The PA Series: Introducing Care Agencies

Introducing care agencies - how they operate and some of the advantages and disadvantages I've found with them.
My foot being washed in bed by a PA

Care agencies are the bedrock of the care sector. They tend to be companies, which employ a large number of carers. They then have clients (disabled people) who contract to buy care from the agency. Sometimes this is done by the client themselves, and sometimes the contracting is done via a “brokerage firm” or your local social services. The agency then takes responsibility for all the employment management, and simply sends you a carer at the agreed time and place (in theory).

If you do not use direct payments or a personal health budget, your care may be being organised for you, without you having any say in it. This is often done through agencies, and means that you only have to receive your care – you’re not responsible for making it happen.

I’ve used agency care on and off for years, usually in the same situations:

  • I’m being discharged from hospital, and need to have care organised. Here, I don’t have the time or ability to recruit for PAs, and need someone who can carry out an assessment of my needs while I’m in hospital, and provide the care reliably when I get out
  • I’ve just moved house and need someone coming from the date of the house move, without me having to recruit in an area that I don’t live
  • I only need someone coming in for an hour or two a day, and I’m struggling to recruit anyone who wants a few hours
  • I need someone coming in at really early or late hours and I can’t find anyone who wants to work them
  • I’m too ill to manage PAs, and cover failing would put me at serious risk. Here, I need to hand over responsibility for everything to a care agency

The advantages of agency care are that:

  • They employ a lot of people, so if someone’s off sick, they’re responsible for arranging cover and are able to do so
  • They are responsible for training their carers, so we design a care plan based on my needs, and I’m sent carers trained on meeting those needs (e.g. hoisting)
  • Because they employ a lot of people, they’re far better at finding someone who wants inconveniently timed hours
  • Because they provide care to lots of people, with one employee travelling around to lots of clients during the day, they can come in to provide a very limited amount of care
  • If there are problems with the carer I simply have to report it to the agency, who will try to resolve the situation
  • I am not responsible for any of the legal aspects of employment – I didn’t provide their contracts, and I’m not responsible for disciplining them if there is a problem

The disadvantages are that:

  • I don’t have a free selection of anyone from whom to receive support. I have to negotiate with the agency but ultimately I get whoever they send
  • In practice the wrong carers often arrive at the wrong time with the wrong training
  • Carers are often in a hurry because they’re allocated inadequate travel time between people, meaning that they need to leave early to get to their next job on time
  • If I have issues with the carer, I have to go via the agency, who may or may not take my side
  • I am not responsible for any of the legal aspects of employment – I didn’t provide their contracts, and I’m not responsible for disciplining them if there is a problem

I have very mixed feelings about care agencies, and have had excellent experiences, dreadful experiences, and a lot of pretty miserable experiences. They fill a vital role in the care sector but often lack consistency of support. They did not seem reliable enough to be the core options for me, especially as I have complex tasks like my bowel program, (peristeen), which many carers haven’t encountered.

I don’t currently use agencies, and while I miss the lack of responsibility, I prefer the amount of autonomy I have now.

In my next blog in this series, I will discuss how to choose an agency, navigate the relationship between you, the carers, and the agency, and what to do if things go wrong.

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