Companion Care for Older Adults: Complete Guide (2026)

• 8(2)(a) exempts care and support "provided by an individual without the involvement of an undertaking acting as an employment agency or employment business... and who works wholly under the direction and control of the person receiving the care and support."
• 8(3) exempts a person who introduces individuals but "has no ongoing role in the direction or control of the care and support provided," whether or not the introduction is for profit.

The "wholly under the direction and control" wording is the same trap as in England, and it bites harder in Wales because the scope underneath it is wider.

Wales regulates workers as well as services. Domiciliary care workers in Wales are legally required to register with Social Care Wales. According to GOV.UK's licence finder the fee is £30 a year, payable in each year of the registration period, with the three-yearly renewal counting as that year's fee rather than being charged on top. Confirm the current schedule with Social Care Wales before you budget. Registration lasts up to three years and applications take up to 12 weeks. Workers starting on or after 1 April 2023 have six months from their start date to register. CIW can take enforcement action against regulated services that employ unregistered social care workers.

Whether you, as a genuinely independent companion working under the 8(2)(a) exemption, are caught by the worker registration duty is unclear from the published guidance, because that duty attaches to workers in regulated services. If you work in Wales, ask both CIW and Social Care Wales in writing and keep their answers. CIW says initial service registration applications generally take up to 14 weeks, so ask now, well before you have clients.

Northern Ireland is regulated separately again, by the Regulation and Quality Improvement Authority, with criminal record checks through AccessNI. Check with RQIA directly.

United States: it depends on your state, and that is the honest answer

The US has no federal licence for non-medical companion care and no single national rule. Regulation sits with the states, and it varies in three separate ways:

1. Whether agencies must be licensed. Many states license non-medical Home Care Organizations or personal care agencies. Some require surety bonds. Some regulate only skilled home health and leave non-medical companion services alone.
2. Whether individual caregivers must be registered. A minority of states do this. Most do not.
3. Where the line sits between companion/homemaker work and personal care. States draw this differently, and a task that is unregulated companion work in one state is licensed personal care in another.

Never take a number for your state from a blog post. Home care licensing is an area where consultancies and franchise sellers publish confident summaries that have gone out of date. Go to the state agency yourself.

California as a worked example

California is the clearest case of a state that regulates individuals as well as agencies. It is worth understanding even if you live elsewhere, because it shows you what the strict end looks like.

Under the Home Care Services Consumer Protection Act, as of January 2016, Home Care Organizations in California must be licensed by the California Department of Social Services, and the state keeps a public Home Care Aide Registry of background-checked aides. CDSS describes the law as intended "to promote consumer protection for elderly and disabled individuals who hire private aides to come into their homes and provide assistance with activities of daily living."

If you are an independent aide (one not attached to a licensed organisation), CDSS publishes the process for you directly:

• Apply through the Guardian Applicant Portal.
• When asked for a PIN, enter the state's published independent-aide PIN rather than an employer PIN.
• Pay a $35.00 registration fee.
• Complete Live Scan fingerprinting for a criminal background check.
• Renew for $35.00.

CDSS also notes something you should know before you register: unless you opt out, the department must release registered aides' names and telephone numbers to labour organisations that ask for them.

That is one state. Others sit at the opposite end and put no licensing on non-medical services at all. The only correct move is to find your own state's licensing agency and read its current rules before you take a client. If your state licenses non-medical agencies and you are a sole proprietor taking several private clients, work out early whether that agency would see you as an unlicensed agency.

US background checks

The US has no DBS equivalent. Screening is a patchwork of state criminal history repositories, FBI fingerprint-based checks (usually only available where a statute authorises them), state abuse and neglect registries, sex offender registries, and the federal OIG exclusion list. States that license home care generally specify which checks are required and who may run them.

If you are independent and your state requires nothing, get a check anyway and show it to clients. A private third-party background check costs little, and it is the strongest trust signal you can give a family who are about to hand a stranger their mother's door key. Think about it from their side: what would you want to see before you gave someone your own mum's key?

Canada: mostly unregulated, with four exceptions

Health and social care in Canada is provincial. The Canadian Institute for Health Information, in material published 26 February 2026, sets out the position plainly:

"In most provinces and territories, personal support workers are unregulated and, therefore, oversight of this occupation varies between jurisdictions. There are currently 4 jurisdictions that have implemented registries or oversight authorities for PSWs. Registration is either voluntary or only mandated for those working in certain publicly funded sectors."

