Companion care is paid company and light help at home. A companion visits, talks, shares meals, helps with errands, drives to appointments and keeps an eye on safety. It is not medical care and it usually does not include hands-on help with bathing or toileting. Medicare does not pay for it, so most families pay privately.
This guide explains what companion care is, who it helps, what a companion does and does not do, how it differs from personal care and home care, how it is paid for and how to choose a companion caregiver. Carevo is a directory. It does not provide care, employ caregivers or vouch for any provider.
What companion care is
The Alzheimer's Association describes companion services as supervision, recreation and visiting. In practice that means a person who comes to the house on a regular schedule and spends the time with an older adult: conversation, cards or a walk, a meal made together, a drive to the doctor, a stop at the pharmacy.
There is a legal side to the word too. The U.S. Department of Labor's home care rule defines companionship services as "the provision of fellowship and protection." Limited care with daily activities counts only if it is attendant to fellowship and protection and takes up no more than 20 percent of the worker's hours for that person in a workweek. The same guidance says medically related tasks such as catheter care or tube feeding are not companionship services. This definition matters because it explains why agencies draw a line between companion and personal care roles.
Who companion care helps
Companion care suits people who are mostly independent but would benefit from regular company and a second pair of hands:
- An older adult who lives alone and does not get out much.
- Someone who should not drive any more and needs rides to appointments, the shop or social events.
- A person who can manage self-care but needs supervision or a reminder to eat, take medications they manage themselves, or stay safe.
- A person with early memory loss who is steady physically but should not be left for long. See dementia care at home.
- A family caregiver who lives far away or works, and wants someone looking in. See respite care.
If the person needs help getting in and out of the shower, with toileting or with moving safely, look at personal care. If the need is nursing, look at home health care.
What a companion does and does not do
A companion commonly:
- Spends time talking, reading aloud, doing puzzles, going on walks or taking part in a hobby.
- Plans and prepares meals and eats with the person.
- Does light housekeeping tied to the day, such as tidying the kitchen and laundry.
- Drives or accompanies the person to appointments, shopping, church or social events.
- Shops, picks up prescriptions and runs errands.
- Keeps watch for safety problems and tells the family or agency if something changes.
A companion does not give medical care. Wound care, injections and IV therapy are skilled nursing. Hands-on personal care, such as bathing and toileting, belongs to personal care, and an agency may or may not let its companions do it. Ask for the list of allowed and not-allowed tasks in writing. If a companion is going to drive the person, ask about the driver's license check and the insurance that covers rides, and decide whether they will drive their own car or yours.
Companion care compared with other services
- Home care is the umbrella. It includes companion care, personal care and homemaker help.
- Personal care is hands-on help with bathing, dressing and toileting.
- Adult day care is company and activities at a center, usually with other attendees. Medicare.gov says attending adult day care does not stop someone being counted as homebound for home health.
- Respite care is defined by its purpose, giving a family caregiver a break. A companion can provide it.
- Home health care is skilled care ordered by a doctor.
When the person says they do not need help
This is the most common sticking point, and it is worth planning for. Few people want to be told they need a babysitter. What tends to help:
- Describe the visit as help with something concrete, such as errands, a drive or a meal, rather than as supervision.
- Let the person meet the companion first, and let them have a say in the choice.
- Start with one or two short visits a week, built around something the person already enjoys.
- Ask the companion to follow the person's routine instead of replacing it.
- Keep the family in the loop, and ask the person's doctor to support the plan if safety is a worry.
If safety is the real concern, for example the person gets lost, leaves the stove on or misses medications, say so honestly to the agency. A companion role may not be enough, and the right answer may be personal care, dementia-trained care or a different setting.
How companion care is paid for
Medicare. Medicare.gov says Medicare does not pay for homemaker services (such as shopping or cleaning) unrelated to your care plan, home meal delivery, or custodial or personal care when it is the only care you need. A companion visit by itself does not fit Medicare's home health rules. The Medicare guide explains what Medicare does cover.
Medicaid. Medicaid.gov lists homemaker, personal care, adult day health and respite among the services a state can offer under a 1915(c) waiver, and says states choose how many people a waiver serves. Waiver programs differ by state, and eligibility is set by the state. If a program pays for companion-type help, it is usually under a name like homemaker or respite. Some states let participants self-direct, hiring workers they choose. See Medicaid and long-term care, the state programs and paid family caregiver programs.
VA. VA's Homemaker and Home Health Aide program can help with activities that include grocery shopping, and VA respite care pays for someone to come into the home so a family caregiver can take a break. VA says all enrolled Veterans may be eligible if they meet the clinical criteria and the service is available, and a copay may apply. See VA benefits.
Long-term care insurance. Some policies pay for care at home. The policy decides what counts, and benefits start only when the policy's conditions are met. Companion visits for a person who is otherwise independent may not meet them. Ask the insurer before you book. See long-term care insurance.
Private pay. For most families, companion care is paid out of pocket. See private pay, and use the care cost comparison if you are weighing it against moving to a community.
What drives the cost
Carevo does not publish a price for companion care. What moves the bill:
- Hours. Companion care is usually booked by the hour. Ask about minimum visit lengths.
- Schedule. Nights, weekends and holidays may cost more.
- Driving. Ask whether mileage or a vehicle fee is charged.
- Agency or independent. An agency's rate covers the companion's pay and the agency's costs, including screening, insurance and back-up cover. The Bureau of Labor Statistics reports a national median wage of $17.21 an hour for home health and personal care aides in May 2025. That is what aides are paid, not what an agency charges.
- Skills. Ask whether the rate changes for experience with dementia.
The Department of Labor says third-party employers such as home care agencies cannot claim the companionship exemption and must pay at least minimum wage and overtime. A household that hires directly typically acts as the employer and may claim the exemptions if the worker meets the tests. Ask a payroll service or employment lawyer what applies to you.
How to choose a companion caregiver
- Decide what you want the visit to be. Conversation, outings, meals, rides, supervision. Say it plainly.
- Match on personality. For companion care, personality matters more than for any other service. Ask the agency how it matches caregivers and whether you can meet the person first.
- Shortlist. Ask the doctor, friends and your Area Agency on Aging. The Eldercare Locator (1-800-677-1116) can connect you. Browse home care agencies on Carevo by state and city. These listings show home care agencies, and we have not yet confirmed which of them offer companion care, so ask each one.
- Interview at home. The Alzheimer's Association suggests interviewing in the home with a third person present, checking references and asking whether criminal background checks were done.
- Start small. Try a few short visits before committing to a schedule.
- Review after the first month. Ask the person how it is going, and ask the agency to change the match if it is not working.
Questions to ask
- Are your companions employees or independent contractors?
- How do you screen them, including background checks and, if driving, the driving record?
- What training do companions have? Is there training in dementia care?
- Are they trained in first aid and CPR, and bonded and insured?
- Can the same companion come each time? Who covers a sick day?
- What tasks are companions not allowed to do?
- How do you handle a medical emergency or a fall?
- What is your minimum visit, your rate and your cancellation policy?
- How do you tell the family about changes you see?
Red flags
- The agency sells companion care but quietly expects the companion to provide personal care or medical tasks.
- No written task list or service agreement.
- A different person every visit.
- Pressure to buy a large block of hours up front.
- A companion who asks the person for money, gifts or access to accounts. Report this to the agency and, if needed, to the police or your local adult protective services.
- No clear way to reach the agency after hours.
Next steps
- Decide the hours you need, and test them in the home care hours cost calculator.
- If you are carrying a lot yourself, take the caregiver burnout quiz.
- Tell us what you need and we will show providers in your area. You decide who to call.