In this conversation, Mike Sizemore discusses the Structured Family Caregiving program, the process of selecting and switching provider agencies, and ensuring continuity of care during the transition. He emphasizes the importance of communication, understanding your individual needs, and the rights of caregivers and care recipients in choosing their providers.
How to Switch Structured Family Caregiving Provider Agencies >>
List of Structured Family Caregiving Agency in Georgia >>
Katie Wilkinson (00:02)
Welcome to Givers, where we enroll, support, and pay family caregivers through state programs. Today, I am here with Mike Sizemore, Givers Director of Administration, and we are talking about transferring Structured Family Caregiving provider agencies. So, Mike, welcome. Thank you for coming to talk to us.
Katie Wilkinson (00:28)
I'm hoping you can just start by sort of painting a picture of what agencies and know stakeholders are involved in structured family caregiving. To make this program possible you need a caregiver, a care recipient, a case management agency, and a structured family caregiving provider agency and I think that can get a bit complicated. Can you just sort of break that down?
Mike Sizemore (00:35)
Yeah. Be happy to do that. Again, thanks for giving me the opportunity to be on here again with you. So, yes, there are four entities, actually five if you add the Area Agency on Aging into the mix. But let's focus on the four that you discussed. The care recipient or the members, we call them here in Georgia.
Mike Sizemore (01:08)
They're the most vulnerable in this situation because if they can't receive services in the home, whether it's structured family or any of the services that are within the waivers, then their next step is institutional care, nursing home, those types of places. The caregiver is the most critical because they're going to make sure that the services are delivered for them in the home.
The case management company is, I like to call them the air traffic controller, if you will. They're the pathway to make sure that the services happen. And then we as the structured family caregiver provider, we're the one that ensures that all of the things that have been set up and set aside for the caregiver actually do take place. And one of the things that folks do need to understand about waivered services versus entitlement programs,
And while we get to the point of what we're talking about today, entitlement programs pretty much dictate what you're going to get, how you're going to get it, when you're going to get it, and where you're going to get it. And though the waiver programs in some ways do some of that, one of the things that folks do need to understand in Georgia and a number of other states that have structured family is it is the members choice. They get to choose how their dollars are going to be spent. And so
case management with the AAA doesn't dictate to them who's going to provide the service, they get to make that choice.
Katie Wilkinson (02:38)
Awesome, I think that's helpful. think the overlap of agencies can get confusing for people. Before we get into why and how you might transfer an agency, can you talk a little bit about how you start with a structured family caregiver provider agency in the first place? Like where does that come into play and how do you choose who you're gonna start with?
Mike Sizemore (02:57)
Great question. So it's possible that a caregiver and a member may have gone on the internet and just begun to have searched for companies that do this. If they have not, when they're talking with either the area agency on aging or when it gets down to case management, case management will begin to discuss with them the services that are going to be available to them through the waiver
And then they will make them aware of the different agencies specific to the area that they live in who can provide that service. And again, like I say, they get to choose at that point who it is that they're gonna work with.
Katie Wilkinson (03:39)
Awesome. So when someone's with an SFC provider agency, they're there, they're feeling like it's not the right fit. I guess what are some of the reasons someone might consider switching to another agency?
Mike Sizemore (03:50)
Yeah. right, so several things. One that I think is probably the most critical is communication. If the agency is not communicating with them or they're having difficulty communicating with their provider agency, that can be a problem. Ease of use is another one because again, within this program, they are required to electronically send notes on a daily basis to the provider. If whatever app
they're using is not something that's easy for them to work with, that can create some problems. And of course, the third one, and the one that seems to be the most critical out of the three would be payment. Are they receiving the amount of money that the state says that they are supposed to get? And are they getting that money on time? Now, the state doesn't dictate
whether you pay weekly or bi-weekly or bi-monthly, but we are required to pay the caregiver. And so again, if it's not getting to their bank account on time and it's the wrong amount, that creates a lot of tension. So like I said, communication, ease of use and payment are the big three.
Those are three big things. Obviously, people want all of those things, payment on time, use of use, et cetera. If someone's trying to figure out their own needs in a provider agency, how can they, like, what should they be looking, how do they assess what their needs are and what they need out of an agency specifically? So when you're comparing, you know, A versus B, how you decide which one's right for you.