The four, according to CIHI:

• Nova Scotia: the Continuing Care Assistant Registry. Mandatory registration for all CCAs since April 2021, set up to collect workforce planning data.
• Ontario: the Health and Supportive Care Providers Oversight Authority public register of PSWs, under the Health and Supportive Care Providers Oversight Authority Act, 2021. Registration is voluntary at present. Employers may still require it.
• Alberta: the Health Care Aide Directory. Enrolment mandatory for HCAs working for a publicly funded employer since 31 January 2020; encouraged but not required for privately funded employers. CIHI notes that as of February 2026 Alberta plans to regulate health care aides under a professional college, with the College of Licensed Practical Nurses of Alberta becoming the College of Licensed Practical Nurses and Health Care Aides of Alberta. If you live in Alberta, treat this as a moving target.
• British Columbia: the BC Care Aide and Community Health Worker Registry, created in 2010. Publicly funded employers (health authorities) require registration before hiring.

If your work is privately paid, non-medical companionship in most of Canada, you have no occupational licence to get. You still have a list, though: register a business, handle GST/HST if you cross the small supplier threshold, carry liability insurance, and follow provincial employment standards if you hire. And provinces regulate facilities (retirement homes, assisted living) even where they leave individuals alone, so your answer changes if you work inside a residence rather than a private home.

Australia: registration follows the funding

Australia rebuilt its aged care regulation with the Aged Care Act 2024, which commenced on 1 November 2025. The regulator is the Aged Care Quality and Safety Commission.

The key point for you as a self-employed companion: the registration requirement is tied to Australian Government funding. The Commission's position is that providers of Australian Government-funded aged care services must be registered. If your companion service is privately paid and takes no government funding, you sit outside that registration requirement.

Two things complicate the simple version:

• Associated providers. The Act brought in the idea of an "associated provider": a third party engaged by a registered provider to deliver funded care. Sole traders can fall into this category. If you subcontract to a registered provider delivering Home Care Packages or Support at Home services, you are inside the regulatory perimeter through them, and the registered provider carries obligations for your conduct.
• NDIS. If any of your clients is an NDIS participant, you are dealing with a separate regulator (the NDIS Quality and Safeguards Commission) with its own registration and worker screening rules, including NDIS Worker Screening Checks.

Wage rates for employed workers are set by the Social, Community, Home Care and Disability Services Industry Award (MA000100). SCHADS rates have moved around unusually: the Fair Work Commission's Annual Wage Review 2026 decision increased modern award rates from the first full pay period on or after 1 July 2026, and separate work value and gender-undervaluation decisions have brought further increases to specific care classifications on their own timetables. Any single SCHADS hourly figure you see quoted is likely to be out of date within months. Use the Fair Work Ombudsman's Pay and Conditions Tool for your exact classification and date rather than a number from any guide, including this one.

Background checks in the UK: the self-employment problem

By now you know which side of the line your work sits on, wherever you live. The next thing between you and your first client is proving to a stranger that it is safe to let you in. How would you prove that, today, if a family asked?

This is the part of UK setup that catches people, so let me be precise.

The levels and their published fees:

• Basic check: shows unspent convictions and conditional cautions. £21.50, applied for directly by you through GOV.UK. Usually processed within about three days.
• Standard check: spent and unspent convictions and cautions. £21.50.
• Enhanced check (and enhanced with barred lists). Everything in a standard check plus relevant local police information, and, where eligible, whether the person is barred. £49.50.
• DBS Update Service: £16 per year, paid by the certificate holder, free for volunteers. It lets someone check online whether your certificate is still current, so you avoid buying a new one for every engagement.

The problem: as a self-employed person working directly for a family, you cannot get your own enhanced check. GOV.UK says so explicitly:

"If you are hiring a self-employed person or 'personal employee' to deliver services to you or a member of your family, you cannot request a DBS check for them. They will need to request one for themselves and you'll need to check their DBS certificate."

And as an individual you can only apply for a basic check yourself. Standard and enhanced checks must be countersigned by an eligible employer or registered umbrella body, and eligibility depends on the role meeting statutory criteria.

Here are three realistic ways to hold an enhanced certificate as an independent companion:

1. Get one through employment first. Work for a registered care provider or agency, get an enhanced check through them, and register it on the Update Service before you leave. That is why care-matching platforms such as Curam ask for "an enhanced DBS (PVG/AccessNI) that is registered on the update service". They assume you came from employment.
2. Go through a platform or introductory agency that can lawfully countersign an application for eligible work.
3. Hold a basic check and be honest about what it is. For pure companionship with no personal care, a basic check plus references may be all you are eligible for. Never describe it as an enhanced check.

One more point: a DBS certificate has no expiry date. It is a snapshot. A family accepting a four-year-old certificate without an Update Service check is relying on nothing.

Insurance: what it costs and what it leaves out

Three separate covers matter, and people routinely buy one and assume it does the job of all three.

