What is Home Health Care?

Empowering Independence at Home

At Professional Home Care Services, Inc. (PHCS), we believe that everyone deserves to live comfortably and independently in their own home, regardless of age, disability, or health condition. “Home Care” is more than just a phrase; it’s a comprehensive approach to health and social services delivered right where you feel most comfortable – your home.

Our compassionate and skilled team provides a wide range of services to support recovering, disabled, chronically, or terminally ill individuals. Whether you need medical, nursing, social, or therapeutic treatment, or assistance with essential daily activities, PHCS is here to help you maintain your independence and enhance your quality of life.

Why Choose Home Care?

• Comfort & Familiarity: Stay in the environment you know and love, surrounded by your cherished memories and belongings.
• Personalized Attention: Receive one-on-one care tailored to your unique needs and preferences.
• Independence: Maintain control over your daily routine and lifestyle.
• Family Support: Our services can lighten the load for family caregivers, offering respite and professional assistance.
• Cost-Effective: Often a more affordable alternative to institutional care.
• Faster Recovery: Studies show that many individuals recover more quickly and effectively in the comfort of their home.

Who Can Benefit from Home Care?

Home care is an ideal solution for individuals who prefer to stay at home but require ongoing support that cannot be easily provided by family and friends alone. This includes:

• Seniors: More older adults are choosing to live independent, non-institutionalized lives and find home care services invaluable as their physical capabilities change.
• Younger Adults with Disabilities or Acute Illnesses: Individuals recuperating from acute illness or managing a disability often prefer the comfort and familiarity of home for their care.
• Individuals with Terminal Illness: Receive compassionate, dignified care at home, allowing for peace and comfort during end-of-life.
• Post-Hospital Discharge Patients: As hospital stays decrease, many patients need highly skilled care upon returning home to continue their recovery safely and effectively.
• Those Avoiding Institutionalization: Home care can prevent the need for facility-based care, providing safe and effective treatment in your own residence.

Is Home Health Care Right for You?

Consider these questions. If you answer “yes” to any, you may be eligible for our services:

• Do you need assistance at home to maintain your independence in the community?
• Would you or your loved one prefer to receive care at home instead of a nursing facility or institution?
• Has your medication regimen recently changed, or do you need help managing your medications?
• Do you require skilled nursing care?
• Has your medical condition recently changed or worsened?
• Are you a family caregiver spending a substantial amount of time providing care, and would you like to explore options for compensation for your services?

Ready to learn more?

Understanding Payment Options for Home Care Services

Navigating payment for home care can be complex, but PHCS is here to help you understand your options. We work with various payment methods, including private pay, Medicare, and Wisconsin Medicaid.

PRIVATE PAY

Private Pay means you pay for home health services directly out-of-pocket. At PHCS, we offer competitive rates for our private pay clients, providing high-quality care that fits your budget. Contact us to discuss our pricing and find a care plan that works for you.

MEDICARE

If you have Medicare, you may be eligible for home health benefits if you meet ALL FIVE of the following conditions:

1. Under a Doctor’s Care & Plan: You must be under the care of a doctor, and your home health care services must be provided under a care plan established and regularly reviewed (typically every 60 days) by an MD or DO. Please note: Physician Assistants or Nurse Practitioners cannot independently order home health services for Medicare eligibility.
2. Need for Skilled Services: A doctor must certify that you need one or more of the following skilled home health care services:
   
   • Intermittent skilled nursing care
   • Physical therapy
   • Speech-language pathology services
   • Continued occupational therapy
   • For a detailed list of our services, please visit our SERVICES.
3. Medicare-Certified Agency: The home health agency providing your care must be approved by Medicare (Medicare-certified). Professional Home Care Services, Inc. is Medicare-certified.
4. Homebound Status: You must be homebound, and a doctor must certify this. To be considered homebound by Medicare, it means:
   
   • Leaving your home is not recommended due to your medical condition.
   • Your condition prevents you from leaving home without significant assistance (e.g., using a wheelchair, walker, cane, crutches, special transportation, or help from another person).
   • Leaving home requires a considerable and taxing effort.
   • You may still be considered homebound if you leave home for medical treatment or for short, infrequent non-medical absences like attending religious services. You can also receive home care services even if you attend adult daycare, provided the home care is delivered in your home.
5. Face-to-Face Encounter & Physician’s Certification: As part of your eligibility certification for Medicare home health benefits, you must have a “face-to-face” encounter with your doctor, or a Physician’s Assistant or Nurse Practitioner working with your doctor. During this encounter, your doctor or practitioner needs to document that you would benefit from home health care services, specifying which services and the reasons why.
   
   • Important: PHCS must obtain this face-to-face encounter documentation and the signed and dated “Physician’s Medicare Certifying Statement” before we can provide Medicare-covered home health care services. Without this, Medicare will deny payment. We work closely with physicians to ensure these requirements are met.

Medicare Eligibility and Service Amount:

If you meet the above conditions, Medicare will pay for your covered home health services as long as you remain eligible and your doctor certifies the continued need. Please be aware that Medicare’s home health benefit generally covers part-time or “intermittent” skilled nursing care.

• Intermittent Care Defined: Medicare defines part-time or “intermittent” as skilled nursing care needed or provided on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less). If you require more than this, you may not be eligible for the standard Medicare home health benefit.

Medicare Does NOT Pay For:

• 24-hour-a-day care at home.
• Meals delivered to your home.
• Homemaker services (like shopping, cleaning, and laundry) when these are the only care you need and are not directly related to your plan of care.
• Personal Care Services (given by home health aides like bathing, dressing, and using the bathroom) when this is the only care you need.

For more in-depth information, you can visit the official Medicare Home Health Services page: (Link to the Official Medicare home health services guide).

WISCONSIN MEDICAID (Medical Assistance/Title XIX)

Wisconsin Medicaid, also known as Medical Assistance or Title XIX (Title 19), is a government healthcare program funded by both the state of Wisconsin and the federal government. To be eligible for Wisconsin Medicaid home health benefits, you generally must meet these criteria:

• Age/Disability/Blindness: You must be 65 or over, or disabled, or blind; and
• Income & Assets: Your family income and assets must be at or below the monthly program limit; and
• Citizenship/Immigrant Status: You must be a U.S. citizen or legal immigrant.

There are several different Wisconsin Medicaid plans. The specific plan or program you may be eligible for depends on your income, assets, and the type of care you need.

If you are eligible, Medicaid may cover long-term home health care. You must be under a doctor’s plan of care, have medical needs that can be safely met in your own home, and receive services from a home health care agency certified by Medicaid. Professional Home Care Services, Inc. is Medicaid-certified.

Wisconsin Medicaid DOES pay for Personal Care Services given by a home health aide (like bathing, dressing, and assistance with using the bathroom), provided you qualify for these services under your specific Medicaid plan.

Some Medicaid programs that may offer home health care services include:

• Community Waivers: These programs help elderly, blind, or disabled individuals live in their own homes or in the community, offering an alternative to institutional care in a state institution or nursing home.
• Medicaid Deductible Plan: This plan can provide assistance if you have high medical bills and your income exceeds the standard Medicaid program income limits.
• Medicaid Purchase Plan: This program offers healthcare coverage for people with disabilities who are working.
• Medicare Savings Programs (Medicare Premium Assistance): These programs can help eligible individuals pay their Medicare Part A and B premiums, coinsurance, and deductibles.

To determine which programs you may be able to enroll in, we encourage you to visit ACCESS.wi.gov and click on “Am I Eligible?” or go directly to “Apply for Benefits.”