Mike Sizemore (05:06)
And I think a great way to think about that is imagine if you were at a four way stop and there are four service stations, one on each corner, they all have gas, they all have it for the same amount of money. They all have snacks. They all have, you know, drink machines with with little crunchy ice in it. What makes you turn and go to that particular station versus the other three?
And again, I think one of the things that you have to think about as a member and the caregiver is likeability. The agency that you're working with, do you like them? Can you communicate with them? Are they communicating with you when you have a need or are they responding to you quickly? Now, when I say quickly, it might not be in the next two or three minutes, but they're responding in a reasonable amount of time.
personality wise, do you feel like you get along with the folks that you're talking to? Or they're being truthful with you? And when I say truthful, they're not trying to just tell you something to make you happy. They do need to be telling you the truth about the services and what's afforded to you. And in doing so, do they give you all of the information?
Do they give it to you in a timely manner? And make sure that you understand exactly what resources are available to you. And again, sometimes people may not like the answer that they're hearing, but they like it when you're giving it to them in a truthful way and you're giving it to them as quickly as you can possibly get it to them.
Katie Wilkinson (06:56)
I like that analogy. So if someone decides it's time to switch providers, how do they actually go about finding a new provider? How do they research them? How do they look up alternatives?
Mike Sizemore (07:01)
Again, the internet's a great resource. can type in to Google search things like, do I get paid to care for a family member? And that will bring up a lot of the different resources that would be available in their community. Obviously, going back to their case management provider and asking them, who are other potential providers that might be available to me?
And like I was saying a few minutes ago, it's a matchmaking process, if you will. So don't be afraid if you are thinking about making a change to look at two or three different potential providers. I would even go as far as to say you might want to take five to 10 minutes with each one and interview them. See how well you like them in a conversation.
You know you can talk about them and I wouldn't get into details about who your current provider is but just some of the things that are important to you and see how they respond to to those questions are all going to be ways to to help out with With you being able to find someone that that is a really really good match, you know for you But but again, like I say going on there going on the internet and looking
and then asking the case management providers who is available because if you go online and look, and that's the sole way you go about this, you may find a lot of different providers around the state, but you have to have one that actually can provide the services in the county in which you live. So even if you do find two or three that you feel like you wanna talk to, again, go back to case management.
and ask them if this is someone that can provide that service for you in the county that you live in.
Katie Wilkinson (08:55)
I think that's great advice and just to tack on, Givers does have a full list online of every structured family caregiving provider agency in Georgia and the counties that they serve. I think your advice to interview a couple and talk to different providers is a good one to find a match for you and your loved one.
Katie Wilkinson (09:17)
Okay, so you've decided to switch. It's time to make a change. How do you approach that with your current agency and with case management? What's the actual procedure in switching providers?
Mike Sizemore (09:26)
So again, Georgia being a freedom of choice state, you get to pick, you get to choose who you want to work with. and again, the having to be, and I hate to use the word confrontational, but that's probably the best word here. There's some issues you really, you know, you've tried to work with someone, you can't really get past this. And you're, and you're ready to move forward and make a change.
Your case management provider is the one that works through this because they're the ones that have to get all the paperwork that that new providers is going to have to have, make all the changes with that and then submit it to the new provider. It is not necessary for you to have any further conversation with the current provider you're working with. You simply let case management know.
that you have decided you want to make a change, you've decided on a new provider, or you would like to have information on a new provider, and they will furnish that information for you, but you do not have to have a direct confrontational kind of conversation with your current provider. So that's something that's critical to know. Now, another thing that a lot of people will ask, especially case management, would be, well, who would you use?
And they can't answer that question that way. They cannot dictate to you who to use. They can't tell you who to use or heavily suggest or move you in a direction toward one particular provider over others. The state is very dogmatic, if you will, about solicitation within the policy manual, so they can't do that.
If you're looking to make a change, something you might consider saying is, well, who are two or three agencies that you find that you work well with now? They're pretty free to answer a question that way, but to ask it, who would you use? Or if you had a family member, who would you? They can't answer a question that way, but they can.
And I feel like in a lot of cases are free to say that there are several agencies that we work with that have a very robust program. They're very responsive to us and might be somebody you should talk to. Again, they're not going to say, yeah, we think you ought to use them, but maybe you'd like to talk to them and see if this might be somebody you'd like to work with.