Public liability and professional indemnity

Specialist carer policies in the UK are cheap next to almost any other trade, because claims are usually property damage rather than catastrophic injury.

Surewise publishes tiered self-employed carer cover starting at £6.49 a month for £2m public liability, £7,500 personal accident, £250 personal possessions and £100,000 legal expenses with no excess; £8.15 a month for a middle tier; and £9.75 a month for £5m public liability and £12,500 personal accident. Cover includes accidental injury to any person in connection with your work, loss or damage to property, replacement of keys and locks up to £100, and damage caused by forcing access in a medical emergency.

Fish Insurance publishes a carer and personal assistant policy from £89 a year with up to £5m public liability, up to £10,000 personal accident cover, and legal costs for defending prosecutions under food and health and safety legislation. Note the £100 excess on property damage claims: Surewise advertises no excess, and Fish has one. That makes a real difference when the claim is a scratched worktop.

A realistic annual figure for you as a solo UK companion is roughly £78 to £160, depending on limits and whether you pay monthly. If someone quotes you four figures for pure companionship work, they are selling you an agency policy.

Read the exclusions before the price. Fish states that cover "wouldn't be valid... if you were performing duties you hadn't had appropriate training to perform." That one clause is why drifting from companionship into personal care is an insurance problem as well as a regulatory one. If you help someone into the shower without training and they fall, you may be both unregistered and uninsured.

Professional indemnity (cover for advice and judgement rather than physical accidents) comes bundled in some carer policies and missing from others. If you advise on anything, check it is there.

Motor insurance when you drive clients

This is the cover people get wrong most often.

Standard social, domestic and pleasure cover stops short of driving for work. If you drive to clients' homes as part of your business, you need business use declared on the policy. Class 1 business use usually covers driving to several work locations in a day, and for a visiting companion that is usually the right class.

The complication is carrying passengers. Business use classes generally exclude carrying goods or passengers for hire and reward: the category covering taxis, private hire and couriers. Insurers each draw their own line between "I drove my client to her hospital appointment as part of the two-hour companionship visit she pays me an hourly rate for" and "I charged her for the journey", so please never guess at where yours sits.

Two rules:

1. Declare it in writing and get the answer in writing. Describe exactly what you do: visiting clients' homes, and carrying clients in your vehicle to appointments as part of an hourly service. Keep the reply. Non-disclosure voids policies.
2. Never price transport separately. The moment you invoice a journey as a journey, outside your hourly rate, you move closer to hire and reward, and in Great Britain that can also bring in taxi and private hire vehicle licensing. GOV.UK's guidance is that a PHV or taxi driver licence comes from the local council (or Transport for London), requires you to be a fit and proper person, may require an enhanced DBS check, a medical and a knowledge test, and that the vehicle needs its own licence and the operation an operator licence. That is a whole different business.

If a client's transport needs are the main event, the honest answer is that a licensed community transport scheme or a PHV will serve them better than you can.

Mileage

If you use your own car, HMRC's approved mileage rates for 2026/27 are 55p per mile for the first 10,000 business miles and 25p per mile thereafter for cars and vans. Note that this went up: the rate was 45p for the first 10,000 miles for every tax year from 2011/12 through 2025/26, and changed for 2026/27. Plenty of published advice still quotes 45p. Charge and claim on the current figure.

Travel between clients is an allowable business expense. Whether the trip from your home to your first client is allowable depends on whether your home is genuinely the base of your business. That turns on your particular facts and is worth twenty minutes of an accountant's time rather than a rule of thumb. Other countries treat this differently.

Safeguarding: your duty and how to act on it

In England, adult safeguarding runs on the Care Act 2014. Wales is different, and this catches people out: adult safeguarding there runs on Part 7 of the Social Services and Well-being (Wales) Act 2014, which uses its own "adult at risk" test and its own reporting duty to the local authority. Scotland is different again, under the Adult Support and Protection (Scotland) Act 2007. If you work across a border, you are working under two regimes. The statutory guidance says safeguarding duties apply to an adult who:

• has needs for care and support (whether or not the local authority is meeting them)
• is experiencing, or at risk of, abuse or neglect
• as a result of those needs is unable to protect themselves from the risk or experience of abuse or neglect

Where a local authority has reasonable cause to suspect that applies, it must make enquiries, or cause them to be made, under section 42.

The guidance's list of abuse types includes financial or material abuse: theft, fraud, internet scamming, "coercion in relation to an adult's financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions," and misuse or misappropriation of property, possessions or benefits. The list is long precisely because you, as a companion, are well placed to spot every item on it. You are also well placed to be accused of several.

