Top-up Policy for care home placements

Status: FINAL

Version: 2.1

Date: 20/02/2026

Author: Helen Trousdale

Lead / Owner: Helen Trousdale

Document control summary 

Defined terms

Introduction and Purpose 

1. The purpose of the Top-up Policy is to ensure that Adults who have been assessed as having eligible needs for care and support under the Care Act 2014, and other relevant legislation, have the ability to make a top-up payment where the cost of their chosen care home exceeds their Personal Budget.
    
2. In developing this Policy, the Council has had due regard to the Care Act 2014 and other relevant legislation, regulations and statutory guidance.

Scope 

3. The scope of this policy applies to: 
   1.  Adults who have been assessed as eligible for care and support under the Care Act 2014; and 6 
   2. Adults eligible for funding under Section 117 of the Mental Health Act 1983 (“MHA 1983”).

Definition

4. Where an Adult requires a care home the Council will source a placement that meets their assessed eligible needs within a reasonable distance, and their Personal Budget will be determined by the most cost-effective placement that can meet those needs. 
    
5. The Adult can choose other options provided by the Council or they can identify their own preference for a care home. However, if the cost of their chosen care home exceeds their Personal Budget a top-up payment would usually be required (following consideration of all relevant factors) to cover any difference. 

6. For example: 

Jane had an assessment about the care and support she needs and will need to move into a care home.

Care homes that meet Jane’s care and support needs have been identified.

There are two care homes that can meet Jane’s needs and have available spaces. Care Home A and Care Home B. 

Care home A can meet Jane’s care and support needs for £800 per week. 

Care Home B can meet Jane’s care and support needs for £900 per week.

Jane’s Personal Budget is set at £800 per week because, after consideration, there is a care home available that is able to meet her care and support needs for this amount of money.

Jane and her family would prefer for Jane to receive care and support in Care Home B.

If Jane and her family decide to choose this option, they will need to top up Jane’s £800 Personal Budget. 

Jane and her family will need to pay a care home top-up of £100 per week to for Jane to have her care and support needs met at Care Home B. 

The top-up is a separate payment to the assessed weekly contribution amount that Jane also has to pay.

7. A third-party top-up is when another person, usually referred to as a Sponsor, agrees to pay the extra cost of the chosen care home when that cost is higher than the Personal Budget as a result of the Adult exercising choice. This may be a single third party or multiple third parties. 
    
8.  A first party top-up is when the Adult receiving care agrees to use their own funds to pay the extra cost of the chosen care home when that cost is higher 7 than their Personal Budget as a result of the Adult exercising choice. This is limited to the following circumstances: 
   1. Section 117 after care.
   2. For self-funders during the 12-week property disregard period.
   3. For self-funders who have made a Deferred Payment Agreement.
       
9. For further information about the 12-week property disregard period and Deferred Payment Agreements please visit our  Deferred Payment Agreement page
    
10. It is important to remember, any top-up amount (first or third party) is payable in addition to the Adult’s assessed weekly contribution to the cost of their care; the Council will send two separate invoices for these amounts.

Affordability

11. The top-up amount is payable for the duration of the care home placement and until up to 3 days after the end of the care home placement, in line with the Council’s contract with care homes. It may be difficult to know at the outset how long a care home placement will last.
     
12. In the example above a top-up payment of £100 per week would amount to a total payment of £5,200 over one year and £15,600 over three years.
     
13. The Adult or Sponsor(s) must ensure that they are able to pay the top-up amount for the duration of the placement, which could be months or years. The Adult or Sponsor(s) should not enter into a top-up agreement if there is any doubt about whether they will be able to afford the top-up payment either now or any time in the future.
     
14. The Adult or Sponsor(s) must give regard to any impact arising from: 
    1. Loss of employment / income. 
    2. Increased expenditure for yourself or another family member, for example paying for university. 
    3. Approaching retirement age
        
15. To reduce the likelihood of the Adult or Sponsor(s) being unable to pay the top-up amount for the duration of the placement, the Council will set an upper top-up amount.
     
16. The upper top-up amount will be calculated based on the value of existing top-ups and taking into consideration likely affordability for a typical Adult or Sponsor(s).
     
17. The upper limit is set per placement, not per sponsor.
     
18. The upper top-up amount will be reviewed at least annually and more frequently if required. The upper top-up amount may be increased or decreased at the discretion of the Council.
     
19. Requests for top-up payments up to the upper top-up amount may be considered and approved within normal business processes. The Council may request evidence of financial circumstances from the Adult or Sponsor(s) to confirm that the top-up payment is affordable.
     
20. Where requests are made for top-up payments above the upper top-up amount the Council will seek evidence of financial circumstances from the Adult or Sponsor(s) to confirm that the top-up payment is affordable, including information about income, expenditure, savings and loans. These requests will be considered through an exceptions process and must be approved by a Band A or B Officer. If the Adult or Sponsor refuses to provide this information the Council is unlikely to consider the application for a top-up.
     
21. The Council will check, before entering into any top-up agreement, to determine any financial risks – for example previous debts with the Council if an Adult has not paid their assessed weekly contribution to the cost of their care. If there are any financial risks, the Council will not enter into a top-up agreement with the Adult or Sponsor(s).
     
