Companion Caregiver Services for Seniors
Companionship care is a level of senior in-home care provided for elderly individuals who do not require the in-home medical care of services such as home health care. A senior companion may be able to offer
What is companionship care?
Generally, companionship care is geared toward emotional needs. Recent studies have shown that feelings of isolation may lead to depression and to a decline in overall health. Seniors are at a high risk of being isolated as they age. In a study of community residents over 65, around 14% of seniors felt isolated. Companionship may include daily or weekly visits, phone calls, and social outings.
Companion care may also include a range of other non-medical services. Which services included in companionship care depend on the senior seeking care and on their individual needs.
Companionship care services
Companion care services may be offered by agencies or individuals. What they are able to offer will depend on the parameters of the companionship care program or private care provider, the licensing of the care worker, and the senior’s needs. Some services that may be offered in addition to conversation and social interactions may include assistance with activities such as:
- Grocery shopping and food preparation
- Transportation to appointments and events
- Errand running
- Medication reminders
- Taking walks and playing games
- Making phone calls
- Personal care and grooming
Activities such as showering, eating, and getting dressed are referred to as the activities of daily living (ADLs). Activities such as light housekeeping and taking medications are known as the instrumental activities of daily living (IADLs). IADLs such as laundry and housekeeping are often called homemaker services when they are provided by a care agency
When to consider companionship care
Companionship care may be an appealing option for clients who do not need medical or skilled nursing care but who could benefit from additional assistance. Companion care may be useful for many individuals and in a range of settings. Examples of situations in which companionship care may be a good choice for seniors needing care include:
- An individual who lives alone and has been having difficulties with IADLs or ADLs
- A couple who are both beginning to be less able to care for themselves
- An individual who is able to do ADLs and IADLs, but who is isolated from family or friends
- An individual who lives with an adult child that is away at work for most of the day
- An individual who is starting to become forgetful or have other cognitive issues
- An individual who does not have reliable access to transportation to get to the store or to appointments
There are many other situations that may make companionship care appropriate. Companionship care may make it possible for a senior to stay in their home longer or for an individual to have an improved quality of life.
Types of companionship care
There are several types of service that may fall under the umbrella of companionship care:
Agencies that provide senior in-home care may have different levels of service available for individuals with different needs
Home visitation services may be available through a church group or other volunteer program
Senior Corps is a national service organization that is a branch of the United States Corporation for National and Community Service (CNCS) that works with volunteers over 55 and trains them in companion care for isolated or homebound seniors
Live-in care for
Hospice-provided companion care is for designed to meet the unique emotional and social needs that often arise at the end of life
Respite companion care is intended to provide a break for another caregiver, such as a spouse or adult child
Hiring a private caregiver for companion care may be a good option in some cases. However, hiring a private caregiver requires planning and a careful selection process. Some pros of hiring a private caregiver may include:
- While not always the case, it may cost an individual and their family less to pay a private caregiver. Hourly caregiver rates will vary depending on a number of factors but will generally be more with an agency
- The senior and their family may have more control over who provides care. Employees of an agency are hired and screened by the agency, but a private caregiver is specifically chosen by the elderly individual and their family
- Agency caregivers are able to do only the work outlined in their role by the agency but a private caregiver may be able to do additional tasks or take on other responsibilities like attending social events or adjusting hours
- While some companion care agencies experience a high rate of employee turnover, a private caregiver may have the chance to build a long-term relationship with a senior client
It may also make sense to use a private caregiver in cases where the caregiver has been recommended by family, friends, community members, or
However, using a private caregiver isn’t right for everyone, and some potential drawbacks include:
- Private caregivers are less likely to be covered by long-term care insurance — though, in some cases, Medicaid or Veterans Aid and Attendance benefits may be able to pay for part of costs
- When a private caregiver is sick or otherwise unable to work, it is up to the individual or their family to find a replacement. With an agency, a replacement will be sent if a caregiver is sick
- Hiring and firing may be overwhelming tasks for an individual or their family without the time to run background checks and verify references
- Payroll and tax issues fall on the clients and their family with a private caregiver. Some families prefer to outsource tasks like managing taxes, leave time, overtime considerations, and bonuses to a professional caregiving agency
- A private caregiver may not be able to continue on as care needs change or increase but many agencies have staff members trained and certified to provide many levels of care
Types of licensing for companion care
Companionship care providers may have a variety of licenses or certifications. In some cases, they may not have any certification or formal education. Some types of training or certification companion care providers may include:
Home health aide certification
Not all HHAs are certified, but home health aide national certification is available and is required for HHAs that work at agencies that have been certified by Medicare or Medicaid. Certified HHAs must complete 75 hours of training and pass exams to earn certification.
