Guidance - Choice and third party 'Top up' for people in residential or nursing care homes, who are financially supported by the council

They will have a choice subject to certain considerations. Their choice will be met where possible. As a council, we must ensure quality of service but also value for money.

When the council has discussed with the person their need for residential or nursing care and they have expressed a preference for a particular home, we must arrange for their preferred home provided we take the following four things into account:

1. Would the chosen home be suitable for their needs?
2. Would their chosen home be at no greater cost to the council than what we would usually expect to pay for someone with their needs?
3. Is the accommodation available now?
4. Is the home accepted on our Approved Provider List?

The council would be unable to support them financially in that home.

The council would consider supporting their choice if they had someone, who was able to pay the difference between the personal budget amount and what the chosen care home charge to meet their needs.

This is known as a 'third party top up', that is the difference between the personal budget amount and the chosen care home’s rate which must, in most circumstance, be paid for by a third party. The person who is willing to 'top up' the fees must agree to continue to pay for as long as the person in receipt of a service is in the home (see point 10 for more details).

The council must ensure that at least one care home option is available to the person that is affordable and within the personal budget amount.

If they are eligible for support from the council, the care home needs to be accepted on the approved provider list and would take account of the approved rates.

The council would offer them an alternative care home that can meet their needs.

Yes, the relevant Adult Social Care Team worker must give them the reasons in writing. These will be based on the four criteria: suitability, cost, availability and terms and conditions as 1 above.

If someone has been assessed to pay the full cost of their care home fees due to having capital tied up in their home, they may wish to apply for a Deferred Payments Agreement.

In these circumstances they could ‘top up’ from their own resources and not need a third party, providing the debts which accrue will be met by the later sale of the house or by their estate. The council will check this for them and consider offering a Discretionary Deferred Payment Agreement.

Note: A top-up fee can be deferred following the end of the 12-week property disregard. Any top-up fees for the first 12 weeks will need to be paid and will not be deferred (unless in exceptional circumstances, these need to be agreed between the budget holder (Adult Social Care Team Manager) and the Benefits Assessment and Charging Team Manager) for the first 12 weeks. You should seek advice from your local Benefits Assessment and Charging Team Manager. Adult Social Care Team Managers should consider budget impactions prior to any agreement to defer.

Whoever pays must see it as a commitment for as long as the council provides the person with that accommodation, and there can be no guarantee that any increases in actual cost will be shared equally by the council and the third party payer. The third party payer will be required to enter into an ‘agreement’ with the council for as long as the council provides the person with that accommodation.

The council works closely with care homes to make sure the arrangements are fair and reasonable, but it is possible that fees will rise by more than the council would normally pay. The council must tell them in advance about any changes in their contributions and the ‘top up’. If the council has entered into a contract with a care home on their behalf, the care home is not permitted to approach the person in receipt of the service or their third party for increases.

If ‘top ups’ stop then it may result in the person in receipt of the service having to move to other accommodation unless a reassessment of their needs shows that their needs can only be met where they are, or a Best Interests decision (as defined by the Mental Capacity Act) is made which states they must remain.

They would have to meet the full cost themselves, although they may be eligible for certain benefits such as Attendance Allowance or Disability Living Allowance. Please direct them to appropriate information. You must strongly recommend to the person that they find out as much as possible before making any major decisions. This is particularly important before they decide to enter a high-cost arrangement which may require them to move at a later date because the fees can no longer be met.

There may be occasions where the person chooses a larger room in a care home or additional extras, not usually covered by the approved rates. If this means that the fees to support the person are more than the approved rates with the care home, then these extras will need to be covered by a ‘top up’.