Companion care vs. personal care vs. home health: what’s the difference in Maryland?

Companion care is non-medical help with company and household tasks such as meals, light housekeeping and errands. Hands-on personal care adds physical help with bathing, dressing, toileting and moving around. Home health is skilled nursing or therapy supervised by a physician or registered nurse. In Maryland, each sits under different licensing rules, so knowing which one you need tells you what kind of provider to look for.

This guide uses Maryland’s own definitions, from the regulations the Office of Health Care Quality (OHCQ) enforces, so you can compare providers on the same terms. It is general information, not medical or legal advice.

The short version

	Companion care	Hands-on personal care	Home health
What it is	Company plus household support	Physical help with daily self-care	Skilled nursing and therapy
Examples	Conversation, meal preparation, laundry, tidying, shopping lists, a steady presence	Help in the shower, dressing, toileting, getting out of bed or a chair	Wound care, nursing checks, physical or occupational therapy
Who does it	A companion or homemaker	A trained aide, sometimes a certified nursing assistant	Nurses and licensed therapists, with aides under their plan
Maryland license	Not required if the agency offers only household support	Residential Service Agency license from OHCQ	Home Health Agency license from OHCQ
Usually arranged by	The family	The family, or through a program	A doctor’s order, often after a hospital stay

Companion care: company and household support

Maryland’s home care regulation (COMAR 10.07.05) describes “household or family support services” as tasks that supplement a person’s ability to manage the instrumental activities of daily living. The regulation lists those as light housekeeping and home management, meal planning and preparation, and shopping and errands.

Companion care builds on that with time and attention: conversation, a walk around the block, a card game, someone noticing that the fridge is empty or the mail is piling up. It suits a parent who still manages their own personal care but is lonely, tired, forgetful about meals, or not safe to leave alone for long stretches. It is also a common way to give a family caregiver a break.

Under COMAR 10.07.05.03, an agency that provides only household or family support services does not need a license. That has a practical consequence: an agency offering only household support may not appear in the state’s licensee directory, so ask any provider directly what it is and is not licensed to do. You can see how Bradley Home Care describes its planned companionship service on the companionship page.

Hands-on personal care: help with activities of daily living

The same regulation defines the activities of daily living as eating or being fed; grooming, bathing and oral hygiene; mobility, transferring and walking; toileting; and dressing. When a parent needs another person’s hands for any of these, the help is personal care rather than companionship.

Agencies that provide this kind of help for pay in someone’s home are licensed by OHCQ as Residential Service Agencies. Some aides are certified nursing assistants, which Maryland defines as people certified by the Board of Nursing who perform nursing tasks delegated by a registered or licensed practical nurse.

The line matters for safety as well as paperwork. A companion who is not trained or permitted to help with transfers should not be lifting your parent out of a bathtub. If you expect hands-on needs soon, choose a provider licensed for them, or plan how you will add that help when it is needed.

Home health: skilled care at home

OHCQ describes a home health agency as one that provides skilled nursing and other therapeutic services under the supervision of a physician or registered nurse. Home health is clinical and usually time-limited: a nurse visiting after surgery, a physical therapist rebuilding strength after a fall, or a speech therapist after a stroke.

Medicare covers home health for people who meet its rules, including needing part-time skilled care and being homebound. According to Medicare.gov, it does not cover 24-hour care at home, homemaker services unrelated to the care plan, or personal care when that is the only care a person needs. A home health aide may help with bathing only while skilled care is also being provided. Questions about whether your parent qualifies belong with their doctor and Medicare.

Home health and companion care often run side by side. After a hospital stay, a nurse may visit twice a week while family members or a companion cover meals, errands and evenings at home.

How to tell which one you need

Write down every task your parent needs help with over a typical week, then sort each one:

Company, meals, housekeeping, errands: companion care or household support.
Bathing, dressing, toileting, moving from bed to chair: hands-on personal care from a licensed Residential Service Agency.
Wounds, injections, therapy, medical monitoring: home health, arranged with your parent’s doctor.

If the list mixes categories, that is normal. Ask each provider four questions: Which of these tasks will your staff do? Which will they not do? What license do you hold, and can I verify it with OHCQ? What happens when needs change? The answers will quickly show whether one provider can cover everything or whether you need two working together.

For a wider view that also covers adult day programs and assisted living, read our guide to home care options in Montgomery County. For what each type of care costs in Maryland, see what in-home care costs in Montgomery County.

Common questions

Does a companion care agency need a license in Maryland?

Under COMAR 10.07.05.03, an agency that provides only household or family support services (such as light housekeeping, meal preparation, shopping and errands) does not need a license. Agencies that provide hands-on care are licensed by the Office of Health Care Quality as Residential Service Agencies.

Can a companion help my parent bathe or get dressed?

Bathing, dressing, toileting and transfers are activities of daily living and count as personal care, not companionship. Look for a Residential Service Agency licensed for that kind of help.

Does Medicare pay for companion care?

Medicare.gov states that Medicare does not cover homemaker services unrelated to a care plan or personal care when that is the only care a person needs. Check Medicare.gov or call 1-800-MEDICARE about your own situation.

Sources

This guide is general information, not medical, legal or financial advice. Phone numbers and programs were checked on the date shown above; confirm details with the agency before you rely on them.