Personal care aide (PCA) certification
Formal training for PCAs varies from state to state and can encompass a large variety of requirements. Personal care aide certificate and training programs exist, but their requirements are not standardized.
Certified nursing assistant training
CNAs are certified by the state, though certified nursing assistant training requirements vary from state to state,
For companionship care provided by church groups, community groups, the Senior Corps, or other volunteer-based groups, the training received will be less formal. These volunteers are able to perform non-medical tasks only. However, volunteer workers will be able to provide many companionship services and they may receive training on issues like talking to seniors in need or handling an emergency. In some cases, they may also be CPR certified.
Choosing a companion care provider
The right provider
- Any additional services offered, such as home health or hospice services that could reduce stress in the future if care needs
- Home safety evaluations — These evaluations may include watching the senior move about the home along with checking for home fall risks like poor lighting and loose rugs, or for home fire hazards like faulty wiring and older kitchen equipment
- If using an agency, do they perform background checks on their employees? If using a private caregiver, are they able to provide references or background documents such as clearances?
- Does the provider have any specialized certifications, such as dementia or heart failure? Additionally, private providers may have acquired certification in these areas or done extensive work with patients with these concerns in the past
- Some agencies or providers are only able to offer services on certain days of the week or for a certain number of hours. They may not be able to provide overnight care on a weekend or for shifts that are over eight hours long
- If using an agency, do they supervise the caregivers and provide training? When using an agency, it may be helpful to know how caregivers report back to that agency, what level of supervision they have, and what training methods are in place
- Providers should take the needs and requests of the individual and their families into account when creating a plan of care. When working with a private caregiver, families may be able to draw up the plan of care with them and adjust it as needed. With an agency, individuals and their families should be able to make requests and suggestions as care progresses
- Find out staff procedures, like how sick day or on vacations are covered and when the senior or family caregivers will be notified of changes — If possible, find out about staff turnover rates too
- What are all the costs of companionship caregiving service and what options are there for payment? Some providers charge extra additional rates for holidays, weekends, overnight hours, or mileage and supply reimbursements
- If hiring a private companion, is the caregiver legally able to work in the United States?
Since hiring a private caregiver means having an employee, elderly individuals and their families should consider tax and legality-related concerns such as the work status of their caregiver. Seniors and their family caregivers may need to get proof of verifying documents such as Social Security cards, ID cards, or employment authorization documents.
Paying for companionship care
The rates for companionship care will vary depending on the care needs of the individual and on the type of companionship provider chosen.
Volunteer-based companionship services will come at no cost to the individual and their families. However, these programs will generally be able to provide fewer services and fewer hours of coverage. They also may not be available in all areas.
When using an agency or private provider for companionship care, options available for payment will depend on that provider and on the individual's financial circumstances. Some general options may include:
Long-term care insurance
A long-term care insurance plan may cover at least part of the cost of companionship care. Many policies will only cover this care if it is provided by an agency. Other plans may cover private care, but only if the caregiver has a license as a CNA or HHA.
Medicare and Medicaid
Medicare will not pay for the cost of companionship care. In general, Medicare only pays for medically-necessary services and not for any type of custodial care.
It may be possible to pay for companion care using Medicaid benefits in some states. The Home and Community-Based Services (HCBS) waiver program allows individuals to pay for care that is received in the community and paid for by an individual or agency. In some states, qualifying for the HCBS waiver program may have less strict requirements than standard Medicaid income qualifications. HCBS waivers may allow for spousal impoverishment, spend-down, and other provisions.
