What are care fee top-ups?
Top-ups are extra daily fees paid when the cost of a care home place exceeds the amount the local authority will pay for that particular care home. A third party (typically a family member) pays the top-up to the care home in addition to the local authority’s contribution.
Common terminology associated with top-ups include ‘top-up’, ‘third party’ and ‘local authority contribution’. Top-ups are generally optional but also compulsory in some cases.
Examples of situations where top-ups are involved include: choosing a higher-grade room (e.g. more expensive than the standard room offered by the care home); an individual service that incurs additional costs (e.g. laundry, beauty treatments); and selecting a specific care home scheduled to charge more than what the local authority is prepared to pay for that particular home.
The Care Act 2014 explains how top-ups work. In all cases, the local authority pays the maximum it considers necessary to meet the individual’s needs. If someone else wishes to pay the additional amount, this is a top-up. The amount can change over time, and the care home is responsible for informing the resident or their representative if it does.
Who pays top-ups in care homes?
Top-ups are normally paid by the care home resident or their family so that the fees charged by the care home exceed the local authority contribution. However, someone else (a “third party” such as a relative, friend, or charity) can pay a top-up, in which case it is no longer a charge on the resident or family. The local authority decides if a top-up is needed and the care home and the third party agree the amount.
In general, the resident or their family is asked to contribute when the resident is moving into accommodation in which the care home costs more than the amount paid by the local authority (usually because the choice is for a room that is assessed as higher grade or of a more expensive care home). The additional cost (the top-up) is then calculated and set by the care home, and the amount is agreed with the third party.
When you might have to pay a top-up
As with all care fees, some residents might have to pay the cost themselves, either from their income and savings or because a third party, such as a family member, relative, friend, or charity, is contributing. However, this is not always the case, and there are instances when even a third party is not required to pay a top-up.
You may have to pay a top-up charge if you choose a higher-grade room or suite, or if you select a specific care home whose cost exceeds the regional rate agreed by your local authority. The care home will explain how the top-up amount is calculated and agree it with you before you move in. Since care home costs can rise, the amount you pay may change. You should be told whenever it changes and when the new figure will start.
When you are unlikely to pay a top-up
Most residents do not pay a top-up, so it is worth checking if that applies to you. You will not have to contribute if your local council fully or partly funds your care home place due to your finances. Nor will you need to pay a top-up if the council pays for your care home fees, the home does not provide standard rooms, and you do not move into a more expensive room.
You do not need to pay a top-up charge if your local authority fully or partly funds your care home place due to your finances. That is, if your capital is below the local authority threshold (£23,250 in England) or if you are eligible for the full means-tested benefit or the Welsh equivalent. In particular, you are exempt from a top-up charge if a top-up facility is not in your local council’s care home guide. You also usually do not have to pay an extra daily fee for the standard room type (if offered) when you choose a care home. However, you may need to pay a top-up charge if your local authority pays for your care home place and you choose a room that costs more than this amount.
You cannot legally be required to pay a top-up charge if the care home does not have such a facility and has only standard rooms, or only standard rooms available at an accommodation rate that your council would expect to pay. However, you could still be billed an extra daily fee if your care home has a more expensive room that is not one of the home’s standard ones. Such top-up requests could arise, for instance, if a room’s condition worsens significantly. It is also possible for top-ups to be temporarily paused or reduced—perhaps during a policy change or following an appeal.
How top-ups are set and charged
The amount of the top-up fee will be set by the care home or care home owner, held for review, and applied if necessary. Written reasons for the proposal must be provided, and the resident (or someone acting on their behalf) will be given the opportunity to comment on it before the decision is made. Once the amount has been agreed, the care home must ensure that the affected resident is given clear and prominent written notification, including a statement explaining how it has been calculated, how often it is reviewed, and what services or facilities it covers. This notification should be repeated whenever the amount is changed.
The top-up fee must appear on the resident’s bill and be charged at the same frequency as the resident’s personal fees. It can be paid to the care home in the same way as the other charges, by the same person responsible for payment, and at the same time, however, that person is not limited to cash payments for their share.
How to check if a top-up is fair
When examining the fairness of a care fee top-up, a few key points need to be checked. These include, first, the amount of the top-up and how it was calculated; second, whether it is likely to change and by how much; and, finally, whether the top-up rate still applies to the room being occupied.
The expected level of top-up is a common source of dispute when the local authority has no spare capacity. Top-up arrangements can be verified against official guidance produced by the Care Guide or the top-up agreement with the care home. Local authority standard charges indicate the amount it considers appropriate for a standard room type within a given care category. Any deviation should be explored; the local authority may have a policy regarding the nature and amount of any top-up. If the care home contract indicates that the care home is out of step with local authority policy, this information should be stored to support a later challenge.
What to do if you disagree with a top-up
When you disagree with a top-up, begin by discussing the matter in a friendly way with the care home. If that doesn’t work or isn’t possible, ask the local authority for a review. If it doesn’t go well, you or someone acting on your behalf can appeal the decision. The review or appeal should include papers that back up your case. For further assistance, consider contacting the Care Advice Service or an independent advocate.
If you don’t think the care home staff about the top-up in a friendly way, they may not feel inclined to help. Always start by complaining to the care home, but note that you are making a complaint. If this doesn’t lead to a satisfactory outcome, or if you are unable to do this, go to the local authority that arranged the funding for a review of the top-up. Once that has happened, you can appeal the decision. When doing this, send supporting papers or copies of any other documents that are relevant.
Involve the Care Advice Service if you are unsure how to proceed or need extra support with guidelines regarding care home top-ups. Alternatively, you can contact an independent advocate or an advocacy service, such as Age UK, to help resolve disputes with care homes.
Help and sources of support
Numerous resources exist to help with care fees and funding sources. Official government guides detail care fees and help, including top-ups. Charitable or independent guides explore the issues, while local authorities are experts in local procedures, care home prices, and available assessments.
For legal or financial advice, consult a qualified adviser in these fields. A charity such as Citizens Advice may be able to assist. In an emergency or urgent situation, contact a support service like Age UK or Action on Depression for further help.
Conclusion
Care fee top-ups are an important and complex issue for anyone entering a care home or for residents already in a care home planning their costs. In many cases, they will not incur any extra fees, but in others, the top-up is unavoidable. The process of setting up the top-up is also crucial, and it is always worth checking that it is reasonable.
The most common scenarios where a top-up must be paid are when someone selects a more expensive room type or decides to live in a care home that does not offer a standard contract with an accommodation and care package that can be met solely with the local authority’s financial support. A top-up is generally calculated and agreed upon when these factors are decided upon.
As the top-up is based on the difference between the funding provided by the local authority and the actual fee charged by the care home, it can fluctuate as these amounts change over time. Care home managers are responsible for notifying residents and those paying any top-up of all changes promptly.
