, if you will, of either program. How would you navigate that circumstance? How would a family navigate that?

Mike Sizemore (11:07)
Yeah. So let's say that someone does elevate to five hours a day, seven days a week. The thing that the state looks at is is how many actual dollars are being spent and they weigh that against the cost of nursing home care. So a lot of times once you get the five hours a day, seven days a week, they're going to automatically put you into structured family because

if they don't and you add other services on top of which you can do under a PSS, then that cost may go above what nursing home costs would be. And then that could get you removed from the program and you either, and of course they don't force you to go into nursing home care, but if you want to be a part of the program, they will say the only thing we can put you into is going to be institutional care.

Some things to understand about personal support is that you can get home delivered meals. You can do adult day, which you can do adult daycare with either program. You can have transportation with either program. You can have an ERS emergency response button with either program. But when you start looking at meals and some of the other home delivered services, those costs, if you're close, can push you over.

And those are all things that the nurse and the line will review and then come back with a decision after that. Again, like I said, if you're already pushing over the five and seven, they're gonna make that decision for you.

Katie Wilkinson (12:38)
Yeah, I think that's really helpful for understanding what might be available to you. This has all been really helpful to understand the difference between these two programs. Is there any, if any final thoughts, anything you, any final notes on either of these programs that you feel like we've missed?

Mike Sizemore (12:39)
I think that, you know, when any family and they're talking with a family member that needs care, they need to sit down and really examine exactly what they want to achieve through this, what kind of quality of life, how much care they really feel like they need, and then decide which track would be best for them to initially take a look at, but also understand that that the state

you know, in this case is going to make that final decision for them. And then they have to go ahead in their mind, have predetermined, yes, that's good. We're going to go that direction or no, that's not what we want to do. And so we'll just take care of things, you know, just as family. But, and you can, you know, obviously go to our website, you can go to the Department of Community Health's website here in Georgia, and you can look at.

a number of the different things that are similar and different about both programs and then kind of decide for yourself on the flame which way you want to go.

Katie Wilkinson (13:54)
Awesome. excuse me. Awesome. Thank you so much, Mike. I really appreciate your time and sharing, I don't know, your knowledge with us. Thank you so much.

Mike Sizemore (14:02)
Absolutely. Thank you.