In this conversation, Mike Sizemore, Director of Administration at Givers, discusses the Structured Family Caregiving program, its history, eligibility criteria, daily responsibilities of caregivers, support and training provided, the payment mechanism, state variations, and how you can get involved.
Katie Wilkinson (00:01.11)
All right, well, I'm here with Mike Sizemore. He is the Director of Administration at Givers, where we enroll, support, and pay family caregivers through state programs. And today we are talking about Structured Family Caregiving. So Mike, maybe you can say hello and then tell us what is the Structured Family Caregiving program and how does it work.
Mike (00:22.694)
Absolutely. Katie, thank you so much for giving me an opportunity to be on with you and your podcast today. And, and as long as I have been working with structured family in Georgia and in other states, I did a little more research today to get ready for our time to together and realize that structured family as an idea actually began back in the 1980s.
when different states and even the federal government began looking at the role that caregivers were taking on. Now, you know, for centuries throughout all of civilization, family has cared for family. That's not anything new. But what this research started doing, it started looking at the role of the caregiver and the impact it was having on them as a family, on the person they were caring for.
their finances and other things. So that was going on in the 80s and the 90s. Legislation actually began to be put together on how states and the federal government could help. And what we saw for the most part, even back then, was to give people access to community information and support groups. But there was not a financial component to it. It wasn't until actually in the 2000s that we began to see
that the federal government began to set aside money through the state Medicaid programs that then allowed family to care for family and be paid for that. In particular, in Georgia, that began back in 2019.
Katie Wilkinson (02:07.286)
Awesome. Can you explain a little bit more about how, so in Georgia there's a Structured Family Caregiving program and we'll talk a bit more about state differences in a little bit, but can you talk a bit about how a family member gets paid through this program? Like what is the structure of that?
Mike (02:22.798)
Sure. Yeah. And actually, it begins with the the person needing the care. Some places we call it a member, some call a participant, rarely do we call them a patient, but it actually begins with them. Are they eligible for the state Medicaid program to begin with? That's that's the primary thing. Do they meet what we call nursing home level of care?
Now, what that means is, you know, if they can't get services in their home and specifically within structured family, what we call activities of daily living, and we'll get more into that in a couple of minutes. But if they can't get these services in the home, the next logical option for them is going to be some sort of institutional care, which in most cases is going to be nursing home care.
So the first thing we have to do is we have to make sure that they meet those criteria.
The caregiver, and I'll deal with the negative first, the caregiver cannot be a conservator. They cannot have actual control over the person as far as their finances and how they live and where they live. In the vast majority of states, it cannot be a spouse. So the conservator and the spouse are out in the majority of cases.
Others requirements of the caregiver are that they are related to by blood or by marriage, that are at least 18 years of age or older, and they are willing to live in the same home with them. Again, in the vast majority of cases, they cannot have another job outside of caring for the family member.
And again, like I said, they're willing to live to live with them in the same home. They're willing to help them with what we call activities of daily living. And they cannot have any significant serious crimes in their background. And what I mean by that is they cannot have been charged and convicted of any type of exploitation of a senior adult, any type of violent crime against another person.
Mike (04:43.502)
whether it be adults or children. So those are the major things that you have to make sure that you have covered before you begin the process of looking at a program like this.
Katie Wilkinson (04:57.428)
And so in this instance where someone might be eligible based off everything you just said to be a caregiver and also their loved one is eligible Medicaid, they have the proper level of care requirement. What kind of care is the caregiver actually providing? Like why would someone, I guess this is two questions, why would someone choose Structured Family Caregiving over say a nursing home? And then what actual care does the caregiver need to provide to their loved one on a daily basis? What does the work look like?
Mike (05:24.982)
Yeah, sure. Two very, very great questions.
What we see is most people want to be at home, want to be in a place that is very, very familiar to them. The idea, especially for older adult, of having to leave a place that maybe they have lived in most of their lives—they want to be able to live there and, as tragic as it may sound, they want to live there and they want to die there. They want that to be the last place that they are. And so it's a critical part of this program that they're able to be there.
