Managed or introductory agency – which is right for me?

If you're looking into arranging home care, you'll likely come across two types of provider: introductory agencies and fully managed agencies. Both can support people with a wide range of care needs, but how they operate, and how much say you have in day-to-day care, are very different. Only you can decide which is the right fit for your family.

What does a care agency do?

A care agency is, quite simply, a provider of care. Every agency, whether introductory or fully managed, exists to connect people who need support with suitable carers. It's also possible to hire a carer privately, but working with an agency can make the process safer, since agencies build quality checks into the process.

Care agencies should confirm that every carer has the right to work in the UK, and carry out background checks, such as a Disclosure and Barring Service (DBS) check, or a Protecting Vulnerable Groups (PVG) check in Scotland. These were previously known as Criminal Records Bureau (CRB) checks, and they help confirm carers are safe and trustworthy. Agencies will usually also verify professional references and any relevant qualifications, so you can be confident your carer has the right skills and experience.

Agencies typically handle a lot of the practical arrangements too, including cover for breaks, and paying your carer, by setting a clear weekly rate and managing their payroll.

Who is the CQC and what does it do?

The Care Quality Commission (CQC) is an independent regulator of adult social care in England. Its job is to make sure health and social care services provide safe, effective, compassionate and high-quality care.

Agencies that provide and direct certain services, known as 'regulated activities' under the Health and Social Care Act 2008, must register with the CQC. Once registered, the CQC regularly inspects and monitors how that provider delivers care.

Scotland and Wales have their own regulators. In Scotland, national standards are monitored by the Care Inspectorate, and the Care Inspectorate Wales regulates providers in Wales.

What types of care does the CQC look at?

There are 14 registered health and social care activities that the CQC assesses, though not all apply to care for older people. If an agency offers any of the following, it needs to be CQC-registered:

• Providing personal care: carers working with agencies that aren't CQC-registered can still support with washing, oral care, toileting, medication prompting, and eating and drinking, but they do this under your direction, not the agency's. Agencies that direct carers on how to perform personal care must be registered.
• Providing accommodation for people who need nursing or personal care
• Providing treatment for disease, disorder or injury
• Providing nursing care
• Providing medical treatment for people detained under the Mental Health Act 1983

What is a managed service provider?

A managed service provider is registered with, and accountable to, the CQC, and it manages every aspect of care: creating the care plan and directing how care is provided day to day. Managed providers may deliver care in purpose-built accommodation, such as a care home, or in your own home.

These agencies recruit and train their own staff of carers to a set standard determined by CQC guidance. They usually decide which carer goes to which family, and shape and review your loved one's care package on an ongoing basis.

Managed care providers can be a good choice if you'd like to be less involved in how care is delivered day to day. A CQC-registered provider is legally required to have a care management team in place to oversee this on your behalf. Managed providers can also support medical treatment directly, such as administering certain medications or assisting with medical devices like stoma bags and catheters, where that's part of the care plan.

How does an introductory agency work?

We've covered what CQC registration means above. An introductory agency like Elder sits outside that registration, because it introduces you to a self-employed carer rather than employing and directing one on your behalf. For the full explanation of that status, see our page on Elder's introductory agency status.

In practice, that means the agency's job stops at matching you with the right carer, often for live-in care arrangements in your loved one’s home. So the information you share tends to cover personality and lifestyle as well as care needs, since you and your family will be the ones agreeing how care runs day to day, not the agency.

Because you're managing that relationship directly, introductory services usually cost less than managed care, and you only pay for the support you actually use rather than a standard package that may include extras you don't need.

What this means if you choose Elder

Some introductory agencies work as employment agencies only: they help you find a carer, and that's where the relationship ends. So when your carer needs a break, you'd usually be responsible for sourcing respite care yourself.

Elder's service includes respite care as standard. We match families with a suitable carer to cover break periods at no extra cost, and you're free to choose the carer you think is the best fit, for both your main placement and any respite cover, from a curated selection based on your loved one’s needs and personality.

Before introducing you to potential carers, our in-house clinical team reviews your case through our detailed Care Appraisal, and can work directly with you and relevant health professionals, such as GPs and occupational therapists, to build a full picture of your needs. We don't get involved in care planning or delivery once care starts, but we don't disappear either: our specialist family support team is on hand to help you through challenges, and your MyElder account lets you keep track of and shape your care experience as things change.

Managed care agency vs Elder: a quick comparison

Here's how the two approaches typically compare side by side:

What makes Elder different?

• You always have the final say on who your carer is
• You manage your care requirements and preferences securely in your own online account
• We help you find a respite carer when your main carer takes a break, at no extra cost
• We don't charge joining fees or surcharges for bank holidays, or for up to two nightly wake-ups
• We have our own dedicated in-house clinical team
• We match your loved one to carers based on the skills and experience your family needs, including specialist experience for conditions like dementia
• Many families choose to keep working with the same self-employed carer over time, so your loved one can build a real relationship with the person supporting them

Sarah's story: taking back control after managed care

“Before I found Elder, my parents had live-in care through other care agencies for two years. My mum had a fall, and when she was discharged from hospital, they put her on a care package for seven weeks, all paid for, without us choosing the provider.

Once the seven weeks were over, we used three managed care agencies. I found it frustrating: I'm an ex-nurse and wanted more input into my parents' care. I know my parents very well, and with my background, I knew what they needed, but I wasn't allowed to help with the care plan.

A friend recommended Elder. He knew of Elder and was impressed with the responsiveness and the 24-hour cover. Someone from Elder called me on a Sunday to talk it through. My main reason for choosing Elder was that they helped organise 24-hour care, and I got to pick and talk to the carer beforehand, so I had someone who was the right fit and could explain what to expect.”

Weighing up managed care against an introductory agency is a big decision, and there's no single right answer for every family. If you'd like to talk it through, speak with a care advisor and find out how Elder can help and see whether an introductory agency is the right fit for your loved one.