Imagine a Tuesday morning at someone else's kitchen table. The kettle is on, you are half listening to a story about a brother in Canada, and at eleven you will drive her to the eye clinic and sit in the corridor with a magazine while she goes in. What would you charge for a morning like that? Companion care is exactly that work: tea, lifts, a load of washing, company. None of it is regulated personal care in England, so none of it needs CQC registration. Washing, dressing and feeding are regulated, and carrying that on unregistered is an offence under section 10 of the Health and Social Care Act 2008, unless you fall inside the Schedule 1, paragraph 1(3) exemption: hired direct by the person or a related third party, no employment agency involved, working wholly under their direction and control. Wales draws its line under the Regulation and Inspection of Social Care (Wales) Act 2016 through Care Inspectorate Wales, and Scotland under the Public Services Reform (Scotland) Act 2010, so read the one that governs you rather than the one you find first. Getting ready to work costs somewhere between £120 and £1,000. Expect two to six months before the round pays, and £600 to £3,100 a month once it is steady, with the bottom of that range the honest figure to plan around, since you can only be in one house at a time. Today, open CQC's scope of registration guidance, last updated 14 May 2026, and write two lists: the tasks you will take, and the tasks you will hand to a registered provider.
That is a real service and people pay for it. It is also a trade with a legal tripwire running straight through the middle, low margins, and an emotional load most people underestimate until they are in it. This guide is for someone deciding whether to do it as self-employed work, not for someone who has already decided.
Companion care, also called social care support, home help, or non-medical home care, is a bundle of ordinary tasks:
What it is not: washing, bathing, dressing, toileting, oral care, foot and nail care, physically assisting with eating and drinking, wound care, injections, hoisting, or administering medication. In England these are the specific tasks that trigger CQC registration. Where the line sits elsewhere varies, and not trivially: see the Scotland, Wales, US, Canada and Australia sections below, none of which draw it in quite the same place.
The tension in this trade is that clients drift. A person you started visiting for conversation in March is, by November, asking you to help her get her cardigan on, or to pop her tablets out of the blister pack. Each request is small and refusing feels unkind. That drift is how unregistered operators commit offences without ever making a decision to.
In England the regulator is the Care Quality Commission. CQC does not register professions or job titles. It registers regulated activities. The relevant one is Personal care, defined in Regulation 2 and Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
So: reminding a mentally sharp 84-year-old that she said she wanted a bath before her daughter arrives is not personal care. Standing in the bathroom doorway supervising someone with advanced dementia through washing, because she cannot decide to do it unprompted, is.
One more condition is easy to miss. The personal care "must be provided in the place where those people who need it are living at the time when the care is provided." Help given in someone's home or supported living scheme is in scope. Help given in a day centre, or in a car, is a different question.
CQC's scope of registration guidance, last updated 14 May 2026, is unusually direct:
That second sentence surprises people. In England, medication prompting on its own does not trigger CQC registration. That does not make it safe or sensible. It is a high-consequence task, your insurer may exclude it, and doing it badly is a safeguarding matter regardless of registration. But it is not, by itself, what puts you inside the regulated perimeter.
Companionship, conversation, errands, shopping, light housekeeping, meal preparation, escorting to appointments, and respite sitting all fall outside the definition of personal care.
Even where personal care is being provided, the regulations exempt some people. Schedule 1, paragraph 1(3) says a care worker does not need to register if they are:
A "related third party" is defined narrowly: someone with parental responsibility for a child receiving care, someone with power of attorney or other lawful authority to make arrangements on the person's behalf, a group of such individuals, or a trust established to meet a named individual's health or social care needs.
This is the route by which directly-hired personal assistants lawfully provide hands-on personal care without registering. It has two hard edges.
If you are considering building something larger than yourself, this distinction decides whether you register.
CQC then lists, in unusual detail, what counts as an "ongoing role" and therefore drags you into registration. Activities that require registration include:
Read that list twice if you are thinking about a matching business. The branded polo shirt and the recurring percentage (the two things almost every founder wants) are both on the wrong side of the line.
Carrying on a regulated activity without being registered is an offence under section 10 of the Health and Social Care Act 2008.
There is also a commercial consequence that arrives faster than any prosecution: your insurer. Liability policies for carers are written around the duties you have declared and are trained to perform. Provide unregistered personal care outside your declared scope and you may find you are uninsured for the claim that made you notice.
