Live-in care, Visiting care | 6 June 2024

For many people in the UK, receiving care in their own home is the ideal way to maintain independence and familiarity. But with that decision comes another: how to find the most suitable carer? Understanding the different ways carers can be employed can help you make an informed choice. Here’s a breakdown of the most common options in England, along with their pros and cons:

1. Carer is Employed by a Care Provider (who is Registered with the Care Quality Commission (CQC))

Pros:

  • Rigorous Vetting: The Care Quality Commission (CQC) regulates care providers in England. These providers carry out advanced Disclosure and Barring Service (DBS) checks (background checks), experience and reference checks.
  • Standardised Training: Reputable care providers understand the importance of continuous learning and development for care staff. They prioritise ongoing training programs to ensure carers are equipped with the latest knowledge and best practices in the industry. They provide essential training, such as the Care Certificate, which includes crucial areas like basic first aid, moving and handling, medication administration, and personal care. In addition to mandatory training, many providers offer advanced sessions on topics like dementia management, controlled medications, and stoma care. These efforts ensure that care staff are well-equipped with the latest best practices and are knowledgeable about specific care needs.
  • Streamlined Support: Care providers manage administrative tasks like payroll (including employers and employees Tax and NI), insurance and HR functions like managing holidays, sickness, appraisals, supervisions and scheduling care, freeing you from those burdens.
  • Continuity of Care: Guaranteed cover – If a carer is unavailable, the provider will arrange a suitable replacement to ensure consistent support. As the Carer works for a company, they will provide a temporary carer (of the same standard) to cover planned leave such as holiday and unplanned absence such as sickness, so you do not have to worry about being left without support or having to find someone else yourself.
  • Costs Are All Inclusive: Usually, the service is provided at an all-inclusive price for the carer and the fully managed service. There are no extras or no agency fees.
  • Personalised Care Plans: CQC-registered providers excel in this area. They work collaboratively with the care recipient, their families, and other healthcare professionals to develop personalised care plans tailored to the individual’s needs and preferences.

These plans typically include:

  • A detailed assessment of the person’s physical, mental, and social needs.
  • Agreed-upon goals for care and support.
  • Specific tasks and routines the carer will perform.
  • Preferred methods of communication.
  • Strategies to promote independence and well-being.

Cons:

  • Additional Cost: As the provider takes care of all the administrative tasks and management responsibilities, a regulated provider may be slightly more expensive as you are paying to have everything taken care of by the regulated provider.

2. Self-Employed but Registered with a Care Agency (Introductory Agency)

Pros:

  • Potential for Flexibility: Once you’ve found your carer, you can discuss your preferred schedule and specific needs directly with the carer, potentially achieving greater control over the support that is provided.
  • Lower Costs: Introductory agencies may charge less than care providers, as they don’t take on the same administrative or management responsibilities. However, usually you have to keep in mind there will also be no care assessment or written care plan – that is down to the family to arrange.

Cons:

  • Administrative Burdens: You’ll be responsible for managing tasks like payroll, tax deductions, and insurance for the carer.
  • Continuity of Care: Finding a replacement if the carer needs a break, is ill or unavailable becomes your responsibility which can be stressful especially if at short notice.
  • Personalised Care Plans: The possibility of personalised care plans here depends on the agency. Some introductory agencies might offer assistance in creating a basic care plan, but it may not be as in-depth as what a CQC-registered provider offers. However, you can still work collaboratively with the carer to develop a plan tailored to your needs.
  • Multiple Payments: You will need to arrange to make two payments, 1 to the carer and 1 to the agency.

3. Private Self-Employed Carer (Independently employed with no ties to and Introductory Agency or Regulated Provider)

Pros:

  • Maximum Flexibility: Ability to negotiate hours, tasks, and rates directly with the carer.

Cons:

  • Minimal Regulation: There is no guarantee of the carer’s qualifications, experience, or DBS checks. The onus is on you to carry out the necessary checks to ensure that the carer can provide care at the level you require.
  • Continuity of Care: As with (2) Carer is Self-Employed but registered with an Agency – if the carer is unavailable for any reason, finding a suitable replacement falls entirely on you.
  • Personalised Care Plans: With a private self-employed carer, you have the most flexibility to create a highly personalised care plan. There are no set guidelines or processes to follow. However, the onus falls entirely on you to develop the plan in consultation with the carer. Consider your skills in assessing care needs, care plan development, and communication to ensure a successful outcome.
  • Carer Support: If there are any administrative or other issues with the carer, these will need to be resolved directly with the carer without the support of a company.

Additional Considerations:

  • Live-in Care: Some carers/providers offer live-in arrangements, providing 24/7 support. This option may be suitable for those requiring full time care.
  • Shared Care: Multiple carers can be employed to share the support responsibilities, potentially offering more personalised care, attention and flexibility. However, unless you opt to choose a regulated provider offering a fully managed service, you will be responsible for organising the rotas, managing the employers national insurance, tax and insurance and ensuring cover is provided when needed – along with managing the care plan & how it is delivered.

Making the Right Choice

The best way to choose a carer depends on your specific needs and priorities. Consider the following:

  1. The level of care required: Do you need basic assistance with daily living, or more complex medical care? Either way, how much involvement do you want, or can you manage?
  2. Importance of flexibility: How crucial is it to have control over scheduling and care plans?
  3. Comfort level with administrative tasks: Do you have the time and are you comfortable managing payroll, taxes, and insurance for a carer?

Next Steps:

  • If considering a care provider, research their CQC rating and try to talk to existing clients about their experiences.
  • If opting for an introductory agency or private carer, conduct thorough reference checks and verify qualifications.
  • Ask for proof of DBS checks, References and Right to Work Documentation and relevant training certificates.
  • Discuss care needs and expectations in detail during initial interviews.
  • Get everything agreed upon in writing, including rates, schedules, tasks, and termination clauses.

Remember:

Feeling comfortable and confident with your chosen carer and/or care provider is paramount. It may be useful to try different types of employed Carer to find which one suits you the best. Ask questions, discuss concerns, and ensure a good fit for everyone involved. With careful consideration, you can find a care solution that fosters independence and well-being for your loved one.