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Care Companions: A Watchful Eye and a Willing Ear for an Older Adult

Not all aging loved ones need medical help


spinner image joanna edelson sitting on a couch with donna gillespie
The writer’s mom, Joanna Edelson (right), with her “new best friend,” Donna Gillespie.
Nick Hagen

After my father died 11 years ago, my mother became fiercely independent. Her social calendar was full, as she drove to book club get-togethers, choir practices and film group meetings. And her memory remained sharp for years. I know this because she could recall incidents from my childhood that I had long forgotten.

Dementia changed all that. Roughly three years ago, my mother started to get into car accidents­ — fortunately not severe, but concerning. One night, she forgot how to get home from choir practice. I noticed her struggling at times to recall the names of friends and relatives. She often couldn’t remember where the utensils she used regularly were kept in the kitchen.

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My family and I knew she needed help, but we didn’t want to move her from her home, the Michigan neighborhood where I was raised and that she adored. She relished being surrounded by young families who would walk past the house with babies and dogs in tow. And the thing is, she was otherwise in relatively good physical health. She didn’t need a home health aide. She needed someone who could just spend time with her.

A different type of care

Such an arrangement is called companion care, a solution for people in my mother’s situation. They need some supervision, but not medical care, as well as help with tasks such as cooking and transportation, but not feeding or dressing. And they crave companionship. Almost half of women 75 and older live on their own. “We’ve got loved ones who are sitting alone and not having conversations and not really staying as much engaged in life or feeling as relevant,” says Sherri Snelling, a gerontologist and spokesperson for Comfort Keepers, an in-home care agency. “They want to have conversations and have that kind of relationship.”

Finding someone to do this work often requires going through different channels than those used for home health aides (typically, agencies that employ or contract with nurses or other skilled labor and who often get paid in part by insurance). How do you get someone who’s simply willing to spend time with an older person and help out around the house?

“The need is great. But I don’t think we have great models for finding companionship care because it does not fit our traditional home care models or home health models,” says Christina Irving, client services director with the Family Caregiver Alliance.

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Helping to fill this void are online registries that also connect families with various types of in-home workers, such as childcare providers, pet sitters and house cleaners. They include such companies as Care.com, Comfort Keepers and CareLinx. One benefit is that they prescreen workers for you so you don’t need to conduct your own background checks. But rates can be higher because the matching service will take a cut.

Levels of Care

Care companion This is the most basic care for an aging loved one, says AARP’s Amy Goyer. A companion caregiver “is a person who has their eyes and ears on your loved one on regular basis,” she says. These types of caregivers generally provide intellectual engagement and transportation to activities and medical appointments, and they assist with meal preparation and light housekeeping.

Home health aide This is someone who can help with bathing, toileting and dressing.

Registered nurse This caregiver provides more intense care, such as administering medications and shots, treating wounds, providing catheter assistance, and taking pulse and blood pressure readings.

Long-term care facilities Assisted living facilities are essentially apartment complexes that employ nurses and certified nursing assistants for residents’ ongoing needs. Some employ a doctor to make regular visits. In nursing homes, medical professionals are on staff around the clock; residents tend to be less ambulatory and require the highest levels of care.

The Genworth Cost of Care Survey, which breaks down average expenses by state, finds that $26 an hour is the national median hourly rate for someone providing care companionship also known as homemaker services. Care.com’s Senior Caregiver Pay Rates Calculator can tell you what a care companion will likely cost in your area.

If you want to hire a worker directly, Irving suggests reaching out to senior centers and other community centers, nursing schools or students in psychology or social work programs at colleges. Word of mouth can sometimes work, too. “There’s a good chance that someone you know may have this same experience and either has hired somebody or will know somebody that they can suggest,” Irving says. A geriatric care manager, usually a licensed nurse or social worker, can also help connect you with companion care. You can locate one in your area at aginglifecare.org.

The benefits of companionship

I found my mother’s first care companion through Nextdoor, the popular neighborhood network app, by posting about my mother’s needs. The woman I chose is a kind, compassionate widow who was eager to spend a few hours a week helping my mom. Initially skeptical, my mother was quickly won over. She looked forward to visits from her companion and seemed happier and more socially engaged. She enjoyed being taken on errands such as grocery shopping that she previously handled herself. 

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When my mother’s health worsened, we hired a second care companion to cover more hours in the week. Over lunches of grilled cheese, vegetable soup and hot chocolate, they’d spend time immersed in conversation, talking about memories of the different countries my mother traveled to with my father, the friends she made when she was a schoolteacher and the pride she felt in her grandchildren.

Now, my mother is in an assisted living facility. A few weeks ago, she had a bad fall that required hospitalization. There were other recent circumstances that indicated she would need a higher level of care. So my siblings and I made that difficult decision. But I’m forever grateful for the way that her companions kept her engaged and happy when she was living in her own home. 

During one of their last visits together, one of the companions took her on a trip to an art museum. My mother was brimming with enthusiasm. “It was just wonderful,” she said. So we’ve decided to hire one of the caregivers to take my mother to lunch weekly, even though she’s in assisted living. My mother was thrilled with the idea. “She’s my new best friend,” my mother would tell me. Neither of us could bear to say goodbye.

Companion Care Tips

Provide explicit details on the care companion’s expected duties in solicitations for care. “Are you looking for companionship in addition to support with errands or housework? A fitness partner? Be sure to include any specifics or goals,” says Caty Kobe, head of community for Nextdoor.  Amy Goyer, AARP’s family and caregiving expert, suggests including the type of activities that your loved one prefers, such as community events or art gallery visits. Sherri Snelling, a gerontologist and spokesperson for Comfort Keepers, says to consider what you would look for if you were seeking a friend for your loved one, indicating his or her preferences in music, for example. Says Anne Sansevero, president of the board for the Aging Life Care Association: “It can’t just be a warm body going in the door.”

Vet the candidates. If you’re hiring through a caregiving service, make sure a background check has been conducted. If hiring directly, verify the candidate’s provided employment record and check references. Ask for their driving records, which candidates should be able to get through their state department of motor vehicles. Getting a complete criminal record will likely require hiring a company that specializes in background checks. “It’s not easy, which is why some families are hesitant to hire privately,” Irving says.

Check your insurance. Although companion care is not covered by traditional Medicare or many private insurers, there are exceptions. Francesca Rinaldo, senior vice president of clinical product and innovation at Sharecare, CareLinx’s parent company, says to ask your insurer about a “home care benefit.” Some Medicare Advantage plans will cover such care, she says. Jill McNamara, Care.com’s senior director, says long-term care insurance can also be tapped in some cases.

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