Registering for Personal care is a serious undertaking: a statement of purpose, policies, a fit and proper registered manager, and ongoing inspection. CQC's published fee table for community social care calculates the annual regulatory fee per location as £239 plus (number of service users multiplied by £54.305), subject to a cap. That table is labelled 2024/25 on CQC's site; CQC has held its fees scheme flat for several years, but check the live page for the year you are registering rather than trusting this figure.
For a solo operator, registration is usually the wrong answer. The right answer is to stay clearly inside the companionship boundary and refer personal care work to a registered provider. Which, done well, becomes a referral relationship that sends work back to you.
Scotland does not copy England, and assuming it does is a common and expensive error. The regulator is the Care Inspectorate, operating under the Public Services Reform (Scotland) Act 2010. Crucially, the Care Inspectorate registers whole services, not discrete regulated activities the way CQC does.
Three consequences follow, none of them obvious.
The practical upshot: in Scotland, do not reason from the English task list. Read Schedule 12, and if you intend to take any local-authority-arranged work, contact the Care Inspectorate before you start. Care at home workers employed by registered Scottish services also register individually with the Scottish Social Services Council, and criminal record checks run through the PVG Scheme rather than the DBS.
Wales operates under the Regulation and Inspection of Social Care (Wales) Act 2016, regulated by Care Inspectorate Wales (CIW).
Note what that does not say. It does not list washing, dressing and toileting. It says care and support: a far broader phrase than England's enumerated tasks. On the face of the statute, a Welsh service providing regular support to someone who cannot manage alone sits closer to the regulated boundary than the equivalent English service.
The "wholly under the direction and control" wording is the same trap as in England, and it bites harder in Wales because the underlying scope is wider.
Whether a genuinely independent companion operating under the 8(2)(a) exemption is caught by the worker registration duty is not clear from the published guidance, because that duty attaches to workers in regulated services. If you are operating in Wales, ask both CIW and Social Care Wales in writing and keep the answer. CIW says initial service registration applications generally take up to 14 weeks, so this is not a question to leave until you have clients.
Northern Ireland is regulated separately again by the Regulation and Quality Improvement Authority, with criminal record checks through AccessNI. Check RQIA directly.
United States: it depends on your state, and that is the answer
There is no federal licence for non-medical companion care in the US and no single national rule. Regulation sits with the states, and it varies in three separate dimensions:
- 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.
- Whether individual caregivers must be registered. A minority of states do this. Most do not.
- 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.
Do not take a number from a blog post about your state. Home care licensing is an area where consultancies and franchise sellers publish confident summaries that are out of date. Go to the state agency.
California as a worked example
California is the clearest case of a state that regulates individuals as well as agencies, worth understanding even if you live elsewhere because it shows 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 maintains 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."
For an independent aide (one not attached to a licensed organisation) CDSS publishes the process directly:
- Apply through the Guardian Applicant Portal.
- When prompted for a PIN, independent home care aides 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 worth knowing before you register: unless you opt out, the department is required to release registered aides' names and telephone numbers to labour organisations on request.
That is one state. Others sit at the opposite end and impose no licensing on non-medical services at all. The only correct action 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 multiple private clients, work out early whether you are an unlicensed agency in that agency's eyes.
US background checks
There is no DBS equivalent. Screening is a patchwork of state criminal history repositories, FBI fingerprint-based checks (usually only accessible 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 mandates nothing, get a check anyway and show it to clients. A private third-party background check is a modest cost and it is the single most effective trust signal you have with a family about to give a stranger a door 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, states 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, per CIHI:
- Nova Scotia: the Continuing Care Assistant Registry. Mandatory registration for all CCAs since April 2021, established 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 nonetheless 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 are 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.
For privately-paid, non-medical companion work in most of Canada, there is no occupational licence to obtain. That does not mean there is nothing to do: you still register a business, handle GST/HST if you cross the small supplier threshold, carry liability insurance, and comply with provincial employment standards if you hire. And provinces regulate facilities (retirement homes, assisted living) even where they do not regulate individuals, so the answer changes if you work inside a residence rather than a private home.
Australia: registration follows the funding
Australia restructured 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 structural point for 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. Privately-paid companion services taking no government funding sit outside that registration requirement.
Two things complicate the simple version:
- Associated providers. The Act introduced the concept 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 client is an NDIS participant, that is 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 been unusually volatile: 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 delivered further increases to specific care classifications on their own timetables. Any single SCHADS hourly figure quoted anywhere 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
You now know which side of the line your work sits on, wherever you are. The next thing standing between you and a first client is how you prove to a stranger that it is safe to let you in.