22. The Council retains the right to refuse any top-up payment request on the grounds of affordability and/or known financial risk, regardless of the value.

Types of placements

23. A respite placement, sometimes referred to as a short break, refers to a maximum of 8 consecutive weeks placement in a care home. A respite top-up amount will remain payable for the duration of the placement, until the person ends their respite stay
     
24. If person subsequently requires a temporary or permanent care home placement, an assessment will be completed to identify their care and support needs, followed by the process to secure a placement, where appropriate.
     
25. It is important to note, this may be a different placement to the respite stay, the top-up amount may change and there is a different upper top-up amount
     
26. A temporary placement means the placement is not likely to be permanent and is unlikely to exceed 52 weeks. A temporary placement top-up amount will remain payable for the duration of the placement, until the person returns home or a permanent care home placement commences.
     
27. A permanent placement is for Adults who will remain in the placement indefinitely and do not intend to return home.

Entering into a top-up agreement

28. For a top-up payment to be considered the Adult or Sponsor(s) must complete a written top-up agreement and return this to the Council.
     
29. If there is more than one Sponsor, each Sponsor must complete a separate top-up agreement.
     
30. The Council is unable to provide any financial advice or guidance; the Adult or Sponsor(s) should take independent financial advice before entering into a top-up agreement to ensure affordability.
     
31. A care home placement which requires a top-up, including in the event of an emergency, cannot commence until the Adult or Sponsor(s) has completed and returned the top-up agreement and the Council has approved the arrangement.
     
32. The Council will review and respond in writing to requests for top-up payments within (typically) 7 working days of receipt of all necessary information.

Payment of the top-up

33. The top-up amount is included in the top-up agreement and is payable in addition to the persons assessed weekly contribution to the cost of their care.
     
34. In the case of a Sponsor entering into a top-up agreement, the top-up payment should not be taken from savings, capital or income of the Adult in the care home placement.
     
35. The Adult or Sponsor(s) is required to make the payment to the Council by Direct Debit for the full top-up amount, unless in the event of a Deferred Payment Agreement.
     
36. If there is more than one Sponsor, each Sponsor will need a separate Direct Debit arrangement with the Council.
     
37. A statement will be issued to the Adult or Sponsor(s) every 4 weeks in arrears, unless in the event of a Deferred Payment Agreement.

Annual increases

38. The Council’s contract with care homes specifies that if an annual fee uplift is applied this will be made to the total placement cost, including any top-up payment.
     
39. The Council is not obliged through its contracts to offer fee uplifts to providers of adult social care services, but it does have the option for discretionary fee reviews. The practice over recent years has been to carry out these reviews annually, ahead of each financial year. Some illustrations of the impact of typical annual fee uplifts on top-up payments are demonstrated in Table 1.

40. Any annual fee uplift is applied from the first Sunday in April after the start of the fiscal year. The Council will write to the Adult and/or Sponsor(s) to advise of the increase and provide a minimum of 10 working days’ notice of the change to the top-up amount (and associated Direct Debit). The Council retains the right to review the amount and application of annual increases, as part of a review and update to contractual arrangements with care homes. Further information on any changes would be shared at the appropriate time.

Annual review

41. The Council will write to the person or Sponsor(s) once per annum to confirm the top-up amount payable by way of review of the top-up payment.

Difficulties making the top-up payment

42. If the Adult or Sponsor(s) is struggling or unable to pay the top-up amount, they must contact their social care practitioner or the Duty Social Work Team at the earliest possible opportunity to request a review. The top-up payment must continue to be paid during this period.
     
43. The Adult or Sponsor(s) must inform the Council of the reasons why they no longer feel able to pay the total top-up amount. The Council retains the right to request evidence to demonstrate a change in financial circumstances.
     
44. Where there is more than one Sponsor, the remaining Sponsor(s) can approach the Council and make an application to pay an increased top-up amount, noting that the remainder of this Policy will apply.
     
45. If the Adult or Sponsor(s) fails to notify the Council that they are no longer able to pay the total top-up amount, they will continue to be liable for the payment in full and will be subject to the Council’s debt recovery proceedings in the event of failing to pay the top-up amount.

Assessment

46. Where the Council accepts that the Adult or Sponsor(s) can no longer pay the top-up amount and there are no other Sponsor(s) able to pay an increased top-up amount then the Council will commence an assessment of the Adult requiring the care home placement.
     
47. The Council’s Choice Policy will apply, and the Adult may be required to move to a different care home that is able to meet their care and support needs in the most cost-effective way.
     
48. In such circumstances: 
    1. The top-up payment must continue to be paid until the existing care home placement ends. 
    2. The Council will not enter into any future top-up agreements with the Adult or Sponsor(s).

Debt recovery

49. If the top-up amount is not paid, at any point during the top-up agreement, the Council will commence their standard debt recovery proceedings against the Adult or Sponsor(s) for any top-up amount owing. This may include legal proceedings.

Changes to this Policy

50. The Council retains the right to review and make proportionate changes to this Policy from time to time.
     
51. Any changes would only apply to new top-up agreements made after this point.