PSW, Nurse, or Companion — What Kind of Home Care Does Your Loved One Need?

When a family starts looking into home care, three job titles come up over and over: PSW, nurse (RN or RPN), and companion or caregiver. They often share a uniform-free, in-the-home setting, so it's easy to assume they're interchangeable. They aren't. Picking the right one for the right task saves money and avoids real safety issues.

Personal Support Worker (PSW)

A PSW is the most common home-care visitor for Ontario seniors. PSWs do hands-on personal care: bathing, dressing, toileting, transfers in and out of bed or a chair, mobility support, meal preparation, light housekeeping that keeps the immediate care environment safe. They get formal training (a Ministry-recognized PSW certificate from a community college, board of education, or private career college).

PSWs are not currently regulated the way nurses are. There's no equivalent of the College of Nurses for PSWs in Ontario yet. What does exist:

• The Health and Supportive Care Providers Oversight Authority (HSCPOA), which opened a public PSW registry under regulations that took effect December 1, 2024. Registration is voluntary at the moment but is expected to become mandatory over time — and as of December 1, 2027, anyone who qualified as a PSW before July 1, 2014 or has no formal training will need to register to work in a long-term care home.
• The HSCPOA Public Register lets families and employers verify a PSW's credentials and complaint history.

Important scope-of-practice note: only a regulated health professional (an RPN or RN) can administer medication in the home. A PSW can prompt and remind a client to take their medication, set out doses, and help open packaging if delegated — but the act of administering a medication legally sits with nursing. The same applies to wound care, injections, catheter care, and most "controlled acts" under Ontario's Regulated Health Professions Act, which can only be performed by a PSW under formal delegation from a regulated professional.

Registered Practical Nurse (RPN) and Registered Nurse (RN)

RPNs and RNs are regulated by the College of Nurses of Ontario. They can perform controlled acts: administering medication, giving injections, doing wound care, managing tube feeding, drawing blood, and providing assessments that PSWs cannot.

The difference between an RPN and an RN, in plain terms, is depth of training and the complexity of patient they typically handle. RPNs care for clients whose condition is predictable and stable; RNs care for clients whose condition is complex, fluctuating, or higher-risk. In a home-care setting, families most often see RPNs for routine clinical tasks (e.g., insulin administration on a stable schedule) and RNs for more complicated situations (e.g., post-surgical care, complex wound management, IV therapy).

Hourly rates for nursing care are higher than for PSW care, and nursing visits are usually shorter and more targeted — a 30-minute clinical visit rather than a multi-hour personal-care shift.

Companion or "caregiver" (unregulated)

Companion care is the lightest level — and it's unregulated. A companion provides social presence, conversation, meals, errands, transportation to appointments, light housekeeping, and gentle activities. They are not trained to do hands-on personal care (no bathing, no toileting, no transfers) and not authorized to provide any clinical care.

For an older adult who is still independent but increasingly lonely, or for an early-dementia client who needs supervision and engagement during the day, companion care is the right tool. It's the wrong tool the moment toileting, bathing, or fall-risk transfers come into the picture — at that point, the family needs a PSW.

How to match the right care to the situation

Think about the tasks, not the title:

• Bathing, dressing, transfers, toileting, mobility help → PSW.
• Medication administration, injections, wound care, catheter care, tube feeding → RPN or RN.
• Companionship, errands, social outings, supervision of a stable senior → companion or PSW (PSWs can do companion work, but the reverse isn't true).
• Light housekeeping or meal prep alongside care → PSW or companion, depending on whether personal care is also needed.

Most Ottawa families don't need to pick just one. A typical setup is a regular PSW for most visits, a weekly or twice-weekly RPN visit for any clinical tasks (often arranged through Ontario Health atHome), and a companion or PSW filling in for outings and supervision time.

What to ask any agency

• "Who provides this visit — a PSW, an RPN, an RN, or a companion?"
• "What is that person's training and registration status?"
• "If my mom's care plan includes medication, who administers it?"
• "Can the same caregiver come to every visit, or does it rotate?"

At Oliveth Care, our team is built around PSWs who provide personal care and companionship as a single, continuous relationship — the same person, every visit, so your loved one isn't restarting their story with someone new each time. For clinical-nursing tasks, we coordinate with Ontario Health atHome and visiting-nurse providers. Book a free in-home assessment and we'll map out who you actually need.

Sources & further reading

• College of Nurses of Ontario — Scope of Practice Practice Standard
• Health and Supportive Care Providers Oversight Authority — HSCPOA homepage and Applicant FAQs
• CBC News — "New authority to regulate personal support workers launches in Ontario"
• Promyse Home Care — Difference Between a PSW and a Nurse