Some of the things that the caregiver will do for them, again, we call them activities of daily living. Simply put, what the caregiver will do, will help them to get up each morning, help them with their, or assist them with their bathing, brushing their teeth, putting on their clothes, making sure they get at least two good hot meals during the day, help them to transfer as far as things like toileting would go.
If they want to spend most of their time in bed, making sure they are able to transfer to and from the bed or from the bedroom to living room where their favorite chair or sofa may be. Sometimes it will involve transportation to like physician appointments or maybe they want to go with them to the grocery store, those kind of things. Maybe go for either a short walk around the neighborhood or going to the park and riding on possibly if they're using a wheelchair.
Those are basically the kinds of things. So as you and I would think about the things we would normally do in a given day, that's what that caregiver is going to do to help that member and support them in that way.
Katie Wilkinson (07:22.934)
Awesome. So obviously one of the big benefits of this program is that caregivers can be compensated for the work that they're doing, that they're probably already doing for their loved one. Can you talk a little bit more about other supports and trainings? Like what else does a caregiver get when they are part of this program?
Mike (07:34.104)
Yes.
Mike (07:42.126)
Sure, yeah. So here at Givers, there several things. One, we have our own proprietary mobile app, which they would install on their smartphone, that will allow them to, on a daily basis, let us know exactly what it is that they're doing, excuse me, the tasks that are assigned to them through the care plan are gonna be on that app. They can ask us questions if they have any concerns.
They can report critical incidents, you know, if the family member fell or had to go to the hospital, all those kind of things they can put put on the app and let us know about that. We're able to communicate with them on a daily basis through the app, through direct messaging. Again, all the states require that whoever's doing the caregiving turn these notes in on a daily basis. So that's part of what this app does for them.
Additionally, we provide training for them through the app. Things like basic first aid, proper lifting, other things about how to prepare a healthy meal, what proper safe transportation looks like. And then we can get into specifics about whatever the particular, whether they may have had some sort of a traumatic brain injury.
Whether it's just age where the member has developed diabetes, heart trouble, maybe they've had a stroke. The majority of the folks that we see in a program like this usually fall into dementia and Alzheimer's. So we're gonna help them to understand not only the disease or the injury that has taken place, but what that progression looks like.
And in particular, when we're talking about dementia in Alzheimer's, help them understand the proper ways to communicate with them, how to understand how that disease progression is actually going to progress, signs that they need to look for. then hopefully, like I say, they're able to live out their life in the home. But if not, what does that transition look like to some other level of
Mike (10:04.534)
of care for them if in fact, you know, they're going to need care that is more than just 24-hour care but is very specific and more having to do with the safety and other needs that they may have that may be more medical.
Katie Wilkinson (10:23.934)
You mentioned that in the Givers App, caregivers can report the tasks that they're doing daily for their loved one. This kind of reporting isn't just true of givers. This is true of any Structured Family Caregiving provider agency that you need to report your tasks that you're doing daily back to the agency. Can you talk a little bit more about why someone needs to give us that information and how that's tied to the payment portion of this kind of program?
Mike (10:49.838)
Sure. Yes, absolutely. So a couple of things. One, obviously, we want to make sure that, you know, that they are caring for the person needing care. I mean, it's most simple basics, if you will. We want to make sure that those things are being done. The care that is done has to be tied to the care plan that is developed by the case manager. Those two things working in concert with each other.
As we turn in our information to the state on a weekly basis, when we can prove or show that these things are being done and that they're being done according to the care plan, then the state then reimburses us for the work we're doing. And then we in turn pay the caregiver for the work that they're doing. Now, when I talk about this and I talk about, again, the majority of the states that do this,
It is a daily stipend. is a fixed amount that they are paid on a daily basis to care for them. And again, this is not just Monday through Friday, but this is seven days a week, 365 days out of the year. Holidays and weekends are all included as a part of this. in the state, each state gets to dictate the amount of funding that the program gets, which then
They also dictate the amount that the caregiver is paid and how much the provider agency is paid in order to provide the service to the caregiver and to the...