How to report a concern. You raise a safeguarding concern with the adult social services department of the local authority where the person lives. Every English and Welsh council publishes a safeguarding adults contact route and an out-of-hours number. If you believe a crime has been or is being committed, contact the police; the statutory guidance says that whenever you come across abuse and are unsure what to do next, you should contact the police for advice. In Scotland, report to the local council's social work service under the Adult Support and Protection (Scotland) Act 2007; in the US, to Adult Protective Services; in Australia, to the relevant state or territory body and, for aged care, the Aged Care Quality and Safety Commission.

The line from the statutory guidance worth writing inside the cover of your folder:

"No professional should assume that someone else will pass on information which they think may be critical to the safety and wellbeing of the adult."

You do not have to be certain. You do have to raise it. If you noticed a new bruise on Thursday, who would you call before Friday?

Everyday safeguarding habits for you as a solo worker:

• Keep a short, dated, factual note of every visit. Treat it as a record and keep feelings out of it: what you did, what you saw, anything unusual.
• Record any injuries and bruising you notice when you arrive, and tell the family or the local authority.
• Never accept gifts of value, and never accept anything at all if the person's capacity is in question. Say so in your terms.
• If you are ever named in a will, tell the family straight away and in writing and, if the person has care and support needs, expect to step back.
• Have a written policy, however short, on what you do if you have a concern. Give it to clients at the start.

Mental capacity and consent

The Mental Capacity Act 2005 governs decision-making for adults in England and Wales who may lack capacity. Its five principles:

• assume a person has capacity unless it is proved otherwise
• help people to make their own decisions wherever possible
• do not treat someone as lacking capacity just because they make an unwise decision
• decisions made for someone who lacks capacity must be in their best interests
• any care or treatment must be the least restrictive of their rights and freedoms

Capacity is decision-specific and time-specific. Your client can lack capacity to manage complex finances while keeping the capacity to decide what to buy at the shop, and capacity can come and go through the day. A person is unable to make a decision if they cannot understand the relevant information, retain it long enough to decide, use or weigh it, or communicate their decision in any way.

For you as a companion this becomes three habits:

1. Take your instructions from the client until you have a documented reason to look elsewhere. The daughter who books you is not automatically the decision-maker. If someone holds a lasting power of attorney or deputyship, ask to see it and record which type it is: property and financial affairs, or health and welfare. The two are different and give different authority.
2. An unwise decision is still the client's decision. A client who wants to walk to the shop in the rain is exercising a right.
3. If capacity is genuinely in doubt, stop and escalate. You are unqualified to assess capacity for anything significant, and acting on a decision from someone who could not make it puts both of you at risk.

Scotland works under the Adults with Incapacity (Scotland) Act 2000 instead. US, Canadian and Australian jurisdictions each have their own substitute decision-making frameworks.

The client's money: hold none of it

This is the shortest section, and the one most likely to protect you.

Do not become a signatory on a client's account. Do not hold their bank card. Do not keep a float of their cash. Do not accept a PIN.

The reasons come from how the situation is built, and your character has nothing to do with it. Financial abuse is one of the listed categories in the Care Act guidance, older people are a target group for it, and you are the person with regular unsupervised access. If money goes missing (including money that was never there), you are the obvious suspect and you will have no way to prove otherwise. Imagine that phone call from a worried son. What would you want to be able to show him?

If shopping is part of the job, these arrangements work:

• Your client pays directly. They tap their own card at the till, or you use their card with them present.
• You pay and reclaim on an itemised invoice, receipt attached, repaid alongside your fee. Cap what you will front (something in the region of £30 to £50 per trip) so your exposure stays small.
• A pre-loaded card in the client's name managed by the family, where the family checks the statement themselves.

Whichever you choose, keep every receipt, itemise every line, and reconcile in writing at least monthly with whoever holds financial responsibility. Write the policy into your terms before the first visit, so that declining to hold money comes across as a professional standard and spares you an awkward conversation in month four.

If a client asks you to be an attorney, executor, or witness to a will, decline. If they insist, tell the family in writing.

What you can actually charge

That covers the law, the insurance and the safeguarding. From here on, this page is about your money, starting with the hour itself.

This is where I need to be straight with you, because the gap between what a client pays and what a worker takes home is the whole economics of this trade.

United Kingdom

Two reference points matter, and they disagree. That disagreement tells you most of what you need to know.

The Homecare Association's Minimum Price for Homecare in England for 2026/27 is £34.42 per hour. Treat it as a calculated floor for employers, well above what the market actually pays. It is the Association's working of what a compliant employer must charge to pay a careworker the statutory minimum wage for all working time (including travel, waiting and training), plus mileage, wage on-costs, and a minimum contribution to running a legally compliant business. The 2025/26 figure was £32.14. The rise reflects the National Living Wage going up to £12.71 from April 2026 and changes to Statutory Sick Pay.

