There are approximately 4.4 million direct-care workers in the United States. Comprising the labor of nurses, home health aides, certified nursing assistants, personal attendants, and companions to the elderly, direct-care work constitutes one of the fastest-growing labor niches in the United States. Within the commodified caregiving sector, cost-cutting imperatives to subdivide care labor introduce insalubrious complications for patients by cleaving – or attempting to do so – their physical needs from their emotional and relational needs, a process that I label ‘rationalized aging’. In this essay, I reflect on my experiences as a paid elder companion in New York City to argue that this process of subdivision combines earlier nineteenth-century rationalization strategies with neoliberal regimes of flexible accumulation and to highlight the consequences of subdivision in this sector both for care workers and for the patients in their care.