Direct payments vs a care agency: what you take on and what you gain

1. What an agency gives you

A registered agency recruits, checks and trains the carers, plans the rota, covers sickness and holidays, keeps the care record and the medication chart, holds the insurance, runs the payroll and answers to the regulator. You get a service and a phone number. What you do not get is a say in who comes, much control over when, or continuity: many families see a different face most days, and calls are timed around the agency's run, not the person's day.

2. What a direct payment gives you

The same money, or close to it, paid to you to spend on the care in the plan. Most families use it to employ carers directly, often called personal assistants. Because there is no office or margin, the money buys more hours. You choose the carers, so your parent sees the same two or three people. You set the times, so the morning call is when she wakes, not when the run arrives. Carers who are chosen and known tend to stay, and the care tends to be better for it.

3. What you take on

• Recruitment and checks: finding carers, references, right to work, DBS if you choose.
• Being an employer: contracts, minimum wage, PAYE and payslips, pension, holiday, sick pay, employer's liability insurance. Councils usually fund a payroll service and a support organisation for this.
• The rota and cover: planning the week, and finding someone when a carer is sick or on holiday.
• The care record: who came and when, what was done, what medicines were given, and the hours that justify the payroll. The council will ask for this at review and almost nobody tells families to keep it.
• The review: showing the council the money was spent on the plan and the needs are being met.

4. Where the risk really sits

The employer duties frighten families most and cause the fewest problems, because there are services to do them. The risk that actually bites is the record. A family that cannot show the hours, the visits and the medication is exposed in three directions at once: to the council at review, to a hospital when something goes wrong, and to a carer dispute about pay or holiday. Agencies keep this record because they are made to. Families have to decide to.

5. Mixing the two

Many families run a mix: their own carers for the regular calls, an agency for nights or for cover. Councils allow a direct payment to pay an agency as well as employ. The practical difficulty is that the agency's record and the family's record are in different places, so nobody sees the whole week. Where the agency agrees, putting its carers on the family's own record solves that.

6. Keeping the safeguards without the agency

The agency's real safeguards are not the office; they are the rota, the check-in, the note and the medication chart. Carelo's Personal plan is the system UK care agencies use for exactly those things, with the company parts removed and the pages built around one person.

Rota: plan the week once; each carer sees their own calls in the app; holidays approved with the gap shown. Check-in: time and location at your door, with a late call shown while it is happening. Notes: written at the call, read by the next carer and the family the same day. Medication: every dose recorded with initials, the MAR chart there the same day. Hours: timesheets from the check-ins for your payroll service, and DBS and right-to-work dates with a warning when one runs out.

What it costs is £30 a month per household, or £288 a year, against agency rates that charge that for about an hour. Many councils accept it as a cost of managing the care; ask yours.