Assuming the "perfect" companion exists - someone who provides the needed assistance AND doesn't steal or otherwise take advantage, there are legal issues involved I would assume.
I'm betting that in most states, such a relationship is illegal if all facts are known. IOW assuming someone receives compensation (even if it's only room and board) many states and perhaps the Fed gummint would require SS payments, tax withholding, licensing, etc. etc. So we end up with a two tier system: The "official" care system ($20 to $50/hour several times a week with all the appropriate "training", licensing, bonding, etc.) or the unofficial live-in helper who is essentially "off the books." Imagine if that person suddenly "turned" on the person they were caring for. All they would have to do is go to the "authorities" and the trouble could be devastating.
The first option is too expensive for most folks - especially if round the clock care is needed - even just "being there" in case the person falls or has an "episode." The second is most likely illegal and could end up with legal costs, fines, penalties, etc. etc. Too bad there isn't something in between such as a vetting system for care companions and having the gummint keep its nose out.
My mom tried the "official" source as respite when my dad was going through AZ. The folks sent were expensive but incompetent and not particularly enjoyable to be around. I did what I could so my mom could get out of the house a few times a week. Most of the time, all I had to do was sit and watch TV with dad and be certain he didn't burn the house down when making coffee, wander off, etc. Eventually dad went to a nursing home which is relatively effective, but still quite expensive.
I think imoldernu is correct: It could work. My gut tells me it would be the fairly lucky person who finds the right match and has few of the known problems we've all discussed. YMMV
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