When families compare live-in care providers, they compare price, reviews and how the website feels. Almost nobody asks the question that separates those providers most: is the carer employed by the company, or self-employed?
It is worth asking before you look at a single price, because the answer explains most of the price differences you will find.
Two models, one name
Managed providers take on their carers as staff. The company finds them, checks them, trains them, oversees them and pays them. It holds the Care Quality Commission registration for personal care. It is inspected and rated, and it answers for the care if something goes wrong. Helping at Home works this way.
Introductory agencies match families with a carer who works for themselves, and charge a fee for making the match. The agency is not the provider of the care and, in several cases, is not registered with the CQC to provide personal care at all.
Both are marketed as live-in care. Both appear in the same search results. The websites look much the same.
In their own words
This is not an inference. Elder, one of the largest live-in care brands in the UK, states on its own cost page:
“Introductory agencies, like Elder, connect families with self-employed professional carers.”
Its legal notice goes further:
“The Care Quality Commission (CQC) defines companies like Elder as an introductory agency pursuant to the Health & Social Care Act 2008.”
Elder is not registered with the CQC as a provider of personal care. Some other platforms work in much the same way. A few run a managed service as well, registered on its own, so one brand can offer both. The difference sits in which one you signed up for.
None of this is hidden. It is on their websites, in plain English, for anyone who reads far enough. The problem is that families comparing a £1,210 headline against an £1,800 headline are usually not comparing like with like. Nothing on either page tells them so.
What the difference means in practice
| Employed carer, managed provider | Self-employed carer, introduced | |
|---|---|---|
| Who recruits and vets | The provider | The agency introduces; you decide |
| Who trains and supervises | The provider, on an auditable record | Largely the carer themselves |
| Who is CQC-regulated for the care | The provider | Often nobody |
| Who arranges cover for illness or holiday | The provider | Frequently the household |
| Who is accountable if it goes wrong | The provider, with a Registered Manager | Less clear |
| Who to complain to | The provider, then the CQC | The agency, with limited remit |
| Typical published price | From about £1,675 | From about £1,200 |
The lower price is not a trick. It reflects lower costs, because employment carries costs that introduction does not. Those include employer National Insurance, pension and holiday pay. They also include paid training, day to day oversight, insurance, and paid cover when someone is ill.
Which one should you choose?
That depends on what you want, and there is a respectable case for each.
An introductory model can suit you if you want to choose your own carer and are comfortable managing the relationship directly. It is the lower-cost route, and it works best if you are confident about arranging cover yourself when the carer is unwell or on holiday.
A managed provider is likely to suit you better if you want one organisation accountable and the CQC overseeing the care itself. It also suits families who want cover arranged for them, or who are arranging care from a distance for a parent they cannot check on daily.
There is no universally right answer. There is only a wrong way to choose, which is to compare the prices without knowing which is which.
Franchises: a third thing to check
Many familiar high-street care brands are franchise networks. Each branch is a separate business, with its own owner, its own staff, and its own CQC registration and rating.
That matters because the rating on the national website belongs to the brand’s flagship or to another branch entirely. The branch that would send someone to your door has its own rating, and it may be different. Always check the CQC rating for the specific local branch, not the brand.
Three questions to ask any provider
Ask these before you discuss price, and ask for the answers in writing.
- Is the carer employed by you, or self-employed?
- Are you registered with the CQC to provide personal care, and what is your current rating? Then check it yourself on the CQC website rather than taking the answer on trust.
- Who is accountable if the arrangement stops working, and who do I complain to?
A good provider will answer all three without hesitation. Our how to choose a home care provider guide has more.
Where we stand
Every Helping at Home carer is directly employed by us, recruited by us, DBS-checked by us, trained by us and supervised by us. We are registered with the Care Quality Commission and rated Good. Courtney Pike, our Registered Manager, is accountable for every care plan.
We pay £14 an hour as a flat rate, above both the National Living Wage and the Real Living Wage, with paid training and paid travel time. Our carers stay with us an average of more than two years, and we have never used agency staff. Our CQC-regulated care page explains what the regulation covers, and our complaints page sets out how to raise a concern.
That model costs more to run, which is why our live-in care starts at £1,800 a week rather than £1,200. We would rather explain the difference than quietly compete on a number that means something else.
Call 01636 646915 or request a care assessment.
