Which Personal Care Services Are Included in GAPP Support?

Parents of medically fragile children become experts out of necessity. They learn to run feeding pumps, manage tracheostomy supplies, read a pulse oximeter at three in the morning, and hold a full-time job on four hours of broken sleep. What they rarely get is help — not advice, not sympathy, but actual hands in the home.

The Georgia Pediatric Program, known as GAPP, exists to provide that help. It is a Georgia Medicaid program that brings skilled nursing and personal care into the home for children who are medically fragile, so that they can grow up with their families instead of in a hospital or institutional setting.

Families new to GAPP often understand the nursing component but are less clear on the personal care side. This guide walks through what personal care services in GAPP typically include, how they differ from skilled nursing, and how the two work together.

A Brief Overview of GAPP

GAPP serves children from birth through age 20 who are enrolled in Georgia Medicaid and who have been approved for services by the state based on medical need. Approval is driven by the child's documented medical condition, the level of intervention required, and physician orders — not by a diagnosis alone.

Once a child is approved, the state authorizes a specific amount and type of in-home service. Provider agencies such as Hope Private Care then deliver those services in coordination with state-appointed case managers, following the physician's orders and the approved plan of care. Hope Private Care provides GAPP services throughout Metro Atlanta and the surrounding counties, including Fulton, DeKalb, winnett, Cobb, and Clayton.

Skilled Nursing Versus Personal Care

GAPP services fall into two broad categories, and the distinction matters because it determines who provides the care.

Skilled nursing must be performed by a licensed nurse — an RN or LPN. It covers clinical interventions such as tracheostomy care and suctioning, ventilator support and monitoring, gastrostomy and other tube feeding, wound care including wound vac management, Foley catheter care, oxygen management, seizure monitoring and response, administration of medications requiring nursing judgment, and vital sign assessment.

Personal care covers assistance with daily living and support tasks. It is delivered by trained caregivers or personal care aides working under the plan of care and, where required, under nursing supervision. Personal care does not involve clinical judgment; it involves the hands-on, everyday support a child needs to be clean, comfortable, safe, nourished, and able to participate in family life.

Many children receive a combination of both. Some, whose medical needs are less intensive but whose functional needs are substantial, are authorized primarily for personal care support.

Personal Care Services Typically Included in GAPP

The list below reflects the categories of personal care commonly delivered under GAPP. What any individual child receives depends entirely on their approved plan of care.

Bathing, hygiene, and grooming

Assistance with bathing, whether in a tub, a shower chair, or as a bed bath for children who cannot be moved easily. This includes hair washing, oral care, nail care, skin cleansing and inspection, and support around incontinence care. For children with fragile skin, contractures, or medical equipment such as tubes and lines, bathing requires patience and technique — protecting sites, positioning safely, and keeping the child warm and calm throughout.

Dressing and undressing

Help with clothing and footwear, adapted to the child's needs. This is more involved than it sounds for a child with limited range of motion, spasticity, braces or orthotics, or a central line. Caregivers learn each child's sequence and preferences and work around equipment without dislodging it.

Toileting and continence care

Support with toileting, diapering, and hygiene, along with careful skin monitoring in areas at risk for breakdown. For older children and adolescents, this is done with attention to privacy and dignity, which becomes increasingly important as a child grows.

Feeding and meal support

Preparation and delivery of meals appropriate to the child's dietary needs and texture requirements, and assistance with eating for children who can take food by mouth. Caregivers monitor intake, watch for signs of difficulty swallowing, and follow positioning instructions during and after meals. For children who are tube fed, the clinical administration is a nursing task, while a caregiver may support surrounding routines as the plan of care allows.

Ambulation, transfers, and mobility

Safe transfers between bed, wheelchair, bath chair, floor, and vehicle, using proper technique and any prescribed lift equipment. Assistance with walking for children who are ambulatory, and support with mobility devices, braces, and standers. Caregivers also help carry out range-of-motion routines set by physical or occupational therapists.

Positional care and repositioning

For children who cannot reposition themselves, regular repositioning protects the skin from pressure injury, supports respiratory function, and prevents contractures. Correct positioning for feeding, sleep, seating, and play is a core part of daily care and is done according to the therapy and nursing instructions in the plan.

Household support related to the child's care

Light housekeeping connected to the child's care — laundering bedding and clothing, cleaning the care area, washing feeding and care supplies, keeping equipment areas sanitary, and maintaining a safe environment. In a home with a medically fragile child, infection control is not incidental; it is a health measure.

Supervision, safety, and observation

Continuous attention to a child who cannot be left unattended — watching for seizures, respiratory changes, choking risk, or equipment alarms, and responding according to the plan of care. Caregivers report changes promptly to the nurse, the family, and the case manager.

Daily routine, engagement, and participation

Supporting the child's routine around school, therapies, and rest, and engaging the child in age-appropriate interaction and play within their abilities. Reinforcing communication methods and therapy activities during ordinary daily moments is part of good pediatric care, not an extra.

What Personal Care Under GAPP Does Not Cover

It is equally important to know the boundaries. Personal care aides do not perform skilled nursing tasks, do not make clinical decisions, and do not administer medications where nursing judgment is required. GAPP services are also authorized for the child, not for the household generally — housekeeping is limited to what relates to the child's care. Authorized hours are set by the state based on assessed need and physician orders, and services must be delivered within that authorization.

How Hours Are Determined and Adjusted

The amount of service a child receives is based on the state's review of documented medical need and physician orders. Children are reassessed periodically, and authorization can change if the child's condition changes.

This is where families have real influence. Keep thorough documentation of the child's needs, including overnight care, frequency of interventions, and hospitalizations. If your child's condition worsens or their needs increase, contact your case manager and physician to request a reassessment rather than waiting for the next scheduled review. Accurate, current documentation is what supports an appropriate authorization.

Support for Georgia Families

Hope Private Care has served Georgia families since 2006 and provides both skilled nursing and personal care under GAPP, working closely with parents, physicians, and state-appointed case managers. Our nurses and caregivers deliver care in the home across Metro Atlanta and the surrounding counties, with the same commitment to dignity and family partnership that has guided us from the beginning.

If your child is enrolled in GAPP, has been approved and is choosing a provider, or you believe your child may qualify, call Hope Private Care at (770) 864-9398 or email info@hopeprivatecare.com. We offer a complimentary in-home assessment and are glad to help you understand your options.