This is the part of UK setup that catches people, and it is worth being precise.
The levels and their published fees:
- Basic check: shows unspent convictions and conditional cautions. £21.50, applied for directly by the individual 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 a certificate is still current instead of buying a new one for each engagement.
The problem: you cannot get your own enhanced check as a self-employed person working directly for a family. GOV.UK states it 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 individuals can only apply for a basic check themselves. Standard and enhanced checks must be countersigned by an eligible employer or registered umbrella body, and eligibility depends on the role meeting statutory criteria.
Three realistic routes to holding an enhanced certificate as an independent companion:
- Get one through employment first. Work for a registered care provider or agency, obtain an enhanced check through them, and register it on the Update Service before you leave. This is why care-matching platforms such as Curam require "an enhanced DBS (PVG/AccessNI) that is registered on the update service". They assume you came from employment.
- Go through a platform or introductory agency that can lawfully countersign an application for eligible work.
- 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. Do not describe it as an enhanced check.
One further point: a DBS certificate has no expiry date. It is a snapshot. Families accepting a four-year-old certificate without an Update Service check are relying on nothing.
Insurance: what it costs and what it does not cover
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 relative 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, Fish does not. That is a real difference when the claim is a scratched worktop.
A realistic annual figure for a solo UK companion is roughly £78 to £160, depending on limits and whether you pay monthly. Anyone quoting four figures for pure companionship work is 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 single clause is why drift 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) is bundled into some carer policies and absent 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 does not extend to 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 typically covers driving to multiple 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 carriage of goods or passengers for hire and reward: the category covering taxis, private hire and couriers. Where an insurer draws the 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" varies by insurer, and is not something to guess at.
Two rules:
- 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. And keep the response. Non-disclosure voids policies.
- Do not price transport separately. The moment you invoice a journey as a journey rather than as part of an hourly rate, you are closer to hire and reward, and in Great Britain that can also engage 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 an entirely different business.
If a client's transport needs are the main event, the honest answer is that they need a licensed community transport scheme or a PHV, not you.
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. A great deal of published advice still quotes 45p. Charge and claim on the current figure.
Travel between clients is an allowable business expense. Whether the journey from home to your first client is allowable depends on whether your home is genuinely the base of your business, which is fact-specific and worth twenty minutes of an accountant's time rather than a rule of thumb. Other countries treat this differently.
Safeguarding: the duty and the mechanics
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 sets out that 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. It is a long list precisely because a companion is well placed to spot every item on it. And 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 in any case where you encounter abuse and are uncertain about next steps, 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 on the inside 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 are not required to be certain. You are required to raise it.
Practical safeguarding hygiene for a solo operator:
- Keep a short, dated, factual note of every visit. Not a diary, a record. What you did, what you observed, anything unusual.
- Record injuries and bruising you observe on arrival, 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, disclose it immediately and in writing to the family and, if the person has care and support needs, expect to withdraw.
- 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. Someone can lack capacity to manage complex finances while retaining capacity to decide what to buy at the shop, and capacity can fluctuate 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 a companion this translates into three habits:
- Take instructions from the client, not the family, until you have a documented reason not to. 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. They are different and confer different authority.
- An unwise decision is not incapacity. A client who wants to walk to the shop in the rain is exercising a right.
- If capacity is genuinely in question, stop and escalate. You are not qualified to assess capacity for anything significant, and acting on a decision from someone who could not make it exposes both of you.
Scotland operates 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 save 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 are structural rather than moral. Financial abuse is one of the listed categories in the Care Act guidance, older people are a target population 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.
If shopping is part of the job, the workable arrangements are:
- 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, reimbursed alongside your fee. Cap the amount you will front (something in the region of £30 to £50 per trip) so the exposure stays small.
- A pre-loaded card in the client's name managed by the family, where the family reconciles the statement, not you.
Whichever you use, 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 declining to hold money is a professional standard rather than 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 is the law, the cover and the safeguarding settled. From here the page is about money, starting with the hour itself.
Here is where honesty is required, because the gap between what a client pays and what a worker earns is the whole economics of this trade.
United Kingdom
Two reference points matter, and they disagree, which is itself the story.