Katie Wilkinson (12:31.51)
Yeah, that's excellent. You just mentioned that there's a state by state difference on the amount of stipend or how the structure of the program is varying on state. Can you talk a little bit about other differences someone might experience state to state?
Mike (12:46.126)
Sure. Yeah. So again, in all the states, and right now there are 10 plus that have this program. Some of them call it something a little bit different in some, but structured family is the term that most use. So all of them do not allow a conservator to be the caregiver, someone that has financial and living control over them.
Some states allow for a spouse to be the caregiver. Now that's very few. In fact, I only know of two that allow that right now. There are, I believe, five that allow what we call fictive kin. Now, what that term simply means is that they might be related and they might not be. But in those states, it doesn't matter. It can be a close friend of the family that is willing, again, to move in and do that care.
And other states that define it as strictly a family member, they must be related by blood or by marriage. So to give you a couple of examples there, a first, second, third, or fourth cousin that's again willing to do the care, they can do that. The state will not recognize what we call a common law marriage.
They had to have gone to the courthouse or gone to the church and actually had a wedding so that they are related. If a divorce takes place and the family that came in by marriage is no longer related, they cannot be a caregiver. So those things have to be fully investigated by the provider agency to make sure that whatever that state says has to be in that relationship is in fact what's taking place.
Katie Wilkinson (14:41.142)
Awesome. Could you talk about, so of course there's state by state differences, so this question is kind of vague, but if someone, if this is sounding relevant to someone, they feel like their care recipient matches this, they might be the right caregiver for this kind of program, how does someone actually get involved? Who do they need to call? Where do they go? And maybe you could answer the question in two parts. One is generally speaking, if you want to, know, where do you go if you're in a different state than where Givers serves? And then how do you get enrolled if you are in Georgia?
Mike (15:09.208)
Sure. Yeah. Yeah. So there are several ways to do this. One of the first ways, if you have no idea what may be available in your state, from a local standpoint, I would reach out to your local area agency on aging. Those are the folks at the local level that can give you the most information about what is available in your community.
They can tell you specifically how the process works there. They can also tell you which case management companies would be available in order to help you start the process. So that's the best way. You can go online and just type in, do I get paid to be a family caregiver? And Google, and of course, that's the term we all use now, Google that.
And you will find, hopefully you'll find Givers is the top choice that you will see in your community. And you simply go to, like I said, go to our website. And we've got a button there that just says, you know, do I qualify or how do I qualify? You click on that. And whether it's us or other agencies do what we do, they're going to ask you some basic information. We need a name, a complete name.
We're gonna need an address. We're gonna need a phone number because we do need to communicate with you We are gonna ask for some other information that you don't normally think, you know I don't know that I want to give that information out, but it's critical in the process We have to know The the person who's gonna need the care we have to know their date of birth If they are already on that state's Medicaid program, we need that Medicaid number not Medicare
but Medicaid and this is one of the things that unfortunately people tend to think, you know, if you have aging parents, go, well, you know, mom or dad or both, they've already made it to 65 plus, they've got social security, they've got Medicare, everything's good. What you have to understand about their long-term care is that social security and Medicare do not cover any of this.
Mike (17:30.124)
And so that's why it's so important that you understand that only through either private pay or other programs, veteran programs or something like structured family through Medicaid are the only way that long-term care from a standpoint of you being paid to be the caregiver is going to happen.
Katie Wilkinson (17:53.526)
Yeah, that is an important distinction to make and something that, you know, families are looking at. Families that are looking at the Structured Family Caregiving Program as a possible option for them. What are some of the common challenges that someone experiences in the program and how might they prepare for both the enrollment piece getting into the program, but then also once they are on the program, what are some things to look out for that, you know, might be a consideration before they join?
