The three main arrangement models
Care can be arranged in three ways: through a managed agency, through an introductory agency, or by hiring directly. Each model has a different relationship between the family, the carer, and any employing organisation.
Managed agencies
A managed agency employs carers directly and is responsible for their training, supervision, payroll, and cover when a regular carer is absent. The agency holds CQC registration and is accountable for the standard of care delivered. If something goes wrong, the agency carries liability. Managed agencies typically cost more per hour than other models because they carry more overhead and responsibility.
Introductory agencies
An introductory agency matches families with carers but does not employ them. Once introduced, the carer works as self-employed. The family may end up with employment-like responsibilities even if the arrangement does not look like employment. Introductory agencies may or may not be CQC registered. Cost is typically lower than managed agencies but oversight is less structured.
Direct hire
A family finds and employs a carer independently — through a job board, word of mouth, or personal recommendation. The family becomes the employer. This means responsibility for PAYE tax, National Insurance, holiday pay, sick pay, and employer liability insurance. Direct hire can offer continuity and a strong personal relationship, but the regulatory framework is thin. DBS checks are the family’s responsibility. There is no agency to call if the carer does not show up.
Continuity of carer
Across all models, continuity of carer — having the same carer or small team of carers consistently — is one of the strongest predictors of care quality. Ask any agency or carer directly: how will cover be managed? Who will be sent if my regular carer is unavailable? A vague answer to this question is a meaningful signal.
Care homes and nursing homes
In residential settings, the arrangement model is simpler: the home employs all staff and is responsible for all care. CQC registration covers the whole operation. The family’s responsibility is choosing the right home and staying involved in monitoring quality over time.
Self-directed support and direct payments
Adults assessed as eligible for local authority funding may receive a direct payment — money paid directly to them to arrange their own care. This gives significant flexibility but also places responsibility for employing or commissioning care on the individual or their representative. Local authorities offer guidance but administration support varies significantly between areas.