Even if the local authority is unwilling to pay the whole cost of the chosen care home, a top-up charge may be able to enable an individual to reside in the care facility that is the most suitable for their need.

What is meant by the phrase “care home top-up fee”?

It is possible that a local authority will agree to pay for a care home in certain circumstances; but, they may not be willing to cover the total cost of the home that you choose. A top-up charge for a care home is an additional payment that is made to make up the difference between what the council will pay and the total cost of the care home that you have selected.

The top-up is typically paid for by a member of the customer’s family, a close friend, or another third party. It’s also known as a “third-party care home top-up” in some circles.

When are supplemental charges allowed to be applied?

Residents typically aren’t able to pay their own top-up fees (they shouldn’t be able to afford this if they’ve qualified for local authority financing), thus it’s typically a relative, a friend, or, on rare occasions, a charitable organization that pays these costs instead.

When a person enters into a deferred payment agreement, it is possible that they will be allowed to pay their own top-up cost. This is one of the few situations in which this is possible.

It is entirely up to the customer whether or not they choose to pay a top-up fee. There is no duty under the law for any member of the family, any friend, or any other person to contribute to the cost of this.

The following are some examples of when it might be reasonable to charge a top-up fee:

You would want to live in a nursing facility that has a higher monthly fee than what the local government is willing to pay.
You desire more amenities, such as a room that is either larger or has a better view, but the funds provided by the council does not cover these costs.
Your requirements assessment did not take into account the fact that you would want to reside in a region that is more expensive so that you can be closer to family or friends.
You were self-financing in the past, but after some time passed, you became eligible for support from the council. You have expressed a desire to remain in the same house, but the local government considers that your requirements may be satisfied in a more cost-effective care facility.

Whoever agrees to pay the top-up price will be required to provide proof that they have the financial means to cover the gap that exists between the budget provided by the local government and the actual fees charged by the care facility.

What you need to know before deciding to pay a top-up for a nursing or residential care facility

Before you commit to paying a care home top-up charge for a family member or friend, give some serious thought to whether or not you can manage the recurring cost of the payment.

Consider what might take place if your current situation were to evolve in the near or distant future. Is it possible that as a result of this, you won’t be able to afford the top-up?

After you have decided to pay the top-up, you will be required to sign a contract and will be legally bound to make the payments at the dates that were previously agreed upon.

Be mindful of the hikes in annual fees.

If you are thinking about paying a top-up, it is crucial that you are aware that even if the care home decides to raise its rates (which happens on a regular basis, typically once a year), the local authority might not necessarily raise its standard rate by the same amount. This indicates that the top-up cost may become more expensive in the future.

What to do in the event that you are unable to make the payment

If you find that you are no longer able to afford the top-up, whether as a result of a change in your financial circumstances or as a result of increased fees at the care home, it is imperative that you get in touch with the local council as well as the manager of the care home as soon as possible. The contract between the two parties (which can be seen further down) should have specified how the council would react to a change in the financing for the top-up and what your responsibilities are in terms of informing them of any changes in your circumstances that may occur.

If you cease paying the top-up, what consequences will it have?

If you cease paying the top-up cost, the local authority is not required to keep your relative’s spot in the more expensive care home even if they are already there. On the other hand, they could try to negotiate a deal with the care facility that would enable your relative to keep living there at a cost that is within the range of the regular budget established by the council. This can involve moving to a different room within the same house that is less expensive. In the event that such an arrangement is not feasible to make, your loved one may be had to relocate to a different residence.

First, the local government should do a fresh needs assessment before making any decisions about what to do. As a component of this, the repercussions of relocating your loved one to a new residence, in the event that such a step is required, will be taken into consideration. The local authority is responsible for making the payments of the fees up until a decision has been made.

What are the guidelines for top-ups at nursing homes?

The local government will want a written agreement to be signed by whoever is responsible for paying the additional fee. This should include the following:

how much the top-up payment will be and when it will be due; how frequently the payment will be reviewed; how the costs will be shared if the care home decides to increase its prices in the future; and what will happen if the person paying the top-up fees can no longer afford it.

Always make sure to reach an agreement with the local authority regarding an additional price. A top-up charge should never be required of family by a residential care facility. They are expected to make an initial visit to the local authorities if they have any reason to suspect that a top-up is necessary.

In the event that a top-up is agreed upon, it is possible that the fees may be paid directly to the care home; however, the council will continue to be held legally accountable for the total expenditures.

If a care facility requests you to pay a top-up fee, you should first inquire as to the reasoning behind the request and then get in touch with the relevant local authorities. It is the responsibility of the council to do a reevaluation of a person’s requirements, and if there is going to be an increase in the cost of care, then the council should pay for it unless they can provide evidence that the requirements can be satisfied in another setting.

Continuing Healthcare under the NHS and additional fees

There have been instances where providers of care homes have demanded additional payments from residents who are receiving funding through the NHS’s Continuing Healthcare programme (CHC). This practise has been the subject of debate. CHC packages should be sufficient to address an individual’s evaluated needs in their whole in order to be considered adequate. Therefore, people who are supported by the NHS should not be required to make additional fees in order to satisfy their requirements for necessary medical care.

However, nursing homes reserve the right to levy additional fees for services that go outside the scope of the resident’s care plan.

What other options are there besides paying additional fees?

When the budget granted by a local authority is insufficient to pay the fees of your desired care facility, an additional fee, known as a “top-up fee,” must be paid. You should get in touch with the local authority and ask for a new needs assessment if you believe that the reason for this funding gap is because your care plan did not take into account the essential care needs of the individual receiving care for them.

You will be expected to provide a justification for your request in the form of a reason. It’s possible that this is that:

your situation has changed significantly since the last evaluation, or you disagree with the results of the evaluation and want to contest them.

Alternately, you have the option of filing a complaint with the local authority if you believe that the personal budget that has been set for you is not sufficient to meet your need for care.