Companion Care for Seniors

The nature of companion care and how it is different from typical caregiving.
a senior with a volunteer
Many services for seniors focus on the provision of medical care or help with activities of daily living such as showering and dressing. While these are fundamentally necessary for survival, they are often not sensitive to the social and emotional needs of a person as they age. For families providing care, it can be hard to know where to turn for relief.

For seniors who suffer disproportionately from social isolation and loneliness, companion care provides — as the name implies — companionship from people who are there to provide emotional support, a friendly face and an improvement in overall quality of life.

What Makes Companion Care Different?

  1. It goes beyond the basics of caregiving. Many services for seniors address physical or medical needs but don’t address emotional well-being, which can be just as important. Addressing the effects of loneliness has important health outcomes, helping to make depression, high blood pressure and even the onset of dementia less likely.
  2. The benefits go both ways. It’s not just the seniors that benefit from a companion care bond. A relationship often forms between companionship providers and seniors, allowing seniors to share stories, wisdom and knowledge that positively impact the service providers’ lives. This has broader social implications, since it’s not only seniors who suffer from what some have called an “epidemic” of modern loneliness.
  3. Its services are diverse. The particular services provided by a companion care agency vary. Some carry out light housekeeping or help seniors get through their daily routine. They might provide reminders when it’s time for medication, help out with planning and scheduling appointments, share games and hobbies with older adults or provide rides and accompaniment when going out to get groceries. In certain cases, companion care providers may be trained to deal with dementia and able to better interact with elders showing the symptoms of this condition.
  4. The models for providing those services are just as diverse. Several models of companion care exist. When they’re provided by adult care hospices or palliative care in an institutional environment, such care takes the form of community volunteers who drop by to provide a friendly face. In-home and live-in companion care, on the other hand, helps seniors age in place. Live-in companions may provide ongoing support for seniors in a one-on-one relationship while in-home companion care could be provided by different workers in shifts. In either case, companion services can be provided at night, during daytime hours or 24 hours a day.
  5. There is no standard picture of its providers. As diverse as the models of companion care are the organizations providing them. Religious organizations, federally regulated agencies, non-licensed local agencies and independent contractors are all part of the picture.

Institutional Long-Term Care Options

Since it’s true that much of companion care comes through in-home services, it’s worthwhile to do a quick overview of the other side of eldercare, which focuses on long-term care in a variety of facilities. Here we provide some detail about the various types of care to help clarify how companion care differs from, supplements or augments each type.

The terminology of long-term care can get a bit confusing, as there’s no overall standard between states, but there are a few broad categories that can serve for a basic summary. These are the solutions that become relevant when in-home care and community services can’t continue to meet a person’s needs on their own.

Independent Living

On a borderline between in-home care and a more managed model of care is the category most commonly known as retirement or independent living. The specific details and costs can vary widely from case to case, but they typically involve self-contained retirement communities or apartment complexes, sometimes with wellness centers on-site.

Independent living communities allow residents to downsize from larger, less manageable homes and benefit from an environment where they no longer have to worry about house maintenance and yard work. They also typically provide a schedule of activities and outings and opportunities for socialization with neighbors in common areas such as pools, outdoor gardens, libraries or on-site coffee shops.

Some downsides to these communities include expenses, a feeling of being less in control of life and struggles to adjust to environments that don’t feel like home, however congenial they might be otherwise. Though seniors in independent living often get plenty of social stimulation, they can still benefit from a friendly helper. Companion care can be hired in independent living for help with setting up an iPhone, watering plants, organizing old papers, and more.

Assisted Living

The term assisted living covers a range of levels of medical care, help with activities of daily living, medication management and proactive work by staff in keeping residents from feeling isolated. Going into an assisted living facility naturally involves a trade-off of privacy and true independence in favor of reliable support. It requires careful research as to what specific kinds of services are provided, the quality of the facility and whether it’s a fit for your loved one; the AARP Foundation provides a useful guide to researching assisted living.

Further Tiers of Care: CCRCs, Medical Foster Care, Nursing Homes and Memory Care 

Long-term care facilities follow a general curve of providing more medical support, more intensive services and more supervision for aging people who struggle with the tasks of daily life or keeping track of their own health. Once the services provided in an independent or assisted living community are no longer sufficient to ensure the health and safety of an older adult, other tiers of care are available. 

  • Continuing care retirement communities (CCRCs) offer multiple tiers of more extensive services within a single facility or site so clientele don’t have to continue moving from place to place as they age and their needs grow. For example, someone might begin with assisted living, step up into memory care and ultimately end up in skilled nursing care, all within the same property.
  • Medical foster care allows caregivers to provide assistance within their own homes to elderly individuals who may be in need of round-the-care supervision or assistance. Some of these services may be covered by Medicaid or other payers, depending on the state. Pros of medical foster care include a low caregiver to senior ratio, the ability to stay in a specific neighborhood and the comfort of a traditional home. The disadvantages can include a lack of clinical oversight or an inability to support certain types of medical needs. 
  • Skilled nursing facilities provide 24-hour specialized medical care for individuals who need more clinical assistance than assisted living communities or in-home care can provide but who do not require a hospital admission.  This can be one of the most expensive forms of long-term care because of the reliance on registered nurses, but it’s also one of the few that is mostly or fully covered by most insurance plans, including Medicare and Medicaid.
  • Memory care facilities provide a range of services that can mimic either assisted living communities or nursing homes. However, these organizations specialize in serving populations with dementia or other memory issues. 
These kinds of long-term care do not ignore the emotional needs of clients. Indeed, their programming of activities and supervision for residents is ideally meant to help provide socialization options and reduce isolation. Still, facilities aren’t equipped to assuage loneliness in quite the same way that individualized companion care can; even in cases of loved ones with dementia, in facility care or both, companion care can provide added emotional support and can provide an extra point of contact for families who may not be able to visit as often as they’d prefer.