The Homecare Association's Minimum Price for Homecare in England for 2026/27 is £34.42 per hour. That is not a market rate. It is the Association's calculation of what a compliant employer needs to 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 uplift reflects the National Living Wage rising 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 purchase 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 deficit 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 operate 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 then National Living Wage. 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 reflects 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.
Where does that leave a self-employed companion? Above employed carer pay and below agency price. Which is the entire commercial logic of going independent. As a concrete published reference point, the care-matching platform Curam requires that carers' advertised rates 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 results in the carer receiving £15.72 per hour.
Directly contracted private clients, with no platform commission, typically sit between the platform rate and the agency price. No aggregate directory figure is quoted here. Ranges circulate on commercial care directories, but they are marketing-page numbers published by businesses that sell care rather than regulator data, and no specific directory could be named and dated, so none is repeated. The Curam and Homecare Association figures above already bracket the market and should be treated as indicative only.
A defensible position for a solo companion in most of the UK outside London is somewhere in the region of £20 to £28 per hour direct, minimum one hour, with London and unsocial hours higher. This is a reasoned range, not a surveyed figure. Below about £18 you are, after unpaid travel, admin, insurance and tax, likely earning less than an employed care worker with none of the sick pay, holiday pay or pension.
United States
The two US numbers to hold in your head are far apart, and the distance between them is the 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
Note how compressed that distribution 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 takes roughly half. An independent caregiver charging $25 to $30 an hour directly is cheaper than the agency median and paying themselves well above the employed median. Which is precisely why this trade attracts independents, and precisely 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 for the UK or US. Provincial home care association rate cards and CIHI workforce data are the places to look, and rates differ substantially between metropolitan Ontario, British Columbia and the rest of the country. Any single Canada-wide hourly figure should be treated with suspicion, including one you find quoted confidently elsewhere. As a 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 position against those.
For Australia, the honest position is that award rates for employed workers under SCHADS moved repeatedly through 2026 following the Annual Wage Review and the work value decisions, and privately-paid rates track 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 clients hold Home Care Packages or Support at Home funding, the relevant ceiling is set by the funding rules, not by 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 within the country.
Three routes, three economics.
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 get paid roughly a third to a half of what the client pays, often for contact time only, with travel between calls historically 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. And it is how you obtain an enhanced DBS check.
Via an introductory platform. You are self-employed, you set your rate, the platform handles matching, contracts and payment. Curam's published terms illustrate 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. Joining requires two years' UK care experience, an enhanced DBS on the Update Service, a Care Certificate dated within the last three years, and two references. The trade is 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 reputational risk alone. Rates are highest. So is the admin, and so is concentration risk. 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 providing baseline hours, and two or three direct private clients providing the margin.
How clients are actually found
So you have a rate you would be happy with. Nobody pays it until they know you exist, and this is where that part gets solved.
Not through a website. Almost nobody searching 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 not one channel among several; it is the channel. One satisfied family in a market town generates years of work. Ask explicitly for referrals, and make it easy by having something a client 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. This is slow and it compounds.
- 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 constantly.
- Care-matching platforms. Curam and equivalents 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 they genuinely operate as introducers and not as an unregistered provider using you as cover. Reread the CQC "ongoing role" list above, because if they are getting it wrong, you are the one 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. They are underused by this trade. Surgeries rarely display a commercial card, but link workers keep informal lists.
- Occupational therapists and hospital discharge teams. Discharge is the moment families realise they need 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 largely closed to sole traders (they require CQC registration, insurance levels, policies and often minimum capacity) and the rates are the compressed 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 taking it. In Scotland, remember that local-authority-arranged work can trigger Care Inspectorate registration even for a sole individual.
- Solicitors specialising in wills, probate and Court of Protection work. Deputies and attorneys need to buy care and want reliable individuals.
What generally does not work: paid social advertising, leaflet drops, and a website with no local proof. The buying decision here is made on trust transferred from someone the family already trusts.
Cancellation, unsocial hours, and terms that protect your income
Companion care has a specific commercial problem: clients cancel, for reasons you cannot 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 terms before your first client, not after your first bad month.
- Cancellation window. A 24-hour notice requirement, with the full visit charged inside that window, is standard and defensible. Some operators use 48 hours for longer bookings.
- Hospital admissions. Decide in advance whether you waive the charge. Most people do for a first occurrence and then apply the policy. Say which.
- 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 not appropriate for people needing support with intimate care, though such visits may be appropriate for checking someone returned home safely or whether medication has been taken. Short visits destroy 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 whether used or not is legitimate and stabilises income.
