Here is how a top-up is explained to most families. The council will fund a care home place at its own rate. The home you actually want costs more. Someone in the family pays the weekly difference, and everyone is happy.
That is broadly accurate and it hides the thing that matters, which is what happens to that arrangement when circumstances change.
What a top-up is
When a council arranges a care home place, it sets a rate it will pay based on what it judges is enough to meet the person’s assessed needs. If the family prefers a home that charges more, a third party can pay the difference. That difference is the top-up.
Two points of principle that are frequently glossed over. The council must be able to offer at least one home that meets the assessed needs at its own rate. A top-up should be a genuine choice about preference, not the only way to get adequate care. If you are being told there is nothing available at the council rate, that is worth challenging rather than accepting.
The trap
The problem is not the top-up itself. It is the contract.
Some care home agreements are drafted so that the person signing is not agreeing to pay the difference. They are agreeing to pay the fees, with the council’s contribution treated as a payment on account. The practical effect is that if the council’s funding changes or stops, the signatory is liable for the full weekly amount at the home’s private rate.
That is a very different commitment. A £200 a week top-up and a £1,400 a week private fee are not the same risk, and families have discovered the difference at the worst possible moment.
When full liability bites
Three situations, all of them common.
The resident’s own capital falls or rises across a threshold and the funding arrangement is reassessed. The council changes what it will pay. Or the placement moves from a council-arranged one to a private one, and nobody quite notices the change in status.
In each case the question is the same: does the contract say you owe the gap, or does it say you owe the fee?
The question to ask before you sign
Ask it plainly, and get the answer in writing.
“If the council’s contribution changes or stops for any reason, am I liable for the full weekly fee or only for the top-up amount?”
Then ask for the contract to say so explicitly. A written cap at the top-up figure is a reasonable thing to request and a well-run home will not object to clarifying it.
Watch for the word guarantor. A guarantor clause creates personal liability for the fees and it is the mechanism by which most of these problems occur.
Who can and cannot pay a top-up
This surprises people. Under the Care Act 2014 a top-up is generally a third-party arrangement, meaning a relative or friend rather than the resident. A resident is normally not permitted to top up their own fees from the income and capital the council has already assessed, because that would defeat the point of the means test.
There are limited exceptions. A resident can usually pay their own top-up during the 12-week property disregard, or where they have a deferred payment agreement in place. Outside those situations, if a home is suggesting the resident funds the difference themselves, check the position with the council before agreeing.
The arrangement also has to be genuinely sustainable. A council should satisfy itself that the third party can afford the top-up for as long as it is likely to be needed, and top-ups typically rise each year with the home’s fees. Budget for the increase, not just the opening figure.
Your options if the contract will not move
You have more room than it feels like in the moment.
Negotiate a written cap at the top-up amount. Ask the council to confirm in writing which homes it can offer at its own rate. Take the contract away and read it properly, which you are entitled to do. Or choose a home within the council rate, which is a legitimate decision rather than a failure.
If you are not in England
Care funding is devolved and the differences are substantial rather than cosmetic. Scotland provides free personal and nursing care as flat weekly payments regardless of income or assets, and its capital limits are more generous than England’s. Wales uses a single capital limit and caps the weekly charge for care at home. Northern Ireland runs its care system through Health and Social Care Trusts rather than councils. Everything below describes England. If you are elsewhere, start with Care Information Scotland, the Welsh Government social care pages or nidirect, because the thresholds quoted here will not apply to you.
Where FamilySafe fits
Top-up arrangements run for years and usually outlast anybody’s memory of what was agreed. FamilySafe keeps the contract, the written confirmations and the annual fee letters in one place, so the family can see what was actually signed rather than what everyone remembers being told.
Sources
- Care Act 2014 and the Care and Support (Choice of Accommodation) Regulations 2014
- Care and support statutory guidance, annex A on choice of accommodation and additional payments
- Age UK factsheet 10: paying for permanent residential care
This is general information about how care funding works, not financial advice. Rates and thresholds change every April. Check the current figures on GOV.UK or with your local council, and take regulated advice before making a decision about a property or long-term funding.
