Care home top-up payments

This guidance applies if the council supports, or will support, you with your care home placement, following a care and support needs assessment and a financial assessment.

Following a care and support needs assessment and financial assessment, we will work with you to develop a care and support plan. When developing your care and support plan, we will calculate a budget that you can use to pay for accommodation to meet your needs. This is called your agreed personal budget. You can read more about personal budgets here.

We will also calculate how much you will need to pay towards the cost of your care. See our paying for a care or nursing home page.
 

Choosing a care or nursing home

When choosing a residential or nursing home, the home you choose must be:

• suitable to meet your needs, and
• affordable at the rate agreed in your personal budget

The council must make sure that at least one option is available that is affordable. It is also in our policy that we will look at placements both in and outside of the geographical area.

If you want to choose a more expensive placement

You may want to choose a different care or nursing home that is more expensive than the one that the council has identified. If you do, someone must be willing and able to pay the difference between the care home fee and the amount in your personal budget, for the duration of your stay. You may have a relative, friend or charity who can pay the extra cost.

This is called a 'top-up payment', or paying a 'top-up fee'.

The top-up payment is in addition to the contribution that the person moving into the care home pays towards their care.

If you need to pay a top-up fee

As we will have calculated how much you can pay towards your care in the financial assessment, you cannot use your own income or assets to pay a top-up. The top-up can be paid by someone else (third party) from their own income or savings.

However, you can pay your own top-up (first party) payment if:

• you are receiving accommodation provided under Section 117 for mental health aftercare, 
  or
• you own a property that can be taken into account in your financial assessment and you have sufficient funds to cover the top-up fee during your trial period and the first 12 weeks of your permanent stay in a care home,
  or
• you own a property that can be taken into account in your financial assessment and you will be entering into a Deferred Payment Agreement with the council

Whoever is paying the top-up must be willing and able to meet the cost for the likely duration of the stay in the care home. As of January 2025, the average stay in a care home placement is 2 years.

The person paying the top-up payment will have to give the council evidence that they can afford the weekly top-up fee. They will need to complete a form providing details and evidence of how they will meet the costs. They will need to complete this form annually as a review.

The Contracts Team will then arrange for the person (or people) paying the top up to sign a top-up agreement (see below). If the person paying the top-up payment cannot do this, the council will not agree to arrange care and support in the preferred accommodation.
 

The top-up agreement

The agreement will include the following:

• the amount of the top up payment
• the amount of the person's personal budget
• how often payments must be paid
• to whom the payments must be paid
• how an arrangement is to be reviewed
• the consequences should you be unable to continue to make a payment - this could include moving the person receiving care
• the effect of any increases in charges made by the care home
• the effect of any changes in the financial circumstances of the person paying the top-up

If you have requested funding from the council for your placement, you should not enter into any private agreement about additional payments for care. The contract for the placement will be held by the council and all fee negotiations must be between the council and the care home. This also means that care homes should not approach an individual or family directly regarding any changes in the care home fee.

Changes to the top-up payment

The amount set in your personal budget will be reviewed regularly and may increase to make sure that it can meet your eligible needs. However, the council cannot guarantee that the accommodation will increase its costs at the same rate and this may affect the level of the top-up payment.

The person paying the top-up payment should be aware that the top-up fee may vary as providers review their fee levels. If fees increase, the top-up amount may also increase.

If you cannot pay the top-up fee anymore

If the person paying the top-up is unable to continue to pay, you may have to move to another room within the accommodation, or to another accommodation within your personal budget.

Any move to other accommodation will only happen after a community care and risk assessment of your needs, to make sure that the other accommodation is suitable for you.