Mike (18:20.718)
Again, Katie, that's a fabulous, that's a great question. I like to think about what I call the big three. When you're getting ready to look at something like this, and you're going to have to meet with the case manager and you're going to have to go through the Department of Family and Children's Services to understand everything they've got to know in order to get you qualified. Like I say, they're the big three. Your finances.
is going to be the first one. You need to get all of your financial records together, in particular the last three months of all of your bank accounts. That's one. Number two, insurance policies. If that person receiving care has insurance policies, you need to have all that information available. And the third one are property records. Does that person own any property? And if so, where?
and how much it's worth and those kinds of things. Now, as I say that there are things that defects will take out of the mix in that, but you don't need to hide that. There don't need to be any surprises for those that are looking to get you qualified. So like I say, those are the big three. To have all of that information together and ready. The most recent medical records, again, are another key.
Because if there's some question about an injury or disease or disease progression, if the state's going to qualify you, they need to have as much of that information at their fingertips so that they can make a qualified decision on you. You need to go ahead and discuss who that caregiver might be. You want to talk to them about this program and about
what's going to be required of them moving into the home if they're not already there. If they currently have a job, giving that job up, understanding the amount of that stipend. And again, another thing about the stipend is it is exempt from federal income tax, but it may be a reduction in what that person is currently making. Can they live on that amount of money? They need to understand
Mike (20:43.65)
whatever that disease is that the person has, whatever the disease progression might end up looking like, are they going to be willing to help them with those activities of daily living? Sitting there with Uncle Bill or Aunt Suzy or Grandma and sitting in living room and having a discussion or watching TV is very, very different from helping grandma get up in the morning and getting her bath and helping her brush her teeth.
It's very, very different. not everyone is not that they're not willing to want to do it, but not everybody is is really able to to to do that kind of caregiving. So those are some of the basic things that you really need to talk through with someone having that information together, making sure that you know who it is that's going to be calling you, who the case management company is.
who it is at the AAA level, Area Agency on Aging level, know what those phone numbers are because again, in this day and time, we all have phones that let us see the phone number of the person that's calling. for most people like myself, if I don't recognize the number, I just don't answer it. But in this case, it is really critical that you're talking to the AAA and that you're talking to the case management company, you're talking to your structured family agency
so that we can move this process along as quickly as possible. In some cases, it can take as little as 45 days to get you approved. In others, where there's more information about your finances and property and other things, it could possibly take six months or more to get you qualified. the faster you have all the information together, the more you communicate with those particular agencies.
Hopefully the quicker we can make this happen and that caregiving process and in particular getting paid for that caregiving process can begin.
Katie Wilkinson (22:48.15)
Awesome. I mean, that's all super helpful. think those your three, your big three was very helpful. All of having all that information available at the start is obviously going to help someone get enrolled more quickly.
As a PSA, have, Givers has a free program matching tool that matches caregivers to programs nationwide that have a caregiver pay option. And some of those programs include Structured Family Caregiving. Check your eligibility here >>
Katie Wilkinson (23:16.404)
And what happens, you'll go through, you'll give all the information that Mike just shared, and it will show you if there's a program in your zip code, which agency you need to call or fax or go to the front door, but we will deliver you exactly where you need to go with extensions and everything so you're not chasing down a phone number. Because we know that that's obviously one of the first hurdles is just figuring out who you need to call.
Mike (23:39.534)
And I can speak personally, I've worked within state Medicaid in Georgia for over 17 years now. And I have seen a lot of different agencies that provide a lot of different services. But I can tell you from personal experience over these number of years, I've not seen anything as comprehensive as what givers does offer just from an information standpoint. So going to our website, www.joingivers.com
is a great place to start, not just for this program, but for any information you even think you might want to know about when it comes to caregiving, in particular with senior adults.
Katie Wilkinson (24:21.14)
Yeah, that's awesome. And we'll make sure that in this episode, there's all the links to the program matching tool on our website and information about the program itself and state differences, et cetera. So we'll make sure that everything's linked down at the bottom. So thank you so much, Mike, for your time and being so comprehensive. Talk to you soon.
Mike (24:32.928)
I enjoyed it. Thank you very much.
