Should I Be Paying Care Home Top-Up Fees?
Navigating care costs can be stressful enough without the added confusion of care home top-up fees. Many families are wrongly told that they must pay these extra charges when, in fact, the NHS guidance says otherwise.
In this guide, we’ll explain what top-up fees for care are, when they’re lawful (and when they’re not) and how you can challenge them if you’ve been paying unnecessarily.
In this article:
What are top-up fees?
Care Home Top-Up Fees are additional charges made when someone is awarded NHS Continuing Healthcare Funding (CHC), but the care costs more than the NHS is willing to cover. The top-up fees bridge the gap between what the NHS agrees to pay for care and the actual care costs.
For example, if the NHS sets a budget of £1000 per week, but the chosen care provider charges £1,250, the £250 difference is the top-up fee.
Read more in our guide to planning for future care home fees.
Are top-up fees unlawful?
Top-up fees are not always unlawful, but they can be deemed so if the right conditions aren’t met.
There is a difference between local authority funding (which is means-tested) and NHS Continuing Healthcare Funding (or ‘CHC’) which is not means-tested.
Local Authority Funding
A local authority must always carry out a proper care needs assessment and identify at least one suitable care home that meets the person’s assessed needs within budget and without requiring extra top-up contributions. If they fail to do this, and/or instead insist on a more expensive placement, any resulting top-up fees may be considered unlawful. Equally, if a person is pressured into accepting a more expensive care home because no suitable alternatives were offered, the third-party top-up fee could also be challenged.
Continuing Healthcare Funding
However, contrast that with someone who qualifies for NHS Continuing Healthcare (CHC), whereby ALL their assessed health and social care needs must be covered in full. In these cases, NHS guidance makes clear that asking families to contribute a top-up is unlawful.
CHC must cover 100% of the care package– so any additional charges, including top-up fees, are a breach of the rules.
More detail is available in our article: Top up fees – are they ever lawful?
Free initial advice
We will be able to give you an honest assessment of whether we believe you may be eligible for Free NHS funding.
When should you be paying top-up fees?
In some cases, top-up fees are permitted, usually when the individual or their family voluntarily agrees to pay for something above the standard care provided. The most common examples include choosing:
- A larger or luxury room
- A care home in a preferred location
- Extra facilities or services beyond assessed needs
Families should also ensure that any arrangement is written down clearly in a contract with the care home, so there is transparency about what the fees relate to (i.e. is it lawful?), who pays the top-up fees and under what circumstances. This transparency means families are less likely to be at risk of unexpected or unaffordable bills for expensive care homes.
Who pays top-up fees?
In most situations, the person living in the care home or their family representative will pay their own top-up fees.
Changes in top-up fees
Care home top-up fees can increase over time due to factors such as annual price rises by the care home or changes in the patient’s wants and desires. Whoever is responsible for paying must be notified in advance of any change.
How much are care home top-up fees?
There’s no fixed amount for top-up fees for care homes – the fee is simply the difference between the NHS’s contribution and the actual cost of the care home (or what surplus they can get away with charging). For some families, this might mean a few extra hundreds of pounds per month which can soon add up.
Before agreeing to pay top-up fees, always request a clear written breakdown so you understand all the care home costs involved and why you are being charged this extra amount. Look out for top-up fees disguised or described as something else to hide their true identity – which may be unlawful.
If the amount paid by the NHS to the care provider is insufficient to cover the actual cost of the assessed care needs for an individual, it is the care provider’s responsibility to go back to the NHS and request additional funding. It is not for the family to pay the shortfall by way of an unlawful top-up. Don’t be bullied by the care provider threatening to evict your relative or withdraw care if they don’t pay an unlawful top-up.
Can you reclaim unlawful top-up fees?
Sadly, for CHC funded patients, many families discover too late they’ve been wrongly paying care home top-up fees that were unlawful. At Farley Dwek, we specialise in helping families reclaim these costs where NHS CHC funding is – or was – in place.
If you, or a loved one, have been paying top-up fees after CHC funding was awarded, you may be entitled to a full refund with interest. Our team can review your case, guide you through the process, and ensure you are properly reimbursed.
Find out more about reclaiming top-up fees or contact us today to speak to one of our experts.