What is actually paid is far less. The Homecare Association's July 2026 submission to the Low Pay Commission reports that local authorities and the NHS buy approximately 80% of homecare, and that in 2025/26:

• only 0.5% of councils and Health and Social Care Trusts paid the Minimum Price
• the weighted average rate paid was £24.39 per hour
• 29% of councils and Trusts paid average rates below the direct employment costs of careworkers at the National Living Wage: nearly four times the 2023 figure
• the resulting funding gap in England alone is put at £1.98 billion
• around 90% of independent sector providers had at least some workers paid below the April 2026 NLW rate of £12.71
• many businesses run on margins of 0 to 4%

For workers, the same submission reports a median careworker hourly rate of £12.60 in December 2025: 39 pence above the National Living Wage at the time. Skills for Care's 2024/25 data put mean nominal hourly pay for independent-sector care workers in CQC non-residential services at £12.28, though that comes from a period when the NLW was £11.44, so it understates today's position. Skills for Care's next annual update is due October 2026.

So where does that leave you as a self-employed companion? Above employed carer pay and below the agency price. That gap is the entire commercial reason to go independent. For a concrete published reference point, the care-matching platform Curam requires carers' advertised rates to be no less than £15 per hour, and takes commission of 12.5% plus VAT, included in the advertised rate. Its published worked example: a client paying £18.50 per hour means the carer receives £15.72 per hour.

Private clients you contract with directly, with no platform commission, usually sit between the platform rate and the agency price. I have left out any aggregate directory figure. Ranges circulate on commercial care directories, but they are marketing-page numbers from businesses that sell care, regulators stand behind none of them, and I could not name and date a specific directory, so I repeat none. The Curam and Homecare Association figures above already bracket the market, and you should treat them as indicative only.

A position you can defend as a solo companion in most of the UK outside London is somewhere around £20 to £28 per hour direct, minimum one hour, with London and unsocial hours higher. That range is my reasoning and comes from no survey. Below about £18, once you count unpaid travel, admin, insurance and tax, you are probably earning less than an employed care worker, and without the sick pay, holiday pay or pension. Where does your town sit in that range?

United States

Keep two US numbers in your head. They are far apart, and the distance between them is your opportunity.

What workers earn. BLS Occupational Employment and Wage Statistics for May 2025 (SOC 31-1120, Home Health and Personal Care Aides) report:

• employment of 4,305,810: among the largest single occupations in the country
• median hourly wage $17.21
• mean hourly wage $17.36; annual mean $36,120; annual median $35,800
• 10th percentile $13.00 an hour; 90th percentile $21.65 an hour

Notice how squeezed that spread is. The 90th percentile is only about 25% above the median. Employed caregiving has no high end.

What clients pay. CareScout's 2025 Cost of Care Survey, published March 2026, puts the national median hourly rate for non-medical caregiver services at $35, up 3% year on year from $34. At 44 hours a week over 52 weeks that is $80,080 a year. CareScout notes it has merged homemaker and home health aide reporting into a single "non-medical caregiver" category because the prices converged.

So the agency keeps roughly half. If you work independently and charge $25 to $30 an hour directly, you are cheaper than the agency median and paying yourself well above the employed median. That is exactly why this trade draws independents, and exactly why several states decided to regulate them.

Rates vary enormously by metro. Use CareScout's location tool for your own area rather than the national median.

Canada and Australia

For Canada, published national medians for privately paid companion care are thinner than in the UK or US. Look at provincial home care association rate cards and CIHI workforce data, and expect rates to differ a lot between metropolitan Ontario, British Columbia and the rest of the country. Be suspicious of any single Canada-wide hourly figure, including one you find quoted confidently elsewhere. As my reasoned estimate rather than a sourced figure: independent non-medical companion rates in major Canadian cities generally sit somewhat below agency prices, which are usually quoted per hour with minimum visit lengths of two to three hours. Check two or three local agencies' published prices and set yours against those.

For Australia, the honest position is that award rates for employed workers under SCHADS moved repeatedly through 2026 after the Annual Wage Review and the work value decisions, and privately paid rates follow those with a margin on top. Use the Fair Work Ombudsman's Pay and Conditions Tool for the current classification rate, then price above it. If your clients hold Home Care Packages or Support at Home funding, the funding rules set the ceiling for you.

In all four countries: check locally. Licensing, tax treatment and what you may lawfully do all vary, and in the US and Canada they vary inside the country too.

