Care home top-up fees: who pays and what families sign

By CareFinder Team · Published 2025-11-13 · Last reviewed 2026-09-18

A top-up fee is the gap between what the council will pay for a care home place and the actual fee of a more expensive home the resident has chosen. In England a relative or friend usually pays it under a written agreement with the council. The resident can only top up from their own money in limited cases, and nobody can be forced to pay one.

A care home top-up fee (the law calls it an "additional cost") is the difference between the amount the council has set aside for someone's care home place and the higher fee charged by a home they have chosen. In England it is usually paid by a relative or friend, under a written agreement with the council. No one can be made to pay a top-up, and the council must always offer at least one home that needs no top-up at all.

This guide explains the rules for England under the Care Act 2014, with notes on where Scotland, Wales and Northern Ireland differ. It is general information, not personal financial or legal advice.

When does a top-up fee arise?

A top-up only comes into play when the council is funding, or part-funding, a care home place. That usually means the person has been through a needs assessment and a financial assessment (means test), and their capital is below the upper limit.

The council then sets a personal budget: what it would cost the council to meet the person's needs in a suitable home. If the family prefers a home that charges more than that figure, someone has to meet the difference.

A top-up is not the same as the resident's own contribution. Most people in a council-funded place pay a weekly contribution from their income (pension and most benefits), keeping a small personal expenses allowance. The top-up is extra money on top of that.

Can the council insist on a top-up?

No, not when the extra cost is caused by the council itself. The Care and support statutory guidance (Annex A) is clear on three points:

• The council must ensure at least one suitable home is available within the personal budget, and should ensure there is more than one.
• A person must not be asked for a top-up because of "market inadequacies or commissioning failures". If no suitable home is available at the budget amount, the council must pay the higher cost itself.
• A top-up can only be sought when the person has actively chosen a more expensive home.

So if the only homes that can meet your relative's needs cost more than the council's usual rate, that is the council's problem, not the family's. The NHS guide to council-funded care puts it simply: you have the right to choose where you live, and the council must give you at least one affordable choice.

Who is allowed to pay a top-up?

A relative, friend or charity (a "third party")

This is the normal arrangement. Any third party can pay: an adult child, a sibling, a friend, sometimes a charity. Age UK's guide to top-up fees recommends getting financial advice before agreeing, because the commitment can last for years.

The resident themselves (a "first-party" top-up)

In England the resident can only pay their own top-up in three situations set out in the statutory guidance:

1. While their home is being ignored under the 12-week property disregard after they first move into a care home permanently.
2. When they have a deferred payment agreement with the council, so the top-up can be added to the amount secured on their home.
3. When their placement is section 117 mental health aftercare.

Outside those cases, a resident cannot use their own savings to pay a top-up.

What does the top-up agreement have to include?

The council must make sure the person paying is willing and able to keep paying for the likely length of the stay, and must put the arrangement in a written agreement. At a minimum it has to set out:

• the extra amount to be paid
• the amount in the resident's personal budget for the accommodation
• how often payments are made, and to whom
• how and when the amount will be reviewed, including when the home's fees rise
• what happens if the payer can no longer afford it, or the home puts its price up

The council remains responsible for paying the whole fee to the home, even where it agrees that the family can pay their share straight to the provider. If family payments stop, the council cannot simply walk away: it must keep meeting the resident's needs, although that can mean a move to a home that costs no more than the personal budget, after a fresh assessment.

Questions to ask before you sign

• Is this home genuinely a choice, or is it the only home that can meet my relative's needs? If it is the second, there should be no top-up.
• How much will the top-up be now, and how will future fee rises be split between the council and me?
• How often is the agreement reviewed, and who tells me when the amount changes?
• What happens if I lose my job, fall ill or die?
• Could my relative be asked to move if payments stop, and what assessment would happen first?

What are the risks for the family paying?

The main risk is that the top-up grows. Care home fees usually rise every year, and council rates do not always rise by the same amount, so the gap can widen. Age UK warns that families can end up paying more each year to cover the difference.

Other things to weigh:

• Length of stay. Many people live in a care home for several years. Work out the total cost over three to five years, not just the monthly figure.
• Several payers. If brothers and sisters share the cost, agree in writing between yourselves who pays what, and what happens if one stops.
• Your own finances. Do not commit money you may need for your own retirement or care.
• The resident's wellbeing. A move forced by a lapsed top-up can be very hard on someone with dementia, so be realistic from the start.

What if the person is paying for their own care?

Self-funders (people with capital above the upper limit) pay the home directly under a private contract, so there is no council top-up. Top-ups often become relevant later, when savings fall towards the upper capital limit and the person asks the council for help.

At that point the council will set a personal budget. If the home costs more than the council would pay, the family may be asked for a top-up to stay put. Ask the council for a needs and financial assessment several months before savings run down, so there is time to plan. The NHS guide to self-funding explains when the council may start to help.

It is also worth asking early whether the home accepts council rates for residents who run out of money, and whether it will expect a top-up if that happens.

How are top-ups handled in Scotland, Wales and Northern Ireland?

The principle is similar across the UK: if someone chooses a home that costs more than the public body will pay, a third party can usually cover the difference. The details differ:

• Scotland. Everyone assessed as needing it gets free personal care and, where needed, free nursing care, paid by the council towards the fee. Capital limits are set by the Scottish Government and are higher than in England. See mygov.scot on financial assessments for care.
• Wales. Wales has its own capital limit, set considerably higher than England's, and its own rules on additional payments. Check with the local council.
• Northern Ireland. Health and Social Care Trusts assess and arrange care. Ask the Trust how it handles third-party contributions.

Frequently asked questions

Can the council make me pay for my parent's care?

No. There is no legal duty on adult children to pay for a parent's care. A top-up is voluntary, and only applies if the family has chosen a home that costs more than the council's budget.

Can a care home increase the top-up without warning?

The written agreement should explain how and when the amount is reviewed, including after a fee rise. If the amount changes, you should be told in writing. If it is not covered, ask the council to put it in writing before you agree.

What happens if I can no longer afford the top-up?

Tell the council straight away. It remains responsible for the full fee, may seek to recover any arrears, and must carry out a new assessment before any move. That may mean a move to a home that costs no more than the personal budget, but the council should consider the resident's wellbeing before any move.

Can my relative pay the top-up from their own savings?

Only in limited cases in England: during the 12-week property disregard, under a deferred payment agreement, or for section 117 aftercare. Otherwise the top-up has to come from a third party.

Does NHS Continuing Healthcare involve top-ups?

NHS Continuing Healthcare is a different system, fully funded by the NHS. Rules on paying for extras are separate, so ask the integrated care board (ICB) directly.

Key takeaways

• A top-up is only due when the family has chosen a home that costs more than the council's personal budget.
• The council must offer at least one suitable home that needs no top-up.
• A relative or friend usually pays; the resident can only top up in three limited situations in England.
• Always get a written agreement that covers reviews, fee rises and what happens if payments stop.
• Plan for several years of rising fees, and take independent financial advice before you commit.