A care home is place to live, where people can be cared for by trained staff day and night. It is an option that people consider for things like; disability groups and for people of all ages and have staff on duty 24 hours a day. Increasingly, care homes look after people with higher levels of need who require more specialist services such as dementia care. They also offer short-term services such as respite care and intermediate care to support people coming home from hospital.
If you are considering a care home as an option it is important to visit the home. You might like to arrange to have a meal or spend a day there so you can see if the general atmosphere and daily life suit you. A good care home will provide lively social environment with plenty of activities. Ask for a copy of the care home’s service user guide. All care homes are registered with and inspected by the Care Quality Commission to make sure minimum standards are met. Ask the care home for a copy of their most recent CQC Report - it is your legal right to see this document. This is also available at
www.cqc.org.uk, alternatively you can call CQC on 0845 015 0120
Find out more about Care Homes and Domiciliary Care Services in your area on NHS choice, CareHome and Age UK websites:
You can find out more from our Customer Services on Tel: 0151 907 8306.
Choosing a Care Home Requiring a Top-Up Fee
It’s your choice
The Council will offer a choice of accommodation that your personal budget can afford and which meets all of your needs. Alternatively, you may prefer to choose your own accommodation, but if you do there could be an extra cost. In this case the 3rd party would need to pay the difference unless you met one of the 1st party criteria above. This extra cost which must be paid is called a Top-Up fee.
You can pay your own Top-Up fee (known as a ‘First-Party Top-Up, if any one of the following conditions are met:
- You have entered into a 12 week property disregard
- You have a Deferred Payment Agreement in place
- You are receiving accommodation provided under S117 for mental health aftercare.
Otherwise, someone (usually a family member or friend) will have to act of your behalf. This individual (known as a 3rd Party) must commit to paying the Top-Up for the full duration of your stay from their own financial resources. They cannot use your assets or your income to pay.
If you do decide to make your own choice, then your care manager will ensure that your care plan clearly shows that your chosen accommodation is suitable (able to meet all of your needs).
Your choice of care home may not have a place available. If you do not want to choose different accommodation, you may have to go on a waiting list until a place becomes available. You can also opt for temporary alternative accommodation. This is called an ‘Interim Care Arrangement’ (ICA). Your social worker will explain how long you are likely to have to wait, but this will only be an estimate and not a guarantee.
Weekly charges for an ICA will be paid from your personal budget. If there is a suitable accommodation within your budget, then the 3rd party would need to agree to a move there. If nothing suitable is available within budget, then the Council would pay the Top-Up as a temporary arrangement, reviewed after 6 weeks. If there is an extra charge (Top-Up) then this will be met by the Council until a place becomes available in the accommodation you chose. When you eventually move there, you or someone acting for you will have to sign an agreement to make the extra payments (Top-Ups) for the duration of your stay.
Sometimes a person will decide to stay permanently in their ‘Temporary’ accommodation. This is their choice, but they will only be able to stay if they agree to pay the extra Top-Up previously paid by the Council. A Top-Up agreement must be signed to this effect and you will be given a copy of this agreement.
If you are in Hospital
You have the same rights set out in this leaflet. However, if you are going to move from hospital to accommodation of your choice, there is one important difference.
Once your hospital discharge team agree you can leave, the Council will arrange your move within a very short period. If the accommodation that you choose does not have a place available, then you will not be able to remain in hospital. Instead, you may need to have an ‘Interim Care arrangement.’
Personal Budget, available accommodation and Top-Up payments
If no suitable accommodation within your budget is available then the Council will not be able to offer you a choice. In such a case the Council will not expect you to pay a Top-Up fee. Instead, your personal budget would be adjusted to meet the higher cost of accommodation that is available. This would be subject to review and you would be expected to move into accommodation within your personal budget if it became available. You could of course stay where you are, but the 3rd party would have to pay the Top-Up for the duration of your stay.
Some additional important points:
- Personal budgets are reviewed regularly (at least annually).
- Providers may increase their accommodation costs annually. This could result in your Top-Up payment increasing annually.
- You or your 3rd party will have to satisfy the Council that the weekly Top-Up amount is affordable for the duration of your stay.
- If it is not possible to satisfy the Council that Top-Ups are affordable the Council will not arrange care and support in your chosen accommodation.
- The Council will at least review annually a person’s ability to pay the Top-Up.
- S117 individuals receiving Continuing Health Care who choose expensive accommodation will also pay Top-Ups.
- If the person paying the Top-Up is unable to continue making payments then the Council may move the resident to another room within the accommodation or to alternative accommodation within their personal budget.
- Any move to other accommodation will only happen after a community care and risk assessment of your needs.
I am a considering paying a Top-Up fee, what does this mean for me?
The Council will want to know that you meet the criteria for a 1st party Top or that a 3rd party is willing to pay on your behalf.
You are asked to sign confirming you have read the information. You will also be asked to sign a written agreement. Should you or your third party representative, fail to make the necessary payments you will be expected to meet the cost of all Top-Up arrears. In addition, the person being cared for may have to be moved to alternative accommodation.
What if I am unable to continue paying Top-Up fees?
If you or your 3rd party representative cannot continue with the Top-Up payments then Halton’s Adult Social Care team will carry out a new assessment before deciding the best approach. An important aspect of this would be to consider the impact of moving you to another care home. For example, how might such a move affect your wellbeing and can the new accommodation meet all of your assessed care needs. Pending a decision, the Council would pay all the required fees, with a view to recovering them from your estate or the 3rd party at a later point.