Now picture the rate you settle on landing in your account every Friday. Two regular clients could mean the heating stays on this winter without a second thought. A full round could mean leaving the job that makes you dread Sunday evenings. You will have earned every hour of it in kitchens where somebody was glad to see you.

Agency, platform, or direct: the rate difference

Three routes, three sets of economics. Which one fits where you are right now?

Employed by an agency. You get holiday pay, sick pay, a pension, employer's liability cover, training, and someone else handling rotas, complaints and safeguarding escalation. You are paid roughly a third to a half of what the client pays, often for contact time only, and travel between calls has long been a chronic source of minimum wage disputes. If you have never done this work, six to twelve months employed is the fastest and cheapest way to find out whether you can. It is also how you get an enhanced DBS check.

Through an introductory platform. You are self-employed, you set your rate, and the platform handles matching, contracts and payment. Curam's published terms show the model: minimum advertised rate £15 per hour, 12.5% plus VAT commission, payment released three working days after the shift for card-paying clients, minimum shift length one hour. To join you need two years' UK care experience, an enhanced DBS on the Update Service, a Care Certificate dated within the last three years, and two references. You pay a real commission for real distribution, and for a compliance structure that keeps the platform on the right side of the CQC introductory-agency line.

Direct. You keep everything and you do everything: finding clients, contracting, invoicing, chasing payment, arranging cover, carrying the reputational risk alone. Rates are highest here. So is the admin, and so is your dependence on a few clients. Lose one of four clients and you have lost a quarter of your income overnight.

Most people who last in this trade end up with a mix: a platform or agency relationship for baseline hours, and two or three direct private clients for the margin.

If your own parents are getting older, there is a quiet symmetry in this work. If a mix of agency hours and two or three direct clients takes you toward the middle of the 600 to 3,100 range, some of what is left after travel could pay for your mum's taxi to her eye appointment. You spend the week looking after other people's parents, and the money lets you look after yours.

How you will actually find clients

So you have a rate you would be happy with. Nobody pays it until they know you exist, and this section is about that.

Forget the website as a first move. Almost nobody looking for care for their mother finds a solo companion through organic search.

What works, roughly in order of yield:

• Word of mouth. In this trade it is the main channel by a distance. One happy family in a market town can bring you years of work. Ask for referrals out loud, and make it easy by giving clients something they can hand on.
• Community groups. Lunch clubs, day centres, U3A, bowls clubs, WI, men's sheds, dementia cafés, bereavement groups, hospital discharge volunteer schemes. Turn up, be useful, be known. It is slow, and it builds on itself.
• Places of worship. Churches, synagogues, mosques and temples have the most accurate informal picture of who in a community is isolated, and their leaders make referrals all the time.
• Care-matching platforms. Curam and similar platforms give you a live stream of enquiries in exchange for commission. Useful for filling gaps and for starting from zero.
• Introductory agencies. Local agencies that introduce self-employed carers to families for a one-off fee. Check that they genuinely work as introducers and are no unregistered provider using you as cover. Reread the CQC "ongoing role" list above, because if they are getting it wrong, you are the one standing in someone's home.
• GP surgeries, district nurses and social prescribers. Social prescribing link workers exist specifically to connect isolated patients with non-clinical support. Few people in this trade use them. Surgeries rarely put up a commercial card, but link workers keep informal lists.
• Occupational therapists and hospital discharge teams. Discharge is the moment a family realises it needs help, and it is urgent. Being known to a discharge coordinator is worth more than any advertising.
• Local authority frameworks. Councils commission through approved provider frameworks. In practice these are mostly closed to sole traders (they require CQC registration, insurance levels, policies and often minimum capacity) and the rates are the squeezed ones described above (£24.39 weighted average against a £34.42 minimum price). If a council route is open to you as an individual, look very hard at the rate before you take it. In Scotland, remember that local-authority-arranged work can trigger Care Inspectorate registration even for a sole individual.
• Solicitors who handle wills, probate and Court of Protection work. Deputies and attorneys need to buy care and want reliable individuals.

Who in your street, your congregation or your old workplace already trusts you enough to mention your name? Start there. What generally fails: paid social advertising, leaflet drops, and a website with no local proof. Families decide here on trust passed on from someone they already trust.

Trust travels fast in a small community, and it settles fast too. The first reliable companion a GP receptionist or a church warden recommends tends to stay the recommended one for years. Somebody will fill that space near you this year. Ask yourself honestly whether you want it to be your name they pass on.

Cancellation, unsocial hours, and terms that protect your income

Companion care has a particular commercial problem: clients cancel, for reasons you could never resent. They are in hospital. They are unwell. Their daughter came instead. Your income disappears with two hours' notice and you cannot fill the slot.

