Top-ups to fees in care homes

If you have been assessed by the council as having needs that are best met in a care home, you have the right, subject to certain conditions, to choose the home you wish to live in.

The home will have to be of the type specified in your care and support plan, and must be suitable to meet the needs specified in the plan. It will also have to have space available, although you may be able to go into alternative accommodation or receive care at home while you wait for a place to become available. This right applies to care homes anywhere in England. (There are special cross-border arrangements if you wish to live in a care home in Wales, Scotland or Northern Ireland.)

As part of the care and support planning process, you will have been allocated a Personal Budget that will cover the costs of meeting your eligible care and support needs. Slough will ensure that you have genuine choice of accommodation and that at least one option is available and affordable within your Personal Budget. However, you might wish to choose a setting that costs more than the amount in your personal budget. If you do, a payment will need to be made to ‘top-up’ the difference between the care home’s weekly charge and your Personal Budget.

Additional costs (top-up payments)

If you choose a more expensive setting, in most cases a third party will need to agree to pay the additional cost. This might be a family member (but not your spouse), a friend, or someone else such as a charity. You may pay your own top-up only in the following circumstances:

  • where your home is subject to a twelve-week property disregard
  • where you have entered into a Deferred Payment Agreement (DPA) with Slough (NB: there is not an automatic legal entitlement to a DPA for top-up payments, but Slough will endeavour to agree such arrangements provided there is adequate security)
  • if the accommodation being offered is funded under section 117 of the Mental Health Act 1983 but not to your liking and you can find accommodation you prefer and pay the difference in cost.

Where there is a top-up, Slough will contract with the care home for the full cost of the placement. The person paying the top-up will need to provide evidence that they are able to afford to make the payments on a continuing basis, and enter into a legally-binding agreement to pay the top-up to the council at a set frequency.

Changes in provider charges

Slough will review your Personal Budget, normally once a year, to ensure that it is still sufficient to meet your eligible needs. However, the council cannot guarantee that the care home will increase its costs at the same rate, and this may affect the level of the top-up payment.

Slough will negotiate price changes with the care home as part of its normal contract management process, and will seek to keep any increase in charges to the lowest appropriate level. But there is no guarantee that cost increases will automatically be shared evenly should the care home’s charges rise more quickly than the increase in your Personal Budget. This may be more likely if you choose a home that Slough does not do regular business with. Cases will be considered on an individual basis.

Reviewing the agreement

Top-up agreements will normally be reviewed on an annual basis. However, other events may arise, eg as part of the care and support planning process, that would prompt a review of the top-up arrangement.

Consequences of ceasing to make payments

It is important that the person who has agreed to pay the top-up continues to make the payments. If payments are not maintained, Slough will take appropriate action to recover the payments due, which can include action through the County Court. Also, you might need to move to alternative accommodation that is affordable within your Personal Budget.

Changes in financial circumstances

Slough will consider sympathetically genuine unforeseen changes in financial circumstances. The person who has agreed to pay the top-up must contact Slough in writing as soon as their circumstances change, or they become aware that their circumstances are likely to change. 

Contact information

For further information,
contact Adult Social Care Services on 01753 475111
or email adultsocialcare@slough.gov.uk