What is Home Care?

“Home Care” is a simple phrase that encompasses a wide range of health and social services.  These services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.

Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends.  More and more older people, electing to live independent, non-institutionalized lives, are receiving home care services as their physical capabilities diminish.  Younger adults who are disabled or recuperating from acute illness are choosing home care whenever possible.  Adults diagnosed with terminal illness also are being cared for at home, receiving compassionate care and maintaining dignity at the end of life.  As hospital stays decrease, increasing numbers of patients need highly skilled services when they return home.  Other patients are able to avoid institutionalization altogether, receiving safe and effective care in the comfort of their own homes.

Who is Eligible for Home Health Care? 

  • Do you need help in your home so that you can maintain your independence in the community?
  • Would you or your loved one prefer to be cared for at home instead of an institution?
  • Has your medication recently changed, or do you need help keeping track of your medications?
  • Do you need skilled nursing?
  • Has your medical condition changed recently?
  • Are you a caregiver that is spending a substantial amount of time caring for a family member or friend? Would you like to get compensated for providing cares?

If you can answer “yes” to any of these questions, you may be eligible for home care.  Please contact PHCS at 414-541-6010. 

Who Pays for Home Care?

PRIVATE PAY– Private Pay is when you pay for home health services out of pocket.  If you choose to Privately Pay for your services, PHCS does offer competitive rates.

MEDICARE – If you have Medicare, you can use your home health benefits if you meet ALL the following conditions:

  1. You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
  2. You must need, and a doctor must certify that you need, one or more of the following:
    1. Intermittent skilled nursing care
    2. Physical therapy
    3. Speech-language pathology services
    4. Continued occupational therapy

See our SERVICES page for more detail on these services.

  1. The home health agency caring for you must be approved by Medicare (Medicare-certified). PHCS is Medicare-certified.
  2. You must be homebound, and a doctor must certify that you’re homebound. To be homebound means the following:
    1. Leaving your home isn’t recommended because of your condition.
    2. Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
    3. Leaving home takes a considerable and taxing effort.

A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.

Medicare Eligibility is also based on the amount of services you need

If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.

To decide whether you’re eligible for home health care, Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less).

Medicare does Not pay for:

  1. 24-hour-a-day care at home.
  2. Meals delivered to your home.
  3. Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care.
  4. Personal Care Services given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.  This is a link to more information about Medicare and Home Health Care: http://www.medicare.gov/pubs/pdf/10969.pdf

WI MEDICAID – Wisconsin Medicaid, also known as Medical Assistance or Title XIX, is a government health care program paid for by the state of Wisconsin and the federal government. To be eligible for Medicaid:

  • You must be 65 or over, or disabled, or in a family with dependent children; and
  • You must have low income and few assets; or
  • You must be paying so much money for health care that you have very little income left.

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

Wisconsin Medicaid does pay for Personal Care Services given by a Personal Care Worker like bathing, dressing, and using the bathroom, if you qualify for these services.