Write your terms before your first client, well before your first bad month.

• Cancellation window. A 24-hour notice requirement, with the full visit charged inside that window, is standard and defensible. Some people use 48 hours for longer bookings.
• Hospital admissions. Decide in advance whether you waive the charge. Most people waive it the first time and then apply the policy. Say which you do.
• Minimum visit length. One hour absolute minimum; two is better. The Care Act statutory guidance itself observes that short home care visits of 15 minutes or less are inappropriate for people needing support with intimate care, though such visits may be fine for checking someone got home safely or whether medication has been taken. Short visits wreck your effective hourly rate once travel is counted.
• Unsocial hours. Evenings, weekends and bank holidays should carry an uplift. A common structure is a modest uplift for evenings and weekends and a larger one (often time and a half or double) for Christmas Day, New Year's Day and other public holidays. Set the percentages in writing at the start; renegotiating in December is miserable.
• Retainer for regular slots. If a client wants a guaranteed Tuesday and Thursday morning, they are buying your availability. Charging a proportion for a reserved slot, used or not, is legitimate and steadies your income.
• Annual review clause. Build in a stated annual rate review date. Without one you will still be on your 2026 rate in 2029, because raising prices on someone you have grown fond of is one of the hardest things in this work. Could you tell a client you love that your price is going up?
• Mileage. Charge it separately at a stated rate, and say whether it applies from your home or between visits.
• Notice period both ways. Two weeks protects everyone, and gives a family time to arrange cover so their parent is never left without support.

Tax and employment status

United Kingdom. You must register for Self Assessment as a sole trader if you earn more than £1,000 in a tax year from self-employment. You can start trading before you register. For 2026/27, Class 2 National Insurance is treated as paid (protecting your NI record) if your profits are £7,105 or more, with no contribution required; below that, voluntary Class 2 costs £3.65 a week. Class 4 is 6% on profits between £12,570 and £50,270, and 2% above £50,270. Keep records from day one; allowable expenses include insurance, mileage, DBS fees, training, and business phone use.

As a sole trader you have unlimited liability, as GOV.UK says directly. In a trade with physical risk to vulnerable people, think about whether a limited company is worth the extra admin. Note, though, that a limited company changes nothing about the CQC individual worker exemption, which is written around individuals, and may take you outside it.

Employment status is a live risk. If you work for a single client, for set hours, doing what you are told, with equipment they provide and no right to send a substitute, you look like an employee: to HMRC, and possibly to an employment tribunal. Families who directly employ a personal assistant have real obligations: PAYE, employer's National Insurance, pension auto-enrolment, holiday pay and employer's liability insurance. Some will try to call you self-employed to avoid them. The label on your invoice does not settle the question.

Protect yourself with genuine self-employment markers: several clients, your own insurance, your own equipment where practical, control over how you work, a real right of substitution, and a written contract for services rather than of service. And remember the uncomfortable clash flagged earlier. The CQC personal care exemption requires you to work "wholly under the direction and control" of the client, which points the opposite way. If you plan to give personal care under the exemption, take advice on both questions together.

United States. Report your self-employment income on Schedule C and pay self-employment tax through Schedule SE; make quarterly estimated payments. Watch the domestic worker rules: depending on the arrangement and your state, a family paying you may be a household employer with withholding and unemployment insurance obligations, and several states have domestic worker bills of rights.

Canada. Report it as business income; register for GST/HST once you pass the small supplier threshold; check whether your services are exempt supplies. Australia. You need an ABN; check whether you cross the GST registration threshold; and understand that a sole trader engaged by a registered aged care provider may trigger superannuation guarantee obligations for that provider, which affects how they contract with you.

In all four countries, check this year's thresholds with the tax authority before you rely on them. Every figure in this section is indexed and several change every year.

The demands nobody puts in the advert

This is a caring profession dressed up as a flexible side hustle, and the emotional cost is why so many people leave it.

Turnover is high, and it is measured. Skills for Care's data for 2024/25 puts the turnover rate among care workers in CQC-regulated non-residential services in England at 29.0%: approximately 109,000 people leaving their role in twelve months. Across all staff in those services the rate was 23.7%. The vacancy rate was 9.9%. Roughly three in ten care workers leave their post every year. Boredom is rarely the reason.

Bereavement is built into the work. You are working with people near the end of their lives. Carry six regular clients and you should expect to lose clients to death and to nursing home admission again and again. Expect it as a regular part of the job, every year you do it.