- Annual review clause. Build in a stated annual rate review date. Without it 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.
- Mileage. Charge it separately at a stated rate, and state 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 rather than leaving someone 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 registering. For 2026/27, Class 2 National Insurance is treated as paid (protecting your NI record) if 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.
Sole traders have unlimited liability, as GOV.UK states directly. For a trade with physical risk to vulnerable people, consider whether a limited company is worth the extra admin. Though note 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 potentially 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 the invoice does not decide the question.
Protect your position with genuine self-employment markers: multiple 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 note the uncomfortable interaction 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 intend to provide personal care under the exemption, take advice on both questions together.
United States. Report self-employment income on Schedule C and pay self-employment tax via 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 as business income; register for GST/HST once you exceed 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 current-year thresholds with the tax authority before relying on them. Every figure in this section is indexed and several change annually.
The demands nobody puts in the advert
This is a caring profession dressed as a flexible side hustle, and the emotional cost is why turnover is what it is.
Turnover is high and measurable. 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. People do not leave because the work is boring.
Bereavement is structural, not incidental. You are working with people at the end of their lives. Carry a caseload of six regular clients and you should expect to lose clients to death and to nursing home admission on a recurring basis. This is not an occasional shock; it is a feature of the work.
You will also usually be excluded from 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. The relationship was, from your side, close and long-running; from the outside, a commercial arrangement. That asymmetry is the specific thing that burns people out, and it is worse for solo operators, who have 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 provided: 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 attend funerals when invited; some do neither. Having decided beforehand is what matters.
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 in it and you catch someone who is falling, you can injure yourself permanently and be outside your insurance.
Boundary work is constant. 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. None of this is exceptional; it is Tuesday.
Isolation. You work alone in other people's houses. There is no office and no colleague. For some people that is the appeal. For others it becomes 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: realistically about 28 hours of your time once travel, admin, invoicing and unpaid gaps are counted. Gives gross revenue of about £480 a week, or roughly £2,080 a month. Take off insurance (about £10 a month), unrecharged mileage costs, 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.
Now the constraints:
- Charged hours do not scale linearly with hours worked. Travel between clients is unpaid unless you build it into your rate. Geographic concentration is the single biggest lever on your effective hourly rate. Three clients in one village beats six across a county.
- Utilisation is the whole game. Cancellations, hospital admissions and deaths punch holes in a schedule you cannot always refill quickly.
- There is no leverage. You cannot serve two clients at once. The only ways to increase income are to raise your rate, work more hours, or employ people. And employing people in the UK means you are no longer an exempt individual and the CQC question reopens 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 are earning less than the employed equivalent.
This is not passive income and it is not scalable in the form described here. It is a trade. It converts your hours into money at a rate somewhat better than employment, in exchange for carrying all the risk yourself.
Who should skip this
Everything above is the job as it really runs. What is left is the question of whether you want it.
Be honest with yourself about all of these.
- Anyone looking for passive or scalable income. There is none here. Every pound requires you to be in a room with someone.
- Anyone who wants to grow fast by hiring. In England, the moment you have staff providing personal care, you are a provider and you register. Growth in this trade means becoming a regulated business, not scaling a side hustle.
- Anyone unwilling to read the regulations for their own jurisdiction. If the sections above felt tedious, this trade will hurt you. The rules are the job.
- Anyone who cannot say no. The drift from companionship into personal care is driven entirely by the difficulty of refusing 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.
- Anyone who cannot absorb repeated bereavement. This is not a character flaw. It is a genuine and reasonable reason not to do this work.
- Anyone with an unstable schedule. Clients with dementia in particular depend on the same person arriving at the same time. Erratic availability does real harm here in a way it does not in most side businesses.
- Anyone relying on this income immediately. Building a book of clients through community trust takes months. Platform work fills the gap, at a lower rate.
- Anyone with an unresolved relevant criminal record. Families will ask. Agencies and platforms will check. Depending on the offence and the jurisdiction, barring lists may apply.
Who it does suit
People already embedded in a community and known in it. People coming out of employed care work who want control over their hours and clients. People with a driving licence, a reliable car, and a small radius they can cover densely. People who genuinely like older adults' company rather than tolerating it. And people who want work that is unambiguously useful, are realistic about what it pays, and understand that the boundary between companion care and regulated care is not paperwork. It is the whole business.