Companion care vs. personal care: which one does your parent need?

What is the difference between companion care and personal care?

The short answer is touch. Companion care keeps your parent company, keeps the house running and keeps an eye on things, without hands-on help with the body. Personal care includes hands-on help: washing, dressing, using the toilet, getting in and out of bed, and help with eating.

Both are non-medical home care, and both come from licensed home care agencies in Pennsylvania. A helpful way to picture it: companion care helps with the life around your parent, and personal care helps with your parent directly.

It's Your Home Care provides both. Many of our clients have a plan that blends the two, and the mix changes as needs change.

What does companion care include?

Companion care covers the everyday tasks that tend to slip first when someone slows down, plus the comfort of another person in the house. A companion caregiver typically:

• Plans and cooks meals, washes up, and notices what is actually being eaten. See Meal Preparation.
• Does light housekeeping and laundry, changes the bed and keeps walkways clear.
• Drives or goes along to the doctor, the pharmacy, church, the hairdresser or the grocery store.
• Gives Medication Reminders and reminders about appointments, drinking water and exercises.
• Plays cards, looks through old photos, goes for a walk, reads the paper aloud, and simply talks.
• Stays with a parent with memory loss who should not be alone, including in the late afternoon and evening, when confusion often gets worse.

Families often choose companion care first for a parent who still bathes and dresses on their own but is lonely, eating poorly, missing medications or no longer driving. Our companion care page describes how a typical visit goes.

What does personal care include?

Personal care is help with what care professionals call "activities of daily living," the basic self-care tasks we all do every day:

• Bathing and showering, including help in and out of the tub and washing hard-to-reach places. See Bathing Assistance.
• Dressing, including buttons, zippers, compression stockings and shoes.
• Grooming: hair, shaving, nail care (not toenails for people with diabetes or circulation problems), lotion, and mouth or denture care.
• Toileting: help getting to the bathroom, changing briefs and cleaning up, done with privacy and respect.
• Moving around: getting out of bed, up from a chair, onto the toilet and into the car, and walking alongside.
• Help at mealtimes for someone who needs help bringing food to their mouth or gentle prompts to keep eating.

Our personal care page explains each task and how caregivers protect your parent's dignity and privacy.

Which tasks fall under each one?

This side-by-side is a handy way to see where your parent's needs land.

How can you tell which one your parent needs?

Look at what is happening in the bathroom and the bedroom, not just the kitchen.

Companion care is usually enough when your parent can bathe, dress and use the toilet alone, even if slowly, but needs help with meals, the house, getting places, reminders or company.

Personal care is worth adding when you notice any of these:

• Skipped showers, unwashed hair, or the same clothes several days in a row.
• A fall in the bathroom or bedroom, or your parent holding onto furniture to cross the room. See what to do after a fall.
• Getting up from the toilet or a low chair takes several tries.
• Toileting accidents, or nighttime trips to the bathroom that worry you.
• Arthritis, a stroke, Parkinson's disease or a recent surgery makes buttons, socks and reaching hard.
• Memory loss means your parent forgets steps in bathing or dressing, or will not accept that help from family.

During our in-home consultation, we walk through a typical day with you and your parent and suggest which tasks belong in the care plan. Very often the answer is something like "mostly companionship, with someone nearby in the shower twice a week."

Can one caregiver do both?

Yes. At a licensed agency, the same caregiver can cook lunch, do the laundry and help with a shower in one visit, as long as those tasks are in the care plan and the caregiver has the training for personal care.

Pennsylvania's home care rules require every caregiver to show they understand things like privacy, infection control, emergencies and spotting changes in a client. Caregivers who give personal care must also show skill in bathing, grooming, transfers, toileting and helping someone take their own medications. Our caregivers complete that training before they are assigned.

One familiar person doing both matters more than it sounds. Your parent gets used to one face. And the caregiver who makes lunch every day is often the first to notice that your dad is getting unsteady on the stairs.

What might a week of each look like?

A couple of examples can make this concrete. These are illustrations, not packages; every care plan is built around the person.

Companion care. A widowed mother in Mechanicsburg stopped driving after cataract surgery and eats mostly toast when she is alone. A caregiver comes three afternoons a week for four hours. She makes lunch and leaves a dinner to reheat, does a load of laundry, drives to the pharmacy or the hairdresser, takes a short walk with her, gives medication reminders, and keeps her company. Her children still visit on weekends and handle bills and appointments.

Personal care. A father in Lititz is recovering from a stroke, and his wife can no longer help him in and out of the shower. A caregiver comes every morning for three hours and two evenings a week. Mornings mean help out of bed, toileting, a shower, dressing, breakfast and a medication reminder. Evenings mean help changing and getting into bed. His wife stays his companion and decision-maker, and the caregiver does the lifting.

In both cases the caregiver writes a short daily note, so the family can see what was done and anything that was noticed.

Is dementia care companion care or personal care?

Usually both, and the balance shifts over time.

Early in Alzheimer's disease or another dementia, the main needs are supervision, routine and company: someone to keep the day on track, prompt meals and medications, and check that the stove is off. That is companion care.

Later, your parent may need prompting and then hands-on help with bathing, dressing and the toilet, which is personal care. Because a person with dementia may push back when family tries to help, a steady caregiver who builds trust through companionship first often finds personal care easier later. Our page on dementia care at home describes how caregivers approach this.

How do you bring up personal care with your parent?

Start with what your parent wants, not with what they can no longer do. "You want to keep living here, and a little help in the mornings makes that easier" usually lands better than "You can't shower by yourself anymore."

Many parents accept help with housework and errands long before they accept help in the bathroom. It is common to start with companionship, let your parent get to know the caregiver, and add standby help in the shower once there is trust. If your parent listens to the doctor more than to you, ask the doctor to suggest it. If your parent refuses outright, our page on a parent who refuses help has gentle, practical ideas.

How is each one usually paid for?

Most ways of paying care about the difference, so it is worth knowing before you file a claim or apply for a program.

• Long-term care insurance usually starts paying when a licensed health care practitioner certifies that your parent needs help with at least two activities of daily living, or has a serious memory impairment that requires supervision. Companionship alone may not qualify yet; supervision for dementia often does. See how long-term care insurance pays for home care.
• Medicare does not pay for ongoing companion care or personal care. It pays for a home health aide only while skilled nursing or therapy is also happening.
• Pennsylvania programs such as OPTIONS, Community HealthChoices and Act 150 approve personal care hours based on an assessment of daily needs. Household help is often included when it goes along with the personal care.
• VA benefits such as Aid and Attendance look at whether a veteran needs another person's help with things like bathing, eating and dressing. See our guide to VA benefits for home care.

Whoever is paying, our care plans and daily notes record which tasks were done, which helps when an insurer or program asks for records.

What is not included in either one?

Neither includes nursing. Home care caregivers do not give injections, change wound dressings, manage feeding tubes, handle IV lines, fill pill boxes from prescription bottles, or decide whether a symptom needs a doctor. Those jobs belong to a nurse, usually through a home health agency or hospice. Our guide to home care vs. home health care explains how the two can work side by side.

How do families usually move from one to the other?

Gradually, and often after something happens. A common path looks like a few afternoons of companionship after a parent stops driving, then help with showers after a fall, then longer shifts or overnight care as memory or mobility changes.

Because the care plan is written down, changing it is usually just a phone call. If you are not sure where your parent is on that path, call us at (717) 695-2704 or request a consultation. We will give you our honest view of whether companionship is enough for now, and there is no pressure to decide on the spot.