Though caring for elderly relatives is no doubt a privilege, it is often very stressful.
If you’ve decided that a care home or nursing home is the best option for your loved one, your next task will be understanding the various costs and complications involved in that decision.
Who pays for care home care?
During the process of applying for care for your elderly relative, your local council will conduct a care needs assessment to determine the extent of care that is needed. They will also look at the finances of the individual who needs care and determine whether or not they can pay for it themselves.
In some cases, such as when the elderly individual has a disability or complex medical condition, the NHS will cover the cost of nursing home care. However, if the elderly individual does not fall into either of these categories and has capital of more than £23, 250, they will need to cover the cost of their own care. This may require the sale of their property, though there are measures that can be taken to avoid this.
If the council determine that the elderly individual cannot afford to pay for their own care costs (this is usually if their capital is less than £14,250), the council will be responsible for the whole cost of a care home. The amount the council agrees to pay will be called a ‘personal budget.’
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The personal budget the council believes is appropriate will not necessarily cover the cost of living at the care home you or your elderly relative would choose. This might be because you would prefer a more luxurious care home, or because you would like to purchase upgraded services.
If this is the case, someone will need to cover the cost of the ‘top up fee’, which is the difference in cost between what the council will cover and what your chosen care home charges.
Top up fees should only be necessary if you or the elderly individual have specifically chosen a care home that offers a genuine upgrade on what the council assessment deemed necessary. This could include choosing a home with better facilities, a larger room, an en suite bathroom, a room with a view or a home in a more expensive area.
Who is responsible for paying top up fees?
By their very nature, top up fees will not be paid by the elderly individual themselves. If the elderly individual could afford to pay top up fees, they would not have been eligible for a personal budget from the council.
Top up fees are sometimes called ‘third party top up fees’ as it’s necessary for them to be paid for by a third party. This is likely to be a close family member, such as grown up children.
There is no legal requirement for you to pay top up fees. If you can’t afford to pay these on your elderly relative’s behalf, you can choose a care home that is fully covered by the personal budget the council has agreed on. If the council are unable to provide a care home place that’s affordable within the set personal budget, they will have to raise the personal budget.
If you do choose to pay top up fees, the council will ask you to sign a contract to commit to this. The council should then invoice you for the amount of the top up fees on an agreed basis. You will not usually be asked to pay top up fees directly to the care provider.
Top up fees and the twelve week disregard
The only circumstances in which an elderly individual is able to pay top up fees themselves is during the so-called 12 week property disregard.
An elderly individual would be eligible for this if they had enough capital to be responsible for paying for their own care, but all capital is tied up in their home. They can choose to take advantage of the 12 week property disregard, which is when this property capital will be disregarded for 12 weeks.
This would allow the elderly individual to have time to sell their property in order to access the capital – or for their attorneys to sell the property on their behalf. During these twelve weeks, the council would be responsible for paying for their care. However, the council would only pay an amount commensurable with a typical personal budget for the elderly individual’s care needs. If they had chosen a care home that charged at a higher rate, they would be able to meet the outstanding amount themselves as a first party top up fee.
What else do you need to be aware of?
There have been reports of local councils taking advantage of top up fees. It’s important to make sure that you are not being asked to pay top up fees in order to cover essential care. If this is the case, you should ask the council to conduct a new needs assessment to ensure the personal budget they are offering matches up with the elderly individual’s care needs.
It’s also important to be aware that care home cost increases are likely to affect the amount you will need to pay in top up fees year on year. If your chosen care home increases their fees at a steeper annual level than the council increases their annual budget, you could find yourself liable for larger top up fees than expected.
If the person paying the top up fees is no longer able to pay them, the council will need to conduct another needs assessment before making a decision on what to do. For example, they will need to determine how the elderly individual would cope with the disruption before simply moving them to a less expensive care facility.
What should you do if you need more advice?
If you or your elderly relative have been paying top up fees that you did not expressly agree to, you may benefit from taking legal advice.
If you would like guidance about any aspect of care home fees or care home top up fees, or if you are concerned about somebody who may no longer have capacity to make their own decisions, please do not hesitate to get in touch with us.