Top ups and additional payments in care homes (with and without nursing)
Background
In Birmingham the personal budget is usually determined by the cost of the placement identified through the council’s Flexible Contracting Arrangement. For older adult placements made in Birmingham, this will usually be the contract rate. For older adult placements made outside of Birmingham, the personal budget will usually be determined by the host local authority rate.
The council has a duty to ensure that the person has been offered a placement through the Flexible Contracting Arrangement without a top up.
Under the Care Act 2014, a person may choose a care home that is more expensive than the amount identified in the personal budget and may also choose to pay for additional services that are not part of their care needs.
Except in limited circumstances, top ups can only legally be made by a third party – usually a friend or relative.This is because the service user’s income will already have been accounted for as part of their Financial Assessment under the Care Act.
Where a more expensive care home is chosen and a third party opts to pay a top up, the council should ensure that the person understands the full implications of their decision. The local authority must ensure that the person paying the top up is willing and able to meet the additional cost for the likely length of the arrangement.
The council’s aim is not to prevent top ups from being put in place, but to make sure:
- we have discharged our statutory duties
- all parties are clear on the agreement being reached and the service that will be provided, where additional payments are agreed
What we mean by a top up payment
The term ‘top up’ is widely used to describe a number of different situations, some of which are covered by statutory guidance and some of which are not.
The most common situations can be summarised as follows:
- an additional cost of providing preferred accommodation, over and above the amount in a person’s personal budget, the payment of which allows a person to choose a provider whose fees cost more than the rate the Council expects to have to pay for meeting their care needs. This situation is covered by the Care Act Statutory Guidance and this is known as a Third Party Top Up.
- an additional charge for something that is not part of meeting the person’s care and support needs as set out in the support plan. There is no defined list of these additional charges, however they include upgrades in accommodation or additional services. These are widely referred to as ‘wants’ and not ‘needs’ and some examples are given below. This situation is not covered by the Care Act statutory guidance but the Council calls this a Third Party Additional Payment.
- a number of other top ups and payments are outlined in Appendix 1 of the factsheet for completeness; however, these are only applicable in a very small number of cases.
For more information about third part top up payments and third party additional payments, download the provider top up fees factsheet.
Page last updated: 25 September 2023
