The short answer
- The arrangement is yours to directA live-in PA works to a plan you write: when you get up, where you go, what they do and what they leave alone. Control over how support is provided is part of the wellbeing a council has to promote under the Care Act.
- The week is built round work, study and a social lifeSomebody there all week can fit round a shift pattern, a lecture timetable or a night out, in a way a booked visit at a fixed hour cannot.
- Direct payments and personal health budgets are the usual routeIf the council or the NHS has agreed to fund your support, taking that money as a payment you control is what lets you choose the person.
- You do not have to become an employer to have your own PAEmploying a personal assistant means running payroll, a pension and insurance. Carers on PrimeCarers are self-employed and invoice you instead.
Figures on this page are what carers on PrimeCarers charge for a live-in week, £1,050 to £1,400, with our fee included. Law and funding here are England.
What the arrangement is
A live-in personal assistant, rather than a care placement
Live-in care means one carer living in your home and working to an agreed plan. That sentence holds whoever the person is. What changes, when the person is a disabled adult in their twenties, thirties or forties, is what the plan is for.
For an older person who is becoming frailer, a live-in carer is often there to keep the household safe and running. For you it is more likely to be what makes an ordinary week possible: getting up in time for work, getting to college, getting into the pool, getting home at midnight rather than being in bed by nine because that was when the last call was booked.
Personal care, at the hours you keep
Washing, dressing, transfers, continence
Getting out of the house
The gym, the match, a friend
Work, study and the paperwork
Weekdays
Nights
Turning, seizures, alarms
If you are weighing this up against hourly visits or a supported living placement, disability care and support at home sets out the range, and personal care for disabled people goes further into the personal care side. How live-in care works covers the room, the food and the working pattern, and what a live-in carer needs from the home lists what you have to be able to offer, starting with a room of their own.
A week around your life
What a week with a live-in PA can look like
The clearest way to show the difference between live-in support and a rota of visits is to draw a week. Here is one, for somebody working three days, studying one and out on a Friday night. Read it as an example rather than a template.
Every night
Your PA sleeps in the house and is there for turning, the toilet, a seizure or a ventilator alarm. If you need somebody awake and working through the night rather than sleeping and getting up when called, that is a different arrangement and it is agreed and priced separately.
One worked example, not a template. What it is meant to show is the shape: the week belongs to the person, and the support moves around it. A live-in carer takes about two hours a day to themselves, and where those two hours fall is something the two of you agree rather than something a rota decides.
There is no line in that week that says "care from 8 to 9". A live-in carer is present rather than clocked on, which is why how many hours does a live-in carer work? does not answer with a number. The two hours a day they take to themselves need thinking about: if you cannot be left alone for two hours, somebody has to be there instead, and the live-in carer's daily break sets out the ways people cover it.
A week like that also shows how much of it is not care. Long stretches are one adult sharing a house with another and staying out of the way. Say so at the interview: a carer whose last job was with a frail elderly client may arrive expecting to be busy all day.
Choosing and directing
Choosing the person, and saying how the work is done
With somebody living in your home, who they are and how they work matters more than any list of tasks.
Under section 1 of the Care Act 2014, the wellbeing a council has to promote expressly includes control by the individual over day-to-day life, including over the support provided and the way in which it is provided.
What helps when you are directing your own support
- Writing down how you want things done, in your own words, before anybody starts
- Doing the interviews yourself and having the final say on who comes
- Asking how somebody would handle the quiet hours, when you are out and there is nothing to do
- Asking a carer how they would step back as you get more able
- Agreeing when the daily two hours will usually fall
- Setting a time in the first fortnight to change whatever is not working
What tends to cause problems
- Letting a relative or a social worker run the interviews because it is quicker
- Leaving the way you do things unsaid and hoping it gets picked up
- A job description written around your diagnosis rather than around your week
- Assuming long experience with older people transfers to what you need
- Waiting until something has gone wrong to raise how personal care is done
Before a carer appears on PrimeCarers we check their identity, their right to work in the UK and an enhanced DBS held on the Update Service, and we interview them online. Carers hold insurance that covers them while they work. We do not check qualifications, training or references, so what a carer tells you about their experience is their own account of it and yours to check with them. How to interview live-in carers has the questions worth asking. Ask about this kind of work in particular: spinal injury, a brain injury, autism, a learning disability and progressive conditions each ask something different. Where transfers and hoisting are part of your day, transfers, hoists and two carers explains when one person can safely do it alone.
Who pays
Direct payments, personal health budgets and paying the rest yourself
Arranging your own support does not have to mean paying the whole bill yourself. Where a council or the NHS has agreed to fund it, the money can be paid over for you to spend, and that is what makes choosing your own carer possible.
A direct payment from the council
Adult social care
A personal health budget from the NHS
Where the need is a health need
Access to Work, for the working day
Separate from social care
Your own money, and PIP
Paying the cost, or topping up
Each route has its own guide, worth reading before you talk to the council rather than after. How to hire a carer with a direct payment covers asking for one, what the money is allowed to buy and the records that come back with it. Personal budgets and personal health budgets explains how the amount is worked out and how to question a figure you think is too low. NHS Continuing Healthcare is the assessment behind an NHS budget. The official pages are direct payments and Access to Work on gov.uk, and personal health budgets on nhs.uk.
