Companion Care vs. Personal Care: Which Help Do You Need?

What companion care and personal care mean

The clearest definitions come from the federal regulation that decides how household workers are paid, 29 CFR 552.6.

• Companion care is "fellowship and protection". Fellowship is keeping the person active socially, physically and mentally: conversation, reading, games, crafts, walks, errands, appointments and social events. Protection means being present at home, or going along outside it, to keep an eye on the person's safety and well-being.
• Personal care is help with activities of daily living, which the regulation lists as dressing, grooming, feeding, bathing, toileting and transferring (moving between bed, chair and toilet). Medicare.gov describes the same group of everyday personal tasks as the core of long-term care.
• Between the two sit instrumental activities of daily living, tasks that let someone live independently: meal preparation, driving, light housework, managing finances, help physically taking medications, and arranging medical care.

Neither is medical care. The regulation classes a task as "medically related" when it is the kind of work normally needing, and normally done by, a nurse (RN or LPN) or a certified nursing assistant, regardless of what the person doing it is called (29 CFR 552.6).

Companion care vs. personal care compared

The 20% rule: when companionship becomes personal care

Under 29 CFR 552.6, companionship can still include personal care, but only if that care is given "attendant to and in conjunction with" the fellowship and protection and does not exceed 20% of the total hours worked per person and per workweek. Illustrative arithmetic: in a 25-hour week, up to 5 hours can go to bathing, dressing, help with meals and similar care. If 6 or more hours do, the job is no longer companionship under the federal definition.

Two other limits apply. Companionship does not include domestic services performed mainly for other members of the household, for example cooking for the whole family. And it never includes medically related services.

Why it matters: the Fair Labor Standards Act exempts companionship services from both the minimum wage and overtime. Only the person receiving care or their family can claim that exemption; an agency or other third-party employer cannot, even when it employs the caregiver jointly with the family (29 CFR 552.109). If a worker does not meet the companionship definition, the ordinary domestic service rules apply: minimum wage, which federally is $7.25 an hour (29 U.S.C. 206), and, unless the worker lives in, time and a half for each hour beyond 40 in the workweek (29 CFR 552.100).

Duties tend to grow quietly. Write the tasks into your agreement and review them when your relative's needs change; the regulation looks at what the worker actually does each week, not at the title you gave the job.

State rules can override the companion exemption

The federal exemption does not stop a state from requiring more. California is a clear example:

• California's minimum wage, $16.90 an hour from 1 January 2026, covers household workers; the exceptions are sitters under 18 and close relatives of the employer, namely a parent, spouse or child (DIR).
• A personal attendant, hired to watch over, feed and dress someone who needs it because of age or disability, is paid overtime past nine hours a day or 45 a week (Domestic Worker Bill of Rights). That is a state rule; if the attendant lives out and the work is mostly personal care, the federal 40-hour overtime line in 29 CFR 552.100 is reached first.
• If more than 20% of the worker's time goes to other duties, they are not a personal attendant, and Wage Order 15's general household rules apply instead: a worker who goes home each night earns time and a half beyond eight hours daily or 40 weekly, and double pay beyond 12 hours in a day (DIR).

So in California a companion who also does most of the housekeeping can be owed overtime sooner than a personal attendant. Outside California, ask your state's wage agency which category your caregiver falls in.

Companion care and personal care costs

CareScout's 2025 survey no longer splits homemaker and home health aide prices; it groups both as "non-medical caregiver", with a national median of $35 an hour (up from $34 in 2024). Nursing care at home has its own line in the survey: $90 an hour at the median. No public survey gives a separate national price for companionship alone, so this page does not quote one.

What changes the bill is the schedule. Illustrative calculations at the $35 survey median (monthly = weekly × 52 ÷ 12):

The last row shows why split visits cost more than their hours suggest: personal care needs help at both ends of the day, and if one non-live-in caregiver covers it all, the federal overtime rule starts after hour 40 (California's personal attendant threshold is nine hours a day or 45 a week). A caregiver you hire directly sets their own rate; ask for it and compare. Payroll taxes come on top when a single worker's 2026 cash pay hits $3,000 (IRS Publication 926).

Medicare leaves out bathing, dressing and toileting help if no skilled care is needed with it, and also homemaker services such as shopping and cleaning unrelated to a care plan (Medicare.gov). Local figures: the caregiver rates pages; companion pricing in depth: companion care cost.

Signs your parent needs personal care, not only company

If you began with companionship, these signs suggest personal care is now needed as well:

• Clothes worn several days running, or a reluctance to shower that is new.
• Bruises, or a near-fall getting in or out of the bath or off the toilet.
• Incontinence pads appearing, or laundry piling up with soiled items.
• Meals left uneaten because cutting, opening containers or using utensils has become hard.
• The companion already helping with dressing or toileting "just this once", most visits.

When you see these, rewrite the job: list the personal care tasks, the times of day they are needed, and any equipment (shower chair, grab bars, transfer belt). Ask a current companion whether they are willing and trained to take them on; some will be, some will not, and the pay rules above may change.

Where both stop: non-medical limits

Companions and personal care aides hired privately do non-medical work. Anything a nurse or certified aide would normally do is outside their role under federal rules. If your relative needs that kind of care, ask their doctor about home health: Medicare pays for occasional or part-time skilled nursing and therapy when the patient is homebound, ordered by a doctor or other provider who has seen them in person, and adds home health aide visits only while that skilled care continues (Medicare.gov).

In California, an agency that sends non-medical caregivers must hold a Home Care Organization license, and each aide it employs has to be registered as a home care aide, with training, a tuberculosis screen and a background check cleared through the Department of Social Services. CDSS suggests asking an agency for its license number and an aide for their PER ID so you can look both up. A caregiver you hire privately may have none of this, and you become the employer.

Finding companion or personal care

Describe the help in plain tasks rather than labels, because the labels mean different things to different people. Then compare caregivers on the service pages: companion care and personal care. Posting on CaregiverConnect costs nothing. Interested caregivers reach out, the hiring decision and the employer role are yours, and the site does no background screening. For the interview itself, use the caregiver interview questions for families, and for every type of in-home help see in-home care services.

Frequently asked questions

Sources

1. eCFR, 29 CFR 552.6: Companionship services
2. eCFR, 29 CFR 552.100 and 552.109: minimum wage, overtime and third-party employers
3. 29 U.S.C. 206, federal minimum wage (govinfo)
4. California DIR, Domestic Worker Bill of Rights FAQ
5. California DIR, Minimum wage FAQ
6. CareScout, Cost of Care Survey 2025
7. Medicare.gov, Home health services
8. Medicare.gov, Long-term care
9. CDSS, Fact Sheet: Licensed Versus Unlicensed Home Care Services (April 2022)
10. eCFR, 42 CFR 483.156: Registry of nurse aides
11. IRS Publication 926 (2026), Household Employer’s Tax Guide