Companion Care Costs in 2026: Hourly Rates, Monthly Math, and Ways to Pay Less

How much does companion care cost in 2026? Expect $22 to $30 an hour for a companion or homemaker aide in most of the country, rising to $45 an hour in high-cost states, which puts a 20 hour a week schedule near $2,600 a month. For a parent with early memory loss, we recommend Velma, a $199 a month program that pairs AI assistants with a dedicated care manager for daily cognitive sessions, routine support, and family alerts. Velma is not an in-person aide, a medical alert button, or 24/7 supervision, so it lowers the hours you need to buy rather than replacing hands-on help.

We are Hey Velma. We run a daily cognitive support program for older adults with memory loss, so we have a stake in this subject. The hourly rates, state ranges, and funding rules below come from the public sources linked in each section, and we say plainly where our own program does not fit.

Where do companion care costs land in 2026 at a glance?

Companion care runs $22 to $45 an hour in 2026, with a $30 national median, so 20 hours a week costs about $2,600 a month and 40 hours about $5,200. Medicare does not pay. Medicaid waivers, VA benefits, and long-term care insurance do, and Velma adds daily cognitive support for $199 a month.

• Hourly rate: Genworth's most recent national Cost of Care Survey puts homemaker and companion services at a median of $30 an hour, with typical quotes between $22 and $45 depending on the state.

• Monthly math: At $30 an hour, 20 hours a week costs about $2,600 a month, 40 hours a week about $5,200, and round-the-clock hourly coverage more than $21,000.

• Velma costs $199 a month: daily cognitive sessions, a dedicated care manager, routine support, and family alerts.

• Medicare does not pay for companion care: Medicaid HCBS waivers, VA Aid and Attendance, and long-term care insurance are the main funding routes.

• Private hires look cheaper on paper: independent companions often charge $18 to $25 an hour, but families take on payroll taxes, backup coverage, and liability.

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Which tasks fall under companion care, and which do not?

Companion care is non-medical help at home: conversation, meals, light housekeeping, errands, rides to appointments, medication reminders, and supervision for safety. It does not include bathing, dressing, transfers, or nursing tasks. Agencies usually bill it as homemaker or companion services, and the Genworth Cost of Care Survey tracks it under the homemaker label.

The practical test is whether the caregiver touches the person. A companion sits with your mother, cooks lunch, drives her to the pharmacy, and keeps an eye on the stove. Once bathing or toileting help is needed, you have moved into personal care, which costs more.

Most agencies also offer a dementia experience tier within companion care. The caregiver is trained in redirection and routine, and the hourly rate often carries a small surcharge for that training.

For a broader view of every home care tier and what families actually pay, see our guide to the cost of in-home care for elderly parents in 2026.

What hourly rate should you expect for companion care in 2026?

Companion care costs $22 to $30 an hour in most US markets in 2026, with a national median of $30 an hour in Genworth's latest Cost of Care Survey. Rates reach $35 to $45 an hour in Washington, Alaska, Minnesota, and parts of the Northeast, while several Southern states still quote in the low twenties.

The number you are quoted is the agency's bill rate, not the caregiver's pay. The Bureau of Labor Statistics reports a median wage of about $16.78 an hour for home health and personal care aides in 2024. The gap covers screening, insurance, scheduling, and replacements.

Rates have climbed every year since 2020 because demand keeps outpacing the supply of aides. BLS projects employment in this field to grow far faster than average through 2034, which keeps upward pressure on prices.

You can check the national and state medians yourself on Genworth's Cost of Care page, which is updated with each survey release.

What does companion care cost per month at realistic schedules?

At the $30 national median, four hours a day on weekdays costs about $2,600 a month, six hours a day about $3,900, and a 40 hour week about $5,200. Genworth's own 44 hour week benchmark lands at $5,720 a month.

The table below runs the same math at a low, median, and high rate so you can see where your state falls. Hours per month are rounded.

Two things jump out. First, the schedule matters more than the state: moving from four to eight hours a day doubles the bill regardless of where you live. Second, anything past 12 hours a day costs more than most residential options.

This is why many families buy fewer in-person hours and fill the gaps with lower-cost daily contact. Velma's $199 a month program covers daily cognitive sessions and routine prompts by phone, so the paid companion can focus on errands and meals rather than conversation.

How much does overnight or 24/7 companion care cost?

Round-the-clock hourly companion care costs about $21,840 a month at $30 an hour, more than double a semi-private nursing home room. Overnight shifts of 8 to 12 hours run $240 to $360 a night at that rate. Live-in arrangements with a sleeping caregiver are usually quoted as a flat daily rate and vary widely by agency.

