What signals mean a parent needs hands-on Personal Care?

Companion Care handles what a parent still does for themselves. Personal Care starts the moment hands-on help is regularly needed for the six activities of daily living: bathing, dressing, transfers (bed, toilet, chair), toileting, continence, and eating. Insurance carriers and clinical assessors use this exact list, which is why the same 2-of-6 threshold defines both Personal Care and LTC insurance benefit triggers.

The signals are usually visible before they are admitted. Bathing avoidance — showers dropping from daily to weekly — is often first. Dressing help follows (shirts left off, mismatched clothes). Transfers become slow enough that the parent grabs furniture; a near-miss off the toilet is a specific line to watch. Continence issues (delayed changes, avoidance of drinking to prevent trips to the bathroom) usually come last and mark the highest urgency.

When two of those are present most days, the case is Personal Care ($29–$37/hr at typical 2026 Southeast Michigan agency rates). Trying to run Personal Care needs at Companion rates produces poor caregiver matches — the Companion-band caregiver is not trained on transfers or continence care and cannot safely handle the shift.

When the ADL count reaches 4 of 6, or a Hoyer lift, two-person transfer, or advanced dementia behavior enters the picture, the case steps up again to Specialized Care ($35–$42/hr). A care coordinator or RN sets the band at the free assessment.

For the full breakdown, see the cornerstone: When is it Time for Home Care? guide.