UKHCA Policy and Campaigns Team
United Kingdom Homecare Association Ltd
Sutton Business Centre
Restmor Way
Wallington
SM6 7AH
Telephone: 020 8661 8188
E-mail: policy@ukhca.co.uk
Website: www.ukhca.co.uk
Twitter: @ukhca
Registered in England. No 3083104

Table of Contents ............................................................................. 2
Thinking of providing live in care? ....................................................... 3
Is there a market for live-in care? .................................................... 3
What type of service? ..................................................................... 4
Can you devote staff resources to the service? .................................. 4
Which model to adopt? ................................................................... 4
What about rules and regulation? .................................................... 5
Have you considered marketing and costs? ....................................... 6
And finally.. .................................................................................. 6
Disclaimer
Whilst every effort has been made to ensure the accuracy of this article, it is a summary, rather than a definitive statement of the law; advice should be taken before action is implemented or refrained from in specific cases. No responsibility can be accepted for action taken or refrained from solely by reference to the contents of this article.
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Thinking of providing live in care?

Live in care provides a flexible option for those with substantial support needs, and is often able to prevent admission to a care or nursing home.
Service users may have physical or sensory needs that mean they require
“round the clock” care, or a condition such as dementia, Parkinson’s, MS or others that make it difficult for them to be on their own. Live in care also provides an answer to social isolation, with the worker acting more as a companion than a careworker. Live in care is increasingly enabling service users to stay in their own homes through to end of life.
Live in Care has been the preserve of a small number of specialist providers and agencies, but is increasingly being offered by homecare organisations that provide daily care, often in response to user demand.
So what issues should a provider consider before branching out into live in care?
Before starting up or expanding a business to offer live in care, the provider should thoroughly research the market. This is not easy as there is very little data specific to the live in care market, and it doesn’t usually feature separately in national statistics.
A would-be live in care provider should decide whether they are targeting their local care market, in which case an exploratory call to the local authority commissioning team might be a good idea, alongside reviewing the council’s Market Position Statement (where they have issued one) and looking to see whether there are already successful live-in providers in the local area.
Alternatively a provider may want to cover a wider area, perhaps even the national market. The latter would need a more sophisticated analysis of the national market for live in care and would need to consider the fact that separate registrations are required for Scotland and Wales.
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Careful thought will be needed on the type of service provided. Do you want to give companionship or provide personal care, or support service users to take their medications? The answer will depend on how you see your business model and the outcome of your local, or national research.
To be successful, you need to have sufficient workers to deliver live-in care properly, and sustainably. Service users will generally expect continuity which can be provided through longer-term arrangements, or a team of two carers sharing a pattern of working, not just when the provider happens to have a careworker available. The provider must also be able to provide alternative trained workers in the event of sickness or staff holiday etc. These individuals will need not only to have the required skill sets to deliver the appropriate care needed but to be the right ‘match’ for the service user. Often service users receiving live in care like to have careworkers with shared interests.
Live in care is usually provided either as a managed service, where workers are employed by the organisation, or as an introduction service - technically an employment agency - which introduces people to hirers to be employed by the hirer directly. Employment agencies are regulated by the Employment Agencies Act 1973 and the Conduct of Employment
Agencies and Employment Businesses Regulations 2003.
The two different models of service have implications which need to be considered carefully.
A live in service operated as a managed service proceeds in the same way as a conventional homecare service. The organisation employs the worker, and the service user pays the organisation for the service. By contrast, the introduction service exists to introduce potential workers who can provide the service required by the service user or “hirer”. The introductory (“employment agency” model) selects a suitable candidate, based in part on information supplied by the organisation, and the service user employs or “hires” the worker directly. The agency does not become involved in the day-to-day supervision and control of the worker.
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A crucial difference is who employs the worker and who is responsible for giving them directions, operating PAYE and national insurance and ensuring that working time and National Minimum Wage (NMW) rules are adhered to.
There are also differences in who is responsible for drawing up a care plan. A direct service provider will draw up a care plan. The employment agency may draw one up as a service to the user, but the user is not required to follow it (some people prefer to draw up their own list of tasks), and the agency mustn’t try and impose it on the careworker. It is also very important to note that not all introduction agencies are regulated services.
The extended hours worked by a live-in careworker (there will be times that they are working and other times when they are effectively on call) mean that a specific rota will need to be drawn up. An average hours agreement is a good idea, to determine how working time and NMW are calculated. UKHCA has a National Minimum Wage Toolkit
( http://www.ukhca.co.uk/downloads.aspx?ID=422 ) and specimen Daily
Average Hours Agreement, drawn up by our preferred solicitors Anthony
Collins Solicitors LLP, available to member organisations.
There may well be regulatory implications for the model chosen. For example, the introduction service model does not trigger regulation by the
Care Quality Commission in England (but is likely to do so in the other UK administrations), unlike the conventional managed service model. Some organisations choose to operate both models side by side, which brings its own challenges for management and administration, and can result in complex legal arrangements. Whichever model is chosen, it is essential to note that with a “hybrid” arrangement, where an introduction agency manages services, it is much harder to prove compliance with regulatory, employment and revenue law.
Pure introductory agencies are bound by the Employment Agencies Act and the Conduction of Employment Agencies etc. Regulations. While these do not require registration with a specific regulator, there is an inspectorate (through BIS) who may come and inspect documentation etc.
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Marketing of live in care tends to be different, with advertising in traditional “up-market” magazines which appeal to those who can afford to self-fund care a popular choice. If you do take the plunge, please inform UKHCA so we can help market your service via our online directory of members and their services.
Overall, the introduction model is generally felt to be a less expensive service to run, because it does not involve employing a workforce, is less regulated or and does not require on-going supervision and control.
However, if your intention is to provide a live-in care service, rather than run a business essentially introducing staff, then the managed service model is the more appropriate.
Whatever direction you take, it is a good idea to take proper advice on your plans, to ensure that your business planning and documentation are in order.
UKHCA has two specimen contracts, drafted by our preferred solicitors, that can help UKHCA members. One is a contract between a self-funded service user and an organisation, for a managed service: www.ukhca.co.uk/downloads.aspx?ID=313
The other is a contract between an organisation and a service user to introduce a care worker for employment by the service user: www.ukhca.co.uk/downloads.aspx?ID=312
UKHCA also offers members human resources advice and a legal helpline to give a limited amount of free telephone advice on business and regulatory issues. To be referred, call our member helpline on 020 8661
8188, option 4.
A word of caution. Live in care demands particular skills from careworkers, who need to be sufficiently trained and self-reliant to be able to function with less supervision than a daily careworker. So you will need to think carefully about pay rates, recruitment, training and supervision to make sure you have sufficient workers of the right calibre to offer the service. That is why a good many live in care specialists, who offer a managed service, invest heavily in developing their workforce and allocate the resources to do this.
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Thinking of providing live in care?

So budget implications will form a very important part of your business planning when considering a move into live-in care, as will checking the skillset of both staff and managers before venturing into live in care.
If you decide to go ahead you will be providing a service that is highly valued by service users and their families in helping to maintain independence at home.
UKHCA’s Policy Director, Colin Angel, said:
“Live-in care can range from providing much-needed companionship and peace of mind, to intensive services which help people remain at home, rather than use residential care. It also increasingly assists service users to stay in their own homes through to end of life and, as such, is an important component of the full spectrum of home-based care.”
UKHCA Policy and Campaigns Team
April 2014
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 UKHCA, Sutton Business Centre, Restmor Way, Wallington, SM6 7AH
 020 8661 8188 |  enquiries@ukhca.co.uk |  www.ukhca.co.uk
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