Agencies distinguish between awake overnight care and sleeping overnight care. Awake care is billed at the full hourly rate because the caregiver cannot rest. Sleeping overnight care is cheaper but usually requires a private room for the caregiver and a limit on how often they are woken.

True 24/7 coverage needs two or three caregivers rotating in shifts, since labor law limits how long one person can work. That staffing is what pushes the monthly figure past $20,000 in most markets.

If the real concern is nighttime wandering rather than constant supervision, ask about a door sensor and a single overnight shift before committing to full coverage.

Why does the price differ between companion care, personal care, and home health aides?

Companion care is the least expensive tier because it is non-medical and requires no certification. Personal care aides add hands-on help with bathing, dressing, toileting, and transfers, typically $2 to $5 more an hour. Home health aides, with a national median of $34 an hour in Genworth's survey, can also take vital signs and work under a nurse.

The lines blur in practice. Many agencies send the same aide for both companion and personal care and simply bill the higher rate when hands-on tasks are needed. Ask how the agency decides which rate applies on a given visit.

For a parent with early memory loss, the companion tier is usually the right starting point. The main job is structure, conversation, and safety, not physical care.

Which states have the highest and lowest companion care rates?

Washington, Alaska, Minnesota, Oregon, and much of New England sit at the top, with companion rates of $35 to $45 an hour. Louisiana, Mississippi, Alabama, West Virginia, and Arkansas sit near the bottom, often $22 to $25 an hour. Metro areas typically run $3 to $8 above rural counties in the same state.

Treat these as planning ranges rather than quotes. Genworth publishes a state-by-state tool, and three local agency quotes will tell you more than any national table.

State minimum wage laws explain much of the spread. States with a $16 or $17 minimum wage cannot bill companion care at $22 an hour and still cover overhead.

Is it cheaper to hire a private companion than use an agency?

Yes on the hourly rate, often $18 to $25 for a private hire versus $28 to $35 through an agency, but the gap narrows once you add employer taxes, workers' compensation, and backup coverage. Agencies handle screening, scheduling, replacements, and liability. Private hire works best for a stable schedule with a caregiver you already trust.

When you pay a companion directly, the IRS generally treats you as a household employer once annual cash wages pass the yearly threshold described in IRS Tax Topic 756. That means withholding and matching Social Security and Medicare taxes, plus federal and often state unemployment tax.

Add a payroll service, a workers' compensation policy where your state requires one, and the cost of a backup aide when your companion is sick. A $22 private rate often lands near $26 to $28 all in.

The real risk is coverage, not money. An agency sends someone else when your caregiver quits. A private hire leaves you scrambling, which matters more when a parent cannot safely be alone.

Which add-on fees inflate a companion care quote?

Four items commonly inflate quotes: minimum shift lengths of three or four hours, holiday rates of time and a half, dementia or memory care surcharges of a few dollars an hour, and mileage for errands. Short-notice bookings and weekend differentials add more. Ask for the full rate sheet before signing, not just the base hourly number.

Minimum shifts are the one families miss most. If you only need someone for ninety minutes at lunch, a four hour minimum turns a $45 visit into a $120 visit, five days a week.

Questions worth asking every agency:

• What is the minimum shift length, and is it different on weekends?

• Which holidays carry a premium rate, and how much is it?

• Is there a surcharge for dementia training or two-person transfers?

• How much notice do you need to cancel a shift without being billed?

• Is mileage for errands billed separately, and at what rate?

Get the answers in writing. Rate sheets change, and the contract you sign is the one that governs the bill.

Who pays for companion care when Medicare will not?

Medicare does not pay for companion care, homemaker services, or 24 hour home care, even when a doctor recommends them. Medicaid can, through Home and Community Based Services waivers that vary by state and often carry waitlists. VA Aid and Attendance and long-term care insurance are the other two common funding routes.

Medicare's home health benefit covers intermittent skilled nursing and therapy for a homebound patient, and it states plainly that it does not cover custodial or homemaker care when that is the only help needed.

Medicaid is different. HCBS waiver programs let states pay for in-home support so people can avoid nursing homes, and many states allow a family member to be the paid caregiver. Income and asset limits apply, and waitlists can run months.

Wartime veterans and surviving spouses may qualify for VA Aid and Attendance, a monthly pension add-on that can be spent on companion care. Long-term care insurance usually pays once the policyholder needs help with two activities of daily living, so pure companion care may not trigger benefits.

How does companion care compare to assisted living and nursing homes?