Katie Wilkinson (11:49)
think that's helpful on how to get feedback from your case management agency. Last question, I think. It can be hard to talk to agencies. Maybe you don't talk to your case manager that frequently. Should anyone ever be prepared for pushback? Would it be an awkward conversation with case management? Or is this pretty straightforward? They're going to be like, heck yes, let's go.
Mike Sizemore (12:06)
Unfortunately, sometimes it can be a little more of a difficult conversation. Sometimes, and not always, but sometimes, you know, case management may not want to have that conversation with your provider. Maybe there is as un-confrontational as you are.
You know, and again, like I said, there's a lot to this. There's paperwork, there's, you know, removing services from one, starting with another. So there are things that are going to create work on their side. And I would never want to say somebody just doesn't want to do it. But like I say, because it can produce a lot of work for them. And some of these case management companies are working with
you know, several hundred or several thousand, you know, people in any given day. It is a big deal. But again, even having said all of that, as I started out in this conversation, you know, you get to choose where you want to spend your waiver dollars. So don't feel like you're putting them out or creating a problem for them.
when you're wanting to make a change, if you've done everything you can do or feel like you want to do, or for whatever reason you feel like, I just cannot work with this agency anymore and I want to make a change, you make that clear to your case manager. If your case manager is giving you some pushback or things go on for several days or a couple of weeks and nothing's happening, then you call back and as I always say, you go to the next person in authority.
And say hey, I've asked about this. I've talked to the case manager Can you please work with them and make sure that this that this happens in a timely manner? So those are again are just some of the some of the ways to go about this I don't always always be you know always be kind be respectful there's no need to to to as we might say trash the the provider that you're working with but just just to make sure that
that your case manager understands this is the decision you've made. You understand that you are free to do this by state policy and you want to move forward with it. And they should be able to take that information, help you find that next provider, make that transition as smooth for you as is possible, and then you're ready to go. Now, we'll say one more thing about that. Most of them would prefer
to start with a new provider on the first day of the week, which on the state clock is Sunday. So if you make that decision on Monday or Tuesday, just know that they're not deliberately holding back. But in order for things to happen and move cleanly through the process, it's always better to start at the beginning of a week.
Katie Wilkinson (15:01)
I think you've just brought up a really good point also. First, I think all that's really helpful. It can be hard to advocate for yourself. So I think this is useful. You mentioned starting on Sunday or just the transition period. Should people expect ever to have a gap in service or days that they're not going to get paid for if they go through a transition between providers?
Mike Sizemore (15:20)
No, should not be any there should not be any gap in service. What what what we have seen and what I'm sure is taking place or should be taking place is that when one provider ends and again, another thing to understand about this particular service structured family doesn't doesn't work on a clock as in you know you work one two or three or four hours in a day. It works on a 24 hour clock.
Because you're rendering a certain certain different types of services over a 24-hour span of time so the clock ends basically for one provider at 11 59 59 on Saturday and the new one picks up on on Sunday at at 1201 11 whatever that clock works But but no there should never be a gap in service with with structured family nor should there be a time when
when you're not getting paid for a particular day. Now again, if that does happen, you go back to case management and let them advocate. If it's the new provider, hey, services were to begin on that day, the other provider was not providing at that time. So they can go back and adjust their billing and make sure that you get paid. If the former provider again ended on Saturday, but they still owe you for, you
Wednesday, Thursday, Friday, and Saturday of the week previous. Then again, let case management go back and advocate for you and make sure that that does happen and you get paid. But to answer the basic answer to your question is no, there's no gap in service, nor should you have to worry about not getting paid when you're transitioning from one to the other.
Katie Wilkinson (16:58)
Excellent. Well, this has been great. Is there anything we've missed about transferring providers? Any missing information you think people should know?
Mike Sizemore (17:05)
Again, I don't think so.
Again, like I say, it's your option to choose who you want to work with. If you receive phone calls because you are in the service from some provider out there and they offer to take you on as a client and offer you certain incentives, again,
That solicitation, that is something that is strictly forbidden by the state. any, excuse me, any calls initiating service always should come from you or from case management.
Katie Wilkinson (17:39)
Excellent. Well, thank you so much again for your time. And we'll be sure to link all the resources you've mentioned, including that list of providers in Georgia so that people can find the right provider for them.
Mike Sizemore (17:50)
All right, Katie, well, thanks again for letting me be on the podcast today and hopefully we'll talk again real soon.
