Companionship care vs home care: what is the difference, and which one do you need?
The legal line between companionship and regulated home care in England, what "personal care" means under the 2014 Regulations, and how to tell which service a relative actually needs.
The difference is personal care. In England, a provider must be registered with the Care Quality Commission if it gives physical assistance with eating, drinking, toileting, washing, bathing, dressing, oral care or the care of skin, hair and nails, or prompts and supervises someone who cannot decide to do those things for themselves. Companionship care is everything else: company, conversation, outings, shopping, errands, meals made together and light help around the house. If your relative needs hands-on help with any of the listed tasks, you need a registered home care provider. If they need company, a lift, the shopping and someone to notice how they are, companionship is the right service, and a good companionship provider will tell you the moment that changes.
The legal line, in plain words
Regulation 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 defines personal care in two parts.
The first is physical assistance given to a person in connection with eating or drinking, toileting, washing or bathing, dressing, oral care, or the care of skin, hair and nails.
The second is prompting, together with supervision, of any of those activities, where the person cannot make the decision to do the activity for themselves without that prompting and supervision.
A provider that does either of those things in the place where the person lives is carrying on the regulated activity of personal care and must be registered with the Care Quality Commission. Carrying it on without registration is an offence. A provider that does neither is not regulated by the CQC, whatever else it does.
That is the whole distinction. Everything else, including the word "care" in a company name, is marketing.
What companionship care covers
Companionship is the part of a good life at home that regulated care visits rarely have time for:
- Conversation, cards, puzzles, hobbies, a photo album, a video call to family set up and left running.
- A walk, the hairdresser, a café, the library, a faith service, a community group.
- The weekly shop done together rather than delivered, prescriptions collected, the post office.
- A meal made and eaten with someone, which is different from a meal left on a tray.
- Light home help that keeps the place feeling looked after: bins, a load of washing, a bulb changed.
- Appointments, door to door, with someone who waits.
- Noticing. A written note to the family after each visit saying how the person really was.
The CQC's guidance is explicit that housing support or social support, such as help with shopping, does not need registration, and that support to prompt or supervise medicines does not either, as long as no other personal care is being provided.
What companionship care does not cover
Whitegreen Companions provides non-regulated independent living support. We do not provide personal care, nursing care, clinical care or any other activity regulated by the Care Quality Commission. Our companions can remind you to take medication but never administer it. If your needs change, we will help you find a registered care provider.
That paragraph is on every page of our website because families deserve to know the boundary before they ring, not after. In practice it means a companion will not help someone wash, bathe, dress or use the toilet, will not manage continence or skin care, and will not give medicines. If a visit reaches the point where one of those things is needed, that is personal care, and it must be provided by an agency registered with the CQC.
How to tell which one you need
Ask three questions about an ordinary day.
- Can they wash, dress and use the toilet without someone physically helping? If no, you need a registered home care provider for those tasks. Companionship can sit alongside it.
- Do they need someone to stand over them and prompt them through washing or dressing because they cannot decide to do it themselves? If yes, that is also personal care under the second limb of the definition.
- Is the real problem the long, empty middle of the day, the shopping, the appointments, the feeling that nobody is noticing? If yes, companionship is the service that fits, and it will usually be cheaper than booking a care agency to do it.
Many families use both. A registered agency handles the morning and evening personal care calls; a companionship service provides the two unhurried hours in between. The two should know about each other, and the family should hold the plan.
Why the boundary matters to you
A companionship provider that quietly drifts into regulated tasks is breaking the law and, more practically, is doing work it is not trained, insured or inspected for. A good provider names the line on its website, trains its companions to stop at it, and has a script for the conversation when a client's needs change. When you are choosing, ask what happens when a client starts to need more. The right answer is that they will help you find a registered provider, and will not charge for doing so.
When needs change
Needs usually change slowly, and a companion who sees someone every week is often the first to notice. The written update after each visit is where that shows up. When it does, the conversation is with the family first, then, if wanted, an introduction to a registered provider. Companionship can continue alongside; it is the personal care that moves to a regulated service, not the friendship.
Common questions
Is companionship care regulated by the CQC?
No. Companionship is not a regulated activity under the Health and Social Care Act 2008, so a companionship-only provider is not registered with the CQC and does not need to be. It must not provide personal care.
Can a companion remind someone to take their tablets?
Yes. The CQC's own guidance says support to prompt or supervise medicines, on its own, does not need registration. Administering medicines is different and stays with a registered provider or a nurse.
Can a companion help someone get dressed or have a bath?
No. Physical assistance with dressing, washing or bathing is personal care under regulation 2 of the 2014 Regulations and must be provided by an agency registered with the CQC.
What if my relative needs both?
Many families use both: a registered agency for the personal care call and a companionship service for the long, unhurried visit. The two should know about each other, and the companionship provider should never quietly drift into the regulated tasks.
Sources
Every figure above comes from one of these. If one has moved or changed, tell us and we will correct the guide.
Start with a conversation, not a contract
Tell us who the visits are for and where they live. If we can help, we will arrange a free meet-and-greet with the companion we have in mind. If we cannot, we will say so and point you somewhere that can.