Companion care is a type of non-medical, in-home support designed to help seniors and people with disabilities maintain their independence at home. It covers everyday needs like meal preparation, light housekeeping, transportation, and, as the name suggests, simple human companionship. The national median cost is $33 per hour in 2025, with state-level rates ranging from $24 to $43 per hour. Most families pay out of pocket, since Medicare and most insurance plans don’t cover it.
What Companion Care Includes
Companion care covers the non-medical tasks that become harder to manage alone as you age or live with a disability. A companion caregiver might help with bathing, grooming, and getting dressed in the morning, then prepare meals, run a load of laundry, and do light housekeeping like dusting or vacuuming. They also provide transportation to doctor’s appointments, the grocery store, or social outings.
In some states, companion caregivers are allowed to offer medication reminders or basic assistance with medications, though they cannot administer injections, manage wound care, or provide any form of skilled nursing. The line is straightforward: if a task requires a nurse or therapist, it falls outside companion care.
The emotional component is just as central as the practical one. Loneliness and isolation in older adults have been linked to higher rates of diabetes, hypertension, heart disease, and faster cognitive decline. For a senior living alone, having someone present for conversation, shared meals, or a walk around the neighborhood addresses a real health risk, not just a comfort preference.
How It Differs From Home Health Care
The distinction matters because it affects who provides care, what they can do, and how you pay for it. Companion care is staffed by trained aides and caregivers. Home health care is staffed by nurses and licensed therapists who deliver skilled medical services like IV therapy, diabetes management, wound care, ostomy care, and physical, occupational, or speech therapy.
Home health care is typically ordered by a physician after a hospital stay, surgery, or acute illness. For Medicare to cover it, three conditions must be met: a physician must create and supervise the care plan, the patient must be certified as homebound (meaning leaving home requires considerable effort), and the doctor must order intermittent skilled nursing or therapy services. Medicare, Medicare Advantage, Medicaid, and private insurance generally reimburse home health care agencies.
Companion care, by contrast, requires no physician order and no homebound status. It exists for people who are largely independent but need a hand with daily life. Because it’s non-medical, Medicare explicitly does not cover custodial or personal care (bathing, dressing, using the bathroom) when that’s the only care needed, nor does it cover homemaker services like shopping and cleaning that aren’t tied to a skilled care plan.
Paying for Companion Care
The majority of companion care is paid for with private funds, either by the person receiving care or by an adult child. At a national median of $33 per hour, costs add up quickly. Someone receiving four hours of care five days a week would pay roughly $2,640 per month at the median rate, though this varies widely by location and the number of hours booked. Many agencies require a minimum number of hours per visit.
Veterans and surviving spouses may have an additional option. The VA’s Aid and Attendance benefit provides monthly payments on top of an existing VA pension for veterans who need help with daily activities like bathing, feeding, or dressing. You may also qualify if illness keeps you in bed for a large portion of the day, if you’re in a nursing home due to a disability, or if your eyesight is severely limited. A separate Housebound benefit exists for veterans who spend most of their time at home because of a permanent disability, though you cannot receive both benefits simultaneously.
Some long-term care insurance policies cover companion care, but coverage varies by plan. It’s worth reviewing the policy language carefully, since many plans distinguish between skilled and non-skilled services.
Agency Caregivers vs. Private Hires
You can arrange companion care through a licensed agency or hire a caregiver independently, and the choice carries real differences in cost, convenience, and liability.
Agencies handle background checks, training, scheduling, and backup coverage if your regular caregiver is sick. They carry insurance, workers’ compensation, and liability coverage, which means you’re not personally responsible if a caregiver is injured in your home. The tradeoff is higher hourly rates, since the agency takes a portion of what you pay.
Hiring privately is often less expensive, and you have more control over who you choose. But private caregivers may not carry their own insurance or workers’ compensation. If something goes wrong, whether it’s an injury on the job or a dispute over pay, you’re navigating it without an intermediary. You also become responsible for tax obligations as a household employer, which catches many families off guard.
How Caregivers Are Trained
Training requirements vary by state, but most states mandate a baseline level of preparation. In Virginia, for example, personal care aides and home attendants must complete 40 hours of training covering personal care techniques, safety protocols, hygiene assistance, and support with activities of daily living. Fingerprint-based state and federal criminal background checks are required for all caregivers, and some agencies conduct periodic re-checks.
Agency-employed caregivers typically receive standardized training through their employer. If you’re hiring privately, ask specifically what training the caregiver has completed and request documentation. A lack of formal training doesn’t necessarily mean someone is unqualified, but it does mean you’re relying on self-reported experience.
Questions to Ask Before Hiring
The National Institute on Aging recommends a specific set of questions when evaluating any care provider. These are worth asking whether you’re interviewing an agency or an individual:
- Licensing: Is the service licensed and accredited by the state or a professional association?
- Fees: What are the fees, and will you provide them in writing before services begin? What is and isn’t included?
- Scheduling: How many days per week and hours per day will a caregiver come? Is there a minimum number of hours required?
- Consistency: Will it be the same caregiver each time?
- Screening: How do you check the background and experience of caregivers? Can you provide references?
- Emergencies: Are you available around the clock for emergencies? What types of emergency care can you provide?
- Communication: How will you share updates with the family?
- Ending services: If you want to discontinue, how much notice is required?
Consistency is one of the most underrated factors. Having the same caregiver visit regularly builds trust, especially for someone with early cognitive decline who may become confused or anxious around unfamiliar faces. If an agency can’t guarantee a consistent caregiver, that’s worth weighing heavily in your decision.