The cost of companionship care may be able to be somewhat offset by a tax deduction. If the caregiver is providing personal care or any services other than homemaking services during the companionship care, it may be tax deductible. A tax professional should able to tell an individual if they qualify for this deduction if they are given a detailed description of the caregiver’s role.
For veterans who are in need and medically eligible, veterans benefits are available to pay for the costs of companionship services. If certain requirements are met, this may be in the form of the Aid and Attendance benefit being added to a monthly pension amount. In other cases, this benefit may take the form of homemaker services provided by Veterans Administration affiliates.
Private payment options
Companionship care FAQs
- How can I find a private caregiver?
There are several ways to find a private caregiver. Large websites such as Care.com have sections for finding senior care providers. Caregivers are able to create profiles on these websites and apply for jobs posted by families. Local websites and classifieds may have sections for this type of care as well. Additionally, local educational programs such as HHA, CNA, or Nursing training programs may have students looking for work in their fields. You may be able to call these local programs and put a job listing out to their students. Local senior centers or churches may also have lists of people able to provide this care available.
When making an advertisement looking for a private caregiver, it is essential to include all the information a potential caregiver will need to know if they might be a fit for the role. Some information that may be useful to put in a job posting includes:
- The level of training or certification required — Some individuals may not require a caregiver with a certain license, but other people may feel more comfortable knowing the companionship care is being provided by a CNA or other professional
- Level of housekeeping required — If the companionship caregiver will be doing tasking such laundry or light housekeeping, be sure to mention this in the job posting
- Any required driving — Some individuals will need a companionship caregiver who has a car and is able to drive them to appointments. Sometimes an individual may have a car the caregiver is able to use, but other times the caregiver will have to have a private vehicle. If the caregiver will need to use their private vehicle during care, mileage reimbursement compensation should also be included
- Special care skills — Any special needs, such as assistance with transfers, use of assistive devices, care for memory or cognitive impairments, and dietary needs
- Other special requirements — If the person in need of care has communication needs such as being hard of hearing or not speaking English as a primary language, this should be included in the job posting. In the cases of someone whose primary language is not English, it may be possible to find a caregiver who speaks their native language, especially in larger communities
- Household details — A job posting should include information about pets, smoking, and other household rules and details
- Hours and wages — List the hours that will be needed and the range of pay available upfront along with how often the caregiver will be paid and any benefits such as provided meals or covered sick days
- My family member is not comfortable with having a stranger in their house. How can I convince them that companion care is a good idea?
Some seniors are resistant to accepting help or having a stranger in their home. It may be helpful to have the senior in need of care be as much of a part of the process as possible. Allowing them to sit in during interviews and to see the results of background checks may reassure them that the caregiver is trustworthy. If using an agency, it may be helpful to have the individual in need of care meet with agency staff.
Sometimes it may be helpful to start small, with a few very short visits to help the individual adjust to having a caregiver giver around. If the caregiver will be doing housekeeping duties, it may help to initially introduce them as more of a housekeeper instead of a caregiver. Family members should let the individual know that the caregiver is there for their comfort and safety and to help them live fuller lives.
- What services are able to covered by volunteers?
What volunteer services are available will vary depending on an individual’s community and area. Generally, volunteers will be able to cover tasks such as driving individuals to appointments and conversations. Volunteers may be able to visit a few days a week and stay for a few hours. If the individual only needs this level of care, looking into volunteer services may be a good place to start.
- When would companion care services not be appropriate?
If an individual needs a skilled level of care, companionship care is not appropriate. Skilled care includes the services of nurses, physical therapists, and other professionals. For example, a person who has pressure sores and requires wound care and range of motion (ROM) therapy could not this care accomplished by companionship care. In some cases, treatments and therapies may be able to be proved by a CNA. However, that CNA would need to be providing that care under the direction of a nurse, and that care would still have to be skilled care.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.