Are you a nanny agency owner feeling frustrated by shifting in-home childcare trends, rising competition, and the constant search for new revenue streams that actually stick?
Have you explored babysitting platforms, corporate backup care, or other add-ons only to find that meaningful, stable growth still feels elusive?
And have you ever thought: I have hundreds (or thousands) of trusted caregivers in my circle… could there be more opportunities for them than I’m currently offering?
Why Elder Companion Care Keeps Coming Up
While building technology in the nanny and in-home childcare space, I’ve heard quiet but persistent buzz about elder companion care for several years. I’ve also been continually impressed by the depth, professionalism, and adaptability of caregivers within nanny agency networks. Many of these caregivers are actively looking for additional or alternative care work.
Some nanny agencies already make occasional elder companion or family assistant placements. A smaller number are licensed home care agencies doing this work at scale. And yet, for most nanny agencies, elder companion referrals remain an underutilized and an often misunderstood opportunity.
This is notable given the broader demographic shift underway. By 2030, roughly 20% of the U.S. population will be 65 or older. The paid in-home elder care market is estimated at over $100B annually, making it significantly larger than the childcare market. At the same time, aging Baby Boomers overwhelmingly want to age in place yet many will struggle to do so in a way that supports wellness, connection, and quality of life.
The Fear Is Real — and Understandable
When I share these realities with nanny agency owners, the response is often the same:
“This sounds interesting… but it also sounds scary.”
Common concerns include:
- I don’t want to cross into medical or personal care
- I don’t understand the licensing rules
- Do I need to become a home health agency?
- Will caregivers even want to do this work?
- What exactly is elder companion care — and what is it not?
These are smart questions. And the good news is: they’re answerable.
Why This Fits Nanny Agencies Specifically
What many nanny agency owners don’t initially realize is that they are already uniquely equipped to do this work well. You understand relationship-based care, careful matching, family dynamics, and the importance of trust. You know how to vet caregivers, set boundaries around scope, and communicate clearly with families about expectations. In many ways, elder companion care draws on the very same skills that make a great nanny agency successful: patience, presence, emotional intelligence, and discernment. Rather than starting from scratch, agencies exploring elder companion referrals are often simply extending their existing care philosophy to a new life stage.
Below are three of the most common questions I hear. And, what I’ve learned through my work, including as an SBIR-funded National Institute on Aging grant recipient.
Question 1: Do I Need Special Licensing to Refer Elder Companions?
In many states, no — as long as the work is clearly non-medical and non-personal care.
In states such as Arizona, Texas, and Florida, agencies may refer elder companions without holding a home health or home care license, provided the services remain firmly in the companion lane.
In other states, including Rhode Island and Massachusetts, the rules can be greyer. In those cases, a simple inquiry to the state health or licensing department can often clarify whether referral-only companion services are permitted under your existing business structure.
The key distinction is this:
Referring non-medical companions is very different from providing licensed home care services. Many agency owners are surprised to learn that the answer is often already available and far less restrictive than they assumed.
There is also the issue of staying squarely in the referral lane, and out of the agency-employes-the-caregiver lane. Most referral agencies are familiar with upholding this line and operate accordingly. Nonetheless, the employment topic must be explored and processes aligned with any state requirements before making referral elder companion care placements.
Question 2: What Is Elder Companion Care and How Do I Stay Out of the Medical Domain?
Elder companion care is generally defined as social support and household assistance, not medical or personal care.
Typical companion activities include:
- Conversation and emotional support
- Engagement activities to reduce loneliness and isolation
- Light household help (meal prep, errands, organization)
- Transportation if the agency and family agree
- Gentle medication reminders (not administration)
A critical rule of thumb: elder companions do not provide hands-on personal care.
This means no bathing, toileting, dressing, lifting, or medical tasks of any kind.
One of the most effective ways to stay squarely in the companion lane is through a careful intake process, similar to how nanny agencies already assess family needs. Ideal early placements involve elders who:
- Are generally healthy
- Can complete activities of daily living independently
- Have minimal memory or cognitive impairment
- Have a Durable Power of Attorney (DPOA) or family contact involved
As your referral program matures, you can build clear referral relationships with licensed agencies for personal care, CNA, or nursing needs without taking those services on yourself.
Question 3: How Do I Know If My Caregivers or Clients Are Interested?
You ask them.
Many nanny agency owners are surprised to discover that:
- Caregivers are curious about elder companion work
- Nanny parents are already asking for help with aging parents
- The opportunity is often “hiding in plain sight”
I’ve developed simple, boilerplate outreach emails to help agencies assess interest on both sides. If you’d like to explore whether this path could make sense for your agency, you can start with this brief assessment:
👉 https://www.booklilli.com/assessments/2148618660
When approached thoughtfully, elder companion care doesn’t have to feel like a leap into the unknown. For many agencies, it becomes a natural next chapter. And one that aligns deeply with why they entered care work in the first place.
A Personal Note
I loved my time working as an elder companion.
After many years as a nurse, I was initially apprehensive but the role surprised me. The pace was slower. The work was relational. Many engagement / empowerment activities felt surprisingly similar to childcare. And the gratitude from clients and families was profound.
Elder companion care doesn’t replace childcare work but for many agencies, it can complement it beautifully, opening the door to a more resilient, diversified future.
If you’d like to talk through whether elder companion referrals could be a fit for your agency, I’d love to connect.
📩 sarah@booklilli.com
Author bio: Dr. Sarah Nadimpalli is a lifelong caregiver as an RN, PhD, former elder companion herself, and more recently is an entrepreneur in the care space. She has experience building care tech that helps individual caregivers and nanny agencies. She is a proud recipient of the NIH National Institute of Aging Grant #R143AG097257-01 with RI Science and Technology Council matching funds: “Implementing a tech platform for training & consumer access to nanny agency sourced caregivers; a nascent elder companion care workforce.”