Employing or engaging
What changes when the person paying the carer is the person being supported
With an older relative, somebody else usually holds the money and signs the agreement. When the support is yours, that is yours too, and underneath it sits a choice: whether to employ a personal assistant or to engage a self-employed carer.
| Employing a PA yourself | Engaging a self-employed carer | Buying from an agency | |
|---|---|---|---|
| Who chooses the person | You recruit and you decide | You decide, from profiles you read yourself | The provider decides who is on the rota |
| What you are, legally | An employer | A client of a self-employed carer | A customer of a care provider |
| Tax and pay | Register with HMRC, run payroll, auto-enrol a pension | The carer handles their own tax | The provider handles it inside its fee |
| Insurance | You need employers' liability insurance | Carers on PrimeCarers hold cover for their work | The provider insures its own staff |
| Cover when they are ill | You arrange it, and you pay statutory sick pay | You arrange it, often with a carer you already know | The provider sends somebody else |
| Ending it | Employment law: notice, and a fair dismissal process | 48 hours, rising to 7 days for live-in once 168 hours have been worked | The provider's terms |
Who chooses the person
- Employing a PA yourself
- You recruit and you decide
- Engaging a self-employed carer
- You decide, from profiles you read yourself
- Buying from an agency
- The provider decides who is on the rota
What you are, legally
- Employing a PA yourself
- An employer
- Engaging a self-employed carer
- A client of a self-employed carer
- Buying from an agency
- A customer of a care provider
Tax and pay
- Employing a PA yourself
- Register with HMRC, run payroll, auto-enrol a pension
- Engaging a self-employed carer
- The carer handles their own tax
- Buying from an agency
- The provider handles it inside its fee
Insurance
- Employing a PA yourself
- You need employers' liability insurance
- Engaging a self-employed carer
- Carers on PrimeCarers hold cover for their work
- Buying from an agency
- The provider insures its own staff
Cover when they are ill
- Employing a PA yourself
- You arrange it, and you pay statutory sick pay
- Engaging a self-employed carer
- You arrange it, often with a carer you already know
- Buying from an agency
- The provider sends somebody else
Ending it
- Employing a PA yourself
- Employment law: notice, and a fair dismissal process
- Engaging a self-employed carer
- 48 hours, rising to 7 days for live-in once 168 hours have been worked
- Buying from an agency
- The provider's terms
Employing a personal assistant gives you the most control and the most administration. Help with payroll can be funded out of a direct payment: councils either run a direct payment support service or pay an independent organisation to run one.
Gov.uk sets out what taking on an employee involves: registering with HMRC, running payroll, workplace pension duties and employers' liability insurance. Some disabled people prefer to employ their own PAs, because an employee can be trained to work exactly as you want.
Engaging a self-employed carer is the lighter route, and it is what happens when you book through PrimeCarers. You agree the work, the rate and the pattern directly with the carer, and the agreement is between the two of you. PrimeCarers introduces you and handles the payment, and does not supervise or manage the work. The terms in our client agreement apply: a visit you cancel is payable in full unless it is unplanned hospitalisation, illness, or another reason the carer agrees; notice is 48 hours for hourly care and 7 days for live-in once 168 hours have been worked; bank holidays are charged at one and a half times, and Christmas Day at double. Ending live-in care covers winding a placement up.
How to set it up
Four steps, starting this week
Whether the money is yours or the council's, the order is much the same, and the first two steps cost nothing.
- 1
Write your week down, in your own words
This weekNot a list of needs: a week. What time you get up on a Tuesday, when you are out, what you want help with and what you want left alone, what has to happen at night. This becomes the plan a carer works from. - 2
Ask the council for an assessment, and ask about a direct payment
FreeA needs assessment is free and does not depend on your income. Say at the care planning stage that you want your budget as a direct payment, and ask for the council’s information pack. If the NHS already funds your care, ask about a personal health budget instead. - 3
Read profiles and talk to two or three carers
FreeSearch live-in carers near you and read what each one says about the work they have done. Message the ones who sound close, tell them what the week looks like and what the room is, then arrange to talk properly. - 4
Start, then change what is not working
Week oneAgree a start date, the rate and the pattern in writing before day one, including where the daily two hours will fall. Put a time in the diary a fortnight in, so the first awkward thing gets said early.
How to find a live-in carer covers the routes open to you, and when live-in care becomes cheaper than hourly visits is the page to read if you buy visits now and are wondering whether to change.
Questions
Questions disabled adults ask about live-in support
No. The arrangement is one carer living in the home and working to an agreed plan, and nothing about it is tied to age. For a disabled adult it is usually called a live-in personal assistant, because the job is built around your working week and your own routine.
Yes, where the support meets the needs in your care and support plan. Gov.uk explains that a direct payment lets you choose and buy the support you need yourself rather than receiving services the council has arranged, which can mean employing a personal assistant or engaging a self-employed carer. It cannot normally pay a partner or a close relative living in your household. How to hire a carer with a direct payment covers the detail.
A personal health budget is the NHS version of the same idea, and it is the usual route when your needs are mainly health needs. The NHS says the right to have one applies to adults and children getting NHS Continuing Healthcare, to people who meet their local wheelchair service criteria, and to people entitled to section 117 aftercare.
Either is allowed. Employing a personal assistant means registering with HMRC, running payroll, pension duties and employers' liability insurance, and it gives you the most control. Engaging a self-employed carer is lighter: you agree the work and the rate directly, and the carer handles their own tax. Carers on PrimeCarers are self-employed, and a live-in week runs from £1,050 to £1,400, fee included.
Getting you there, and personal care during the day, are things you can agree with a live-in carer. Support inside the workplace is usually funded separately through Access to Work, which gov.uk says does not affect other benefits and does not have to be repaid.
Say so before anybody starts, and write it into the plan. Much of a live-in week is one adult sharing a house with another and keeping out of the way. A live-in carer also takes about two hours a day to themselves, which is time the house is yours.
You end it and choose somebody else. The notice in the PrimeCarers client agreement is 48 hours for hourly care, and 7 days for live-in once 168 hours have been worked. PrimeCarers charges nothing itself for ending an arrangement, though the terms between you and the carer are the ones you agreed. It helps to say at the outset that the first month is a trial on both sides.