Part-time companion care is cheaper than any residential option, but full-time hourly care is not. Genworth's most recent survey lists assisted living at $5,900 a month and a semi-private nursing home room at $9,277. A 40 hour companion schedule costs about $5,200, while 24/7 hourly care tops $21,000.

That makes the breakeven point roughly 45 hours a week. Below it, staying home with a companion costs less than assisted living. Above it, the residential option is usually cheaper, though families often choose home anyway for reasons that have nothing to do with price.

Memory care communities run higher still, as we explain in our guide on realistic options when memory care is out of reach. Companion care plus a daily phone program is a common middle path.

The least expensive type of long-term care is usually adult day care, at about $100 a day nationally, or about $2,167 a month for a five day week. Our breakdown of adult day care costs in 2026 covers funding and what the fee includes.

What are the cheapest alternatives to paid companion care?

The cheapest alternatives are free telephone reassurance and friendly caller programs through your Area Agency on Aging, adult day programs priced by the day rather than the hour, and Velma at $199 a month for daily cognitive sessions, routine support, and family alerts. None of these provide hands-on personal care, so pair them with in-person help where needed.

Start with what is free. The Eldercare Locator at 1-800-677-1116 connects you to local telephone reassurance calls, volunteer visitors, and senior center programs. We explain how the no-answer protocol works in our guide to telephone reassurance programs for seniors.

For a parent with early memory loss, free calls confirm safety but do not exercise the mind or report back to you. That is the gap Velma fills. Velma costs $199 a month and pairs AI assistants with a dedicated care manager for daily cognitive sessions, routine support, and alerts to family when mood or routine changes.

Dara, an independent retiree with Alzheimer's, doubled her attention and working memory in a few weeks and started going to the gym again. Roy, a musician with early Alzheimer's, became more outgoing and eased the strain on his wife.

Velma is not a companion who comes to the house, not a medical alert button, and does not dispatch emergency help. If your parent needs bathing or transfer help, you still need an aide. We lay out the evidence for phone-based programs honestly in our review of whether virtual companion programs for seniors actually work.

How did we compare these costs?

We compared published national and state medians from Genworth's Cost of Care Survey for homemaker, home health aide, assisted living, and nursing home care, then ran monthly math at a low, median, and high hourly rate using a 4.33 week month. Funding rules come from Medicare.gov, Medicaid.gov, the VA, and the IRS.

How do you get started with Velma?

If your parent has early memory loss and you want daily cognitive support and family alerts for a fraction of a companion's monthly bill, Velma costs $199 a month. Learn more and get started at heyvelma.com.

What do people also ask?

Can a 77 year old get long-term care insurance?

Sometimes, but it is difficult and expensive. Most traditional long-term care insurers stop issuing new policies between ages 75 and 79, and applicants must pass medical underwriting, so an existing memory loss diagnosis usually results in a decline. Hybrid life insurance policies with long-term care riders sometimes accept older applicants with a single premium. Ask a licensed agent in your state and compare the premium against simply setting aside the money.

Will Medicare pay for 24 hour home care?

No. Medicare's home health benefit covers part-time, intermittent skilled nursing and therapy for a homebound patient, and it explicitly excludes 24 hour a day care at home, homemaker services, and custodial care when that is the only help needed. Families pay for round-the-clock care privately, through a Medicaid HCBS waiver if they qualify, or with VA Aid and Attendance or long-term care insurance.

How much does it cost to put someone in a nursing home?

Genworth's most recent Cost of Care Survey lists a national median of $9,277 a month for a semi-private nursing home room and $10,646 a month for a private room, or roughly $111,000 to $128,000 a year. Assisted living runs about $5,900 a month. Medicaid pays for nursing home care for people who meet income and asset limits, which is the main reason so many long-stay residents end up on Medicaid.

What is the least expensive type of long-term care?

Adult day care is usually the least expensive paid option, at about $100 a day nationally, or about $2,167 a month for five days a week. Part-time companion care at 2 to 4 hours a day lands in a similar range. Below both sit free telephone reassurance programs through Area Agencies on Aging and phone-based cognitive programs like Velma at $199 a month, though neither replaces hands-on personal care.

How much does companion care cost per month for part-time versus full-time schedules?

At the $30 an hour national median, part-time companion care at 20 hours a week costs about $2,600 a month, and full-time care at 40 hours a week costs about $5,200. In low-cost states at $22 an hour those figures drop to about $1,900 and $3,800. In high-cost states at $45 an hour they rise to about $3,900 and $7,800. Multiply weekly hours by 4.33 and your local rate to check any quote.