What is a care home top-up fee?

If you are not eligible for NHS continuing healthcare but you have social care needs and are therefore eligible for a packet of care provided by the local authority, they will limit the weekly costs they will pay towards this care. If you wish to live in a more expensive and possibly luxurious care facility, the local authority will not be obliged to fund the excess costs. Someone will need to make up the difference, which is known as a top-up fee.

Who can pay top-up fees?

First party top-up fees

You usually cannot pay your own top-up fees. A first party top-up is paid by the resident/person requiring care and is only used if that person is:

1. Subject to a 12-week property disregard.
2. Has a deferred payment agreement in place.
   Where this is the case a deferred payment agreement must reflect this arrangement.
3. Receives accommodation under Section 117 for Mental Health Aftercare.

Third party top-up fees

To reside at a more expensive care home, your family members/friends may be asked whether they are prepared to pay a top-up. This is known as a 'third party payment.'

Third party top-ups can be paid by anyone other than the person who is receiving the package of care. Top-ups should not be applied if you have a 'need' rather than a preference for a particular package of care.

An example would be where the local authority is unable to place you in a local care home.

• Local care homes have vacancies but their rates are higher than the local authority's usual rate.
• You need to be placed locally as your disabled daughter would be unable to visit you if you were moved out of the area.

Therefore, you have a 'need' to be placed in a more expensive local care home. The local authority will need to meet the cost of this care without requesting a top-up until a vacancy becomes available in a local care home that will accept local authority rates.

Top-ups will not apply if you have sufficient funds to privately fund your own care. This is because you will be using your own income and capital to pay for more expensive accommodation that the local authority would not fund for a person who has limited assets.

What is my personal budget?

The local authority will provide you with an amount of money based on your specific needs and the actual costs of meeting these needs. This is your personal budget.

It is always important to challenge a personal budget if you think that the funds provided by Social Services to meet care needs are not sufficient. Also, where the needs being funded are assessed care needs and not the preference of the individual.

You should always have a choice between a range of high-quality providers and options and should never be pressurised into accepting one option. Once the local authority has prepared a care plan and personal budget they will carry out a financial assessment. This will ascertain whether you need to contribute to the cost of your care.

Should I pay for a relative’s top-up fees?

When considering whether you should pay a person’s top-up fees, you must remember that a top-up payment should be arranged through the local authority. This ensures they remain responsible for paying all fees, including any top-ups. Requests for further top-ups without the knowledge of the local authority are likely to infringe Consumer Law.

You must be willing and able to meet the additional costs for the likely duration of the arrangement. This is because the top-up may have to be paid for a considerable length of time into the future. You will have to enter into a written agreement with the local authority to meet the cost. It is always advisable to speak to a legal advisor to make sure that the agreement includes the relevant provisions required.

What happens if I can no longer afford to pay a top-up fee?

You should obtain advice before entering into a top-up agreement. Depending on the agreement entered into, there may be consequences of ceasing to make payments. Bear in mind that if a person’s care needs increase, it will mean a weekly increase in their fee.

Also, it is important to remember that care home fees are usually increased every year in January or April.

Challenging a request for a top-up fee

Top-up fees are not compulsory. It is up to the relevant friend or relative to carefully consider whether they are willing to take on the commitment. They need to give serious thought as to whether they can afford the top-up fee on an ongoing basis or not.

Social Services should not request a top-up fee if the person requiring the package of care has a need, rather than a preference, to live in a particular care facility that is more expensive than the local authority’s usual weekly rate.

If you can prove that the person requiring a package of care needs that specific package of care then Social Services will need to increase their rate. They should not be asking for a relative to top up.

It may be possible to persuade Social Services to increase the local authority funding contribution with the right evidence. However, there may still be a gap between the weekly care charge of local authority contribution and the resident’s income contribution but at least the top-up rate will be lower.

In certain circumstances, you may be able to prove a need for a more expensive package of care and therefore a top-up may not be required. This includes:

• if the person needs a particular package of care or a more expensive care home because of their religious or cultural needs,
• the need for a couple to be placed together,
• or even the need to be close to family.

Do you need help and legal advice about care home top-up fees?

The key point to remember before you consider care home top-up fees is: have you been correctly assessed for your care needs? Often someone will miss out on funding because they have not been correctly assessed. Remember that no questions should be asked about a person’s ability to fund their own care before their care needs are assessed using the continuing healthcare assessment.

To find out more about care home top-up fees, contact our Funding Care Team who will be happy to help.