Direct payments vs Care Plan

Nutty Nan

Registered User
Nov 2, 2003
I have been contemplating giving up work to care for my husband, who has been on Aricept for 5 years and is declining gradually. He is safe at home, but I am not comfortable leaving him, even with my daughter calling in during her lunch hour. The biggest juggling act is early morning: I have to leave before 8am, he is rarely ready to 'function' before 9am.
General advice is 'not to give up work'. Social Services said "if you were a man, you would not think about giving up work". They said there's lots of help available. 6 months on, I am still waiting ...... (no surprise to most of you reading this, I am sure).
We have a brilliant CPN, a care worker for my husband (who actually raised my hopes with the above statement, and whom we have not seen nor heard from for months since then), and a care worker for myself, who spent many hours doing a carer's assessment, then went off on leave. Day care has been offered, and we are still trying to get him there, but there are obviously practical problems associated with this.
I have not been offered a care plan yet (although I have been asked to write one, which I did), but Direct Payments have been mentioned.
I am a bit worried: how would I go about finding a suitable carer, who would vet him/her, how much would they charge, and most importantly, how is the amount for direct payments worked out? How often is it reviewed?
Am I right in thinking that a care plan with carers coming in (ideally) every weekday morning to get my hubby sorted out after I have left for work would be a safer bet?

I would be grateful for your experiences / advice!


Registered User
Mar 7, 2004
Dearest Nan, can emphasise with your situation. Social workers, carers assistance, CPN's all talk of the help available, BUT TRY PUTTING IT IN PLACE.

I don't want to appear negative, but, make sure evrythig is in place before you ACTUALLY give up work. Too many carers I know have been left in the lurch.

Thinking of you, Love Connie


Registered User
Oct 23, 2003
West Sussex
Hi Nan, I had trouble with this care plan versus direct payment thingy too. As I had to move Mum in with us and sell her flat when she became unsafe to live alone, she then had capital in the eyes of SS. Her SW told me I could get the package cheaper if I went private, but, when I went into it, there were fors and againsts. If I stayed with SS, OK, Mum had to pay the full amount, but we retained the SW and had someone in our court so to speak. If I went private, if the carer became ill or was on holiday etc. I would be left to cope. I decided to stay with the SS package for the back up it gave us. You may feel differently. Try doing a list, for, and against. Do the costings breakdown. Also look at the stress factor. Then see what it comes out at. This is a very personal choice because we all have different circumstances. If you can get a reliable package or carer to come in and see that your husband gets up and off to daycare, then you may not need to give up your job. If your job is one you enjoy, it may be good for your morale to keep it for as long as you can. If it is stressful and you also worry about what is happening at home all the time you are there, then perhaps you should think about whether it is worth it. I can't possibly advise you one way or the other, but by weighing it all up, you should be able to decide what is best for you. All the best, love She. XX


Registered User
Mar 23, 2005
Hi Nan,

What a big decision to wrestle with. Regardless of what you ultimately decide to do, I would push for a meeting with your husband's social worker to get them to put an up-to-date care plan together. Initially, it might be a good idea to get them to put together a care plan based upon you continuing to work and a care worker providing assistance during the week.

We were in a similar situation to Sheila in that my father-in-law's social worker said that we could contract directly with the care agency that she recommended. It would be cheaper, but after asking a few questions, we found that it would also mean that my f-i-l would no longer be considered an "active case" by SS as he would not be receiving services through them.

As my husband and I live 70 miles away, and my mother-in-law does not always like to "bother" us with requests for more help, we thought it was better to continue to get services via SS. This meant that the agency carers could also give feedback to the SW if they thought the package needed adjustment. This has worked for us as my m-i-l agreed to an extra afternoon's help and the whole thing was arranged easily. Your situation is different, so this might not be a consideration for you.

If you do want to get a feel for what registered domestic care agencies there are in your area, you might want to use the search facility on the Commission for Social Care Inspection's web site:

Take care,



Registered User
Nov 30, 2003
Hello Nan
I wasn't in the position of needing to give up work as I was very close to retirement and had had enough of work. Direct payments were mentioned by our social worker as a way of giving my husband and myself a breathing space as the stress was telling on me, resulting in me retiring 6 months early.
I can only speak from my own experiences and it doesn't involve early mornings. Our local social services did all the advertising for a "personal assisstant" in the local papers and then you interview and choose the right one. In our case the carer was recommended by my husbands other carer who is attached to the local early onset dementia ward. The council do all the payroll, time sheets etc and all we do is pay the invoices on a monthly basis. If you get the right person, it works well, as my husband has built up a good rapport with him and the carer has become more of a friend.
You do need to open a bank account purely for the council to pay the money into and guess what? Yes , you have to have a financial assessment for a contribution towards this and the contribution will also depend on how much savings yuou have.
I have found it the perfect answer for us as we can use our 6 hours a week quota in any way we like and my husband has gained a friend who takes a lot of trouble to find interesting trips/activities for him.
Hope this helps a bit.


Registered User
Mar 28, 2005
Care Plan

Dear Nutty Nan,

When our Care Plan was made for my mum, I work full-time so she spends most of the time at the Day Centre (I drop her off at 8.40a.m) and then 1 day a week and 2 evenings at a Nursing Home - I drop her on the way to work and pick her up when I have finished work.

When we were discussing all this with SS I said that my mum has savings and they said she would not have to pay for this.

I am really confused about all this, does it make the difference that you are bringing people into your own home to be with your husband who need to be paid and not take him to a Nursing Home to be cared for when you are not at home??

I hope the above make sense (even I'm confused when I read it back).


Nutty Nan

Registered User
Nov 2, 2003
Thank You!

Thank you all so much for your replies - there are so many factors to consider, and in the end it will all depend on what is available in practice.
I will keep you posted in case it helps others in a similar situation.
Feeling a bit emotional tonight, as we have just been told to stop the Aricept. After 5 years it is not completely unexpected, but still feels as though we are getting onto even more slippery slopes on this journey.
Sad - angry - tired ......

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