If an individual does not qualify for NHS CHC funding, the local authority must complete a financial assessment to determine their responsibility for the cost of their care. Briefly, if an individual has assets and capitol over £23,500 (England) or £50,000 (Wales) they are responsible for the full cost of their care.
Funded by the local authority
Where an individual’s capital falls below the threshold of £23,250 (£50,000 in Wales) the local authority become responsible for the majority cost of the care placement. At this stage, the individual is only responsible for making a contribution towards the cost of their care from their income (such as from their pension).
There are instances where a top up fee can become payable. A top up fee, or third-party contribution, is an additional payment made on top of what the local authority is willing to pay for care.
However, the decision to pay a top-up fee is a voluntary one. The local authority has a responsibility to provide you with options of affordable accommodation which fall within the Local Authority rate.
A top-up is appropriate if you are provided with a genuine choice of funded accommodation but reject the same, opting to enter into a care home that costs more than the local authority is prepared to pay. This could be due to a personal preference, for example, regarding the aesthetic look of the care home, or in relation to optional extras such as an ensuite room or additional social facilities.
Residents usually can’t pay their own top-up fees (they shouldn’t be able to afford this if they’ve qualified for local authority funding), so it’s normally a relative or friend who is responsible for funding the top up. The local authority can charge top up fees, provided the individual responsible is aware of, and agrees to fund, the top up on a fully informed basis.
If there is a proposal to charge a top up fee, the local authority (in England) have a responsibility to ensure that you are provided with clear and accurate information regarding alternative, affordable care placements. This provides a genuine choice of accommodation. The Local Government and Social Care Ombudsman (The Ombudsman) considered this issue in 2015 and compiled a report providing guidance around top-up fees as families could be paying too much for social care.
The report confirms that where there is an assessed need, there is a duty to provide an affordable placement which is within the contract rate the local authority will pay. A choice of options should be offered to an individual about affordable care, in addition to options which may require a top up to ensure that there is a “proper choice”.
The rules are similar in Wales and are dictated by the Social Services and Well-being (Wales) Act 2014. These rules confirm that a local authority must have more than one option available for a person to choose from in relation to alternative placements to amount to a “genuine choice” over whether to enter into care in a more expensive setting.
In the event that alternative placement options have not been offered in England or Wales, we may be able to recover the cost of the top up fee paid. Please note that in both England and Wales the local authority must fund the full cost of care if they are unable to provide any accommodation options within the local authority standard rate and are unable to request payment of a top up fee.