Your Guide To Companion Care – Forbes Health - Forbes

In general, there are two types of companion care—in-home care and live-in care. However, companion care doesn't have to take place solely in private homes, according to Hannah Karpilow, who has more than 40 years of experience providing attendant care and is based in the Bay Area. Older adults who reside in skilled nursing communities, group homes or assisted living communities may also receive companion care, usually as an additional paid service that families can opt into for their loved one at the community where they live. A companion working with a client who lives in a care community can be hired through a home care agency or individually—check with the community to see if they have specific guidelines regarding companion care workers.

In-Home Companion Care

Many older adults choose to hire a companion so they can remain in their own homes safely. For in-home care, the companion comes to the home on a set schedule. Until the companion becomes accustomed to the client's routines and preferences, they are often provided with a list of tasks. If there are other people living in the home, the companion's duties should only pertain to the person receiving care—the companion is not responsible for performing chores or activities for or with other people living in the home, says Karpilow.

Live-In Companion Care

In certain cases, an older adult needs to have a companion live with them, such as someone with dementia who cannot be safely left alone or someone with a chronic condition who experiences sudden medical emergencies. A live-in companion can perform the same duties as a companion who doesn't live in the home, but they may need to be available at night to help the client go to the bathroom or to redirect a client who gets confused and wanders.

It's important for live-in companions and their clients to establish clear expectations and boundaries, such as when the companion is expected to work and when they have time off, says Karpilow. "No one is capable of working every day around the clock," she adds.

Prior to hiring a live-in companion, it's important to review state and local employment laws as well. For example, some states have laws for live-in employees that may make it difficult to get them to move out if necessary. Paying the companion legally, as opposed to paying them "under the table," is also important—a companion who works independently needs to be issued W-2 or 1099 documentation that records the amount of pay they receive in a given tax year.

Differences Between Companion Care, Home Nurses and Health Aides

There can be overlapping duties between a home health aide and a companion. A home health aide performs protection and fellowship, similar to a companion, but they typically spend more time assisting with activities of daily living (ADLs), such as assisting with the restroom, bathing and feeding. The federal government defines a companion as someone who spends no more than 20% of their time helping with ADLs. The primary function of a companion is to make sure their client is safe and that they have contact with another person.

Some home health aides also provide medication reminders and administer medication. The training and certifications for home health aides vary from state-to-state. Some states require training and others do not. The distinctions between a home health aide and companion are most important for insurance coverage and may impact the selection of a caregiver when using a home agency.

A home health nurse, on the other hand, performs medical treatments that only licensed professionals can provide, such as injections, wound care and the administration of intravenous (IV) medication, often in addition to the duties listed above. A client who is recovering from surgery could use the services of a home health nurse and a companion. The nursing services would require a referral from a physician and may be covered by insurance.

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