Adult residential care top-up fees

If you're thinking of moving into a residential or nursing home, you'll need to be aware that some providers charge top-up fees.

Paying a top-up fee could increase your choice of accommodation.

What is a top-up fee?

A top-up fee is an additional fee set by the care home provider which is over and above the service user’s personal budget which is determined through the local authority’s assessment process.

Not all care homes charge top-up fees. The amounts charged vary by provider and can sometimes vary from room to room within the same care home.

The person making the payments must be willing and able to pay a top-up fee.

Types of top-up fees

There are 2 types of top-up fees: first party top-up fees and third party top-up fees.

First party top-up fees - this can be paid by the service user if they fall into one of the following categories:

• They are subject to section 117 following detention under the Mental Health Act.
• They are subject to the 12-week property disregard.
• They have opted to take out a deferred payment with the local authority.

Third party top-up fees - this covers anyone who doesn't fall into any of the 3 categories to qualify for first party top-up fees.

Third party top-up payments should not come from the service user's own income, savings or capital. This means that the third party who has agreed the top-up will fund this from their own income and/or savings.

The third party top-ups can be split between several contributors if preferred.

For all placements which carry a top-up fee (this includes respite placements, short term and assessment care periods as well as permanent placements) you will be asked to sign a declaration document in the first instance. This is an interim agreement stating that you will pay the top-up fee for the duration of the placement.

Who is responsible for providing information about top-up fees?

The adult residential care provider and the placing practitioner are responsible for providing information about top-up fees to prospective residents and their representatives.

The service user must be aware if a top-up fee applies to the placement. This can be from the date of placement or following a period of Discharge to Assess (D2A).

About dual agreements

For permanent placements, you will also be required to sign a dual agreement. A dual agreement is a legal document signed by us and the person(s) paying the top-up fee or an appropriate financial representative.

This agreement provides protection for the care home provider against non-payment and allows us to pursue any debt through our corporate debt recovery processes, if necessary.

The agreement also states that care home providers must inform us of any intention to increase top-up amounts. We'll then discuss this with the first or third party. If the increase is agreed upon, a new dual agreement will be generated for the new weekly top-up amount. All parties will be required to sign any new agreements.

What happens if I can't afford to pay a top-up?

Where a top-up contribution exceeds £100 a week and is only paid by one individual, we'll need to undertake a financial sustainability assessment to ensure the payments are affordable. If the top-up is judged to be unsustainable following this assessment, we will not enter into a dual agreement.

If a top-up exceeding £100 a week is split between several contributors and results in individual payments of less than £100 per week, there is no need for a financial sustainability assessment.

We'll need to discuss the top-up with the provider and first or third parties. This may result in a change of placement with either a lower top-up or no top-up.

If the top-up amount cannot be negotiated to a more affordable amount, you'll be advised to find an alternative placement with either a lower top-up or no top-up.

We don't encourage private arrangements with the provider.

What happens if payments can't be met after signing a dual agreement?

It's the responsibility of the first or third party, or their representative, to inform us of any change in circumstances.

Negotiations around the top-up should then take place with all parties. If no agreement can be reached, it may result in a change of placement for the service user with either a lower or no top-up.

What happens if the person responsible for top-up payments passes away?

If someone responsible for top-up payments passes away, this is a change of circumstances. You must let us know about it as soon as possible.

It may be possible for another relevant party to take over the payments. If this is the case, a new dual agreement will be generated. There may be exceptions, which will be dealt with on a case-by-case basis.

What happens if a first or third party refuses to sign an agreement?

We have a duty to inform the provider that a dual agreement hasn't been put in place.

We must decide with the provider and first or third parties if the placement will continue or to serve notice to the service user.

Depending on the decision, it may result in a change of placement for the service user with either a lower or no top-up.