You will also usually be left outside the grief that follows. You are not family. You may not be told the person has died. You may not be invited to the funeral. You may find out because nobody answered the door. From your side the relationship was close and long; from the outside it looked like a commercial arrangement. That imbalance is the specific thing that burns people out, and it is worse when you work alone, with no team debrief, no supervision, and no colleague who also knew the person.

If you do this work, deliberately build what an employer would have given you: a peer you can talk to who understands the work, a clear end-of-visit routine that separates work from home, and a decision made in advance about what you will do when a client dies. Some independent carers write to the family; some go to funerals when invited; some do neither. What matters is that you decided beforehand. Have you thought about what you would do?

The physical load is real even without personal care. Housework, carrying shopping, being on your feet, driving between calls in bad weather. Moving and handling is where injuries happen. And if you are untrained and you catch someone who is falling, you can injure yourself permanently and find yourself outside your insurance.

Holding boundaries never stops. Requests to lend money. Requests to do "just one thing" outside your scope. Adult children who want you to report on their parent. Loneliness that makes a client want more of you than you have sold. Clients whose views you find offensive. A person who will not let you leave. All of it is ordinary; it is a normal Tuesday.

Isolation. You work alone in other people's houses. You have no office and no colleague. For some people that is the appeal. For others it turns into the problem after about eight months.

The money, modelled honestly

Assume the UK, direct private clients, £24 per hour, no platform commission.

Twenty charged hours a week is realistically about 28 hours of your time once travel, admin, invoicing and unpaid gaps are counted. That gives gross revenue of about £480 a week, or roughly £2,080 a month. Take off insurance (about £10 a month), mileage costs you cannot recharge, phone, training and accountancy, and you are at perhaps £1,900 before tax. Thirty charged hours a week gets you to roughly £3,100 a month gross. How many of those hours could you really give, alongside everything else in your week?

Now the limits:

• Charged hours grow more slowly than the hours you work. Travel between clients is unpaid unless you build it into your rate. Keeping your clients close together is the biggest lever on your effective hourly rate. Three clients in one village beat six across a county.
• Keeping your diary full is the whole game. Cancellations, hospital admissions and deaths punch holes in a schedule you cannot always refill quickly.
• You have no leverage. You cannot serve two clients at once. The only ways to earn more are to raise your rate, work more hours, or employ people. And employing people in the UK means you stop being an exempt individual, and the CQC question opens again if any personal care is involved.
• You have no sick pay, holiday pay or pension. Take four weeks off and be ill for one, and you have lost five weeks of income. Price that in, or you will earn less than the employed equivalent.

In the form described here, this income is active and it stays small-scale. It is a trade. It turns your hours into money at a rate somewhat better than employment, and in exchange you carry all the risk yourself.

Suppose your diary holds close to its ceiling of 3,100 a month through a whole winter of visits. After travel, tax and a reserve for sick days, that could be the kids' winter coats and a week away in the school holidays, booked without touching your savings. Income like that builds slowly, one family's trust at a time.

Each week you put this off, an older neighbour spends another week alone and a daughter in another city worries a little more. Your own finances stay exactly where they are too. Write your two lists tonight, ring one person who trusts you tomorrow, and let the first booking arrive while you still feel unsure. Confidence comes after the first visit.

Who should skip this

Everything above is the job as it really runs. What is left is whether you want it.

Be honest with yourself about each of these.

• You want passive or scalable income. There is none here. Every pound needs you in a room with someone.
• You want to grow fast by hiring. In England, the moment you have staff giving personal care, you are a provider and you register. Growth in this trade means becoming a regulated business, which is a different undertaking from growing a side hustle.
• You are unwilling to read the regulations for your own area. If the sections above felt tedious, this trade will hurt you. The rules are the job.
• You find it hard to say no. The drift from companionship into personal care is driven entirely by how hard it is to refuse a kind, frail person who needs help. If you cannot hold a line with someone you like, you will end up unregistered, uninsured, or both.
• You cannot absorb repeated bereavement. That is no character flaw. It is a genuine and reasonable reason to choose other work.
• Your schedule is unstable. Clients with dementia in particular depend on the same person arriving at the same time. Erratic availability does real harm here, far more than in most side businesses.
• You need this income straight away. Building a book of clients through community trust takes months. Platform work fills the gap, at a lower rate.
• You have an unresolved relevant criminal record. Families will ask. Agencies and platforms will check. Depending on the offence and where you live, barring lists may apply.

Who it does suit

You, if you are already part of a community and known in it. You, if you are coming out of employed care work and want control over your hours and clients. You, if you have a driving licence, a reliable car, and a small area you can cover densely. You, if you genuinely enjoy older people's company rather than putting up with it. And you, if you want work that is plainly useful, you are realistic about what it pays, and you understand that the boundary between companion care and regulated care is the whole business.