Aging in Place with Medical Home Care Services

Leaving institutional spaces to look at true aging-in-place solutions brings up the subject of medical home care. Medical care isn’t just available in long-term care facilities, and it isn’t necessarily the case that your loved ones will need to leave their homes when they start to encounter difficulties with maintaining their medical regimen or handling activities of daily living. A wide range of services can be provided in the home to help seniors with what they need.

The Return of the Doctor’s House Call

For a long time, house calls were seen as a quaint practice of a bygone era — one observed by few modern medical practitioners. But the internet is full of surprises, and the digital age has seen a resurgence of in-home care by doctors, courtesy of a wave of mobile urgent care startups. Some doctors are seeing tens of thousands of patients per year after opening their doors. Thanks to growing numbers of online dispatch services, getting a personal visit from a doctor is easier than ever, although this rising trend may not be able to reach people in more remote communities. Average costs per visit tend to fall between $50 and $200.

Seniors and their family members can also turn to the internet for digital medical services. Doctors take on-demand appointments, conversing with patients via webcams to help seniors and their caregivers understand and deal with minor medical issues that may not require a trip to the office or ER.

Home Care from Certified Nurses

A more common version of home health care is a customized program of nursing care based on the specific needs of the older adult in question. This is generally carried out by a registered nurse in consultation with the client’s doctor, and it can include anything from administering medicines to intravenous therapy. It’s common for this kind of service to cost around $38 an hour, but what this comes out to as a monthly expense is determined by individual circumstance: it can range from as little as $550 to as much as $4,000 monthly.

Physical, Occupational and Speech Therapy

In-home therapy of various kinds helps people relearn how to carry out daily activities, revive muscle memory and improve speech if they’ve suffered a recent illness or injury. Different types therapists focus on various needs. Physical therapists focus on muscles and joints, occupational therapists help with redeveloping comfort with daily living tasks and speech therapists are often the crucial link in making sure your loved one can communicate their needs. Outpatient treatment can be expensive, but Medicare does help to diffray some of these costs.

Home Health Aides

Home health care aides have a more generalized focus, going beyond medical services to provide support with transportation, laundry, personal hygiene needs and cooking. But on the medical front, they offer services such as skilled check-up care and help with medical devices. The average costs for this kind of care run from $16 to $27 an hour, with aides visiting most homes between two and eight hours a week.

All of these medical services can make an enormous difference in seniors’ lives, but they are fundamentally focused on the medical aspect of care and not the social aspect that’s addressed by companion care.

Non-Medical Home Care

Bringing us closer to the various models of companion care are services focused on nonmedical home care. Some of these services overlap with things companion care providers do, but each service typically has a specific focus on a limited task. 

Community groups, volunteers and local agencies and businesses all come together to play a role in making certain conveniences more available for everyone. Here three of the most common nonmedical home care services older adults can take advantage of.

Homemaking Services

People often choose to remain at home because of the importance of the memories or the simple feeling of comfort and familiarity that comes from being at home. Homemaking services help those who are suffering from limited mobility or reduced energy keep up with housekeeping tasks, ensure grocery shopping is completed or make healthy meals. The costs involved depend on the frequency and type of services provided, House cleaners, for example, earn just over $16 an hour on average.

Meal Delivery

Getting the right nutrition and deriving real pleasure from food are things that can go by the wayside for seniors living at home alone. The body is undergoing major changes in later life as muscle mass shrinks and metabolism slows down, and a well-rounded diet is key to keeping your loved one healthy and happy. A wide variety of charitable or nearly-free meal services are provided for seniors nationwide, and there are also a range of apps that can help seniors access food deliver. These kinds of services can be supplemented by the help of dietitians, some of whom now have their own in-home mobile services.

Transportation Services

Mobility is a major factor in avoiding social isolation and maintaining a strong quality of life. There’s a considerable list of transportation service options for seniors, ranging from senior-specific busing and van services to specialized rideshares and unique forms of companion care services. These services come with a wide range of costs and options. 

Each of these kinds of services has its own critical role to play in reinforcing quality of life for clients. Although they may partially overlap with companion care, they still aren’t designed to confront head-on the problems of isolation that companion care providers have to address.

The Unique Role of Companion Care

Looking at the larger picture of services brings home more clearly the unique and compelling role of companion care in improving the lives of seniors. Companion care is designed to address the question of loneliness as its primary mission, not as a part of a comprehensive portfolio, as is the case of many long-term care facilities or medical care. The role played by companion care providers truly stands out, and can even be sufficient on its own to address the needs of seniors who are early enough in diagnosis of dementia or other ailments to be able to cope without Activities of Daily Living support.

How does companion care stack up? The Genworth Cost of Care survey pegs most companion care services at an average of $18 an hour, but it’s worth noting that this is mostly based on services that require a minimum length of visit of around four hours. 

At Mon Ami, we provide a flexible model that specifically focuses on the benefits of intergenerational companionship. We recruit college students — America’s other loneliest demographic — to provide compassionate companion care for clients at a cost of $25 per hour with no mandatory minimum visit length.

There are many kinds of eldercare to choose from and many reasons to seek them out, but companion care serves the senior community in a specific way that no other kind of service replicates. It’s well worth keeping this in mind as a service in its own right and a worthy supplement to any care plan when you need to make such plans for a loved one.