Top-Up Fees
Reclaim unlawful top-ups
If you or your relative have been “topping-up” and Continuing Healthcare package, you may be entitled to repayment.
CHC funding must cover the full cost of the care package, yet families are often asked to pay additional fees on top. Farley Dwek Solicitors act for families seeking repayment of “top-up” fees, unlawfully charged by care providers.
NHS Continuing Healthcare Funded Care
When an individual has been clinically assessed for CHC, those funds should be sufficient to meet all their healthcare needs and all related costs (including accommodation). A care home should not, and indeed, is not lawfully permitted to charge any additional sums (‘top-up fees’) to meet those assessed core healthcare needs.
‘Top-up’ fees are usually associated with the additional costs of accommodation.
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care states:
“NHS care is free at the point of delivery. The funding provided by the ICBs in NHS Continuing Healthcare packages should be sufficient to meet the needs identified in the care plan. Therefore it is not permissible for individuals to be asked to make any payments towards meeting their assessed needs.”
So, if your relative is awarded NHS Continuing Healthcare Funding, it should be sufficient to pay for all their clinically assessed healthcare needs, and the care home should not be asking for extra funds.
If the NHS Continuing Healthcare package is not enough to cover the cost of care, then the care home should approach the ICB for more funds – not your relative!
Our legal team will review your contractual documentation and advise you as to the merits of claiming reimbursement for any unlawfully charged top-up fees.
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Local Authority, Social Services funded care
If your relative doesn’t qualify for NHS Continuing Healthcare, then they may be able to have all or part of their care home and social needs fees paid by their Local Authority (Social Services). Financial support for social care needs is ‘means-tested’ – whereas NHS funded healthcare needs is not – so your relative may be required to contribute to the cost of their social care if their capital is more than £23,500.
If the Local Authority has assessed your relative’s needs as being eligible for funded care, and they need to live in a care home, they have the right to choose where they live. Distance and travel time from family and friends might be an important factor to consider in their choice of care home.
The Council are obliged to give your relative at least one ‘affordable option’ which is suitable for their assessed needs.
But, if they can’t give an affordable option, then the Local Authority is obliged to pay the difference between their standard rate and the other more expensive care home’s rate.
As above, the running costs of a care home will inevitably increase annually. But, if the Local Authority funding does not match that increased rate being charged, then beware – the care home may ask you to pay a ‘top-up’ fee to cover the shortfall. That is unlawful. The care home should first ask the Local Authority to reassess your relative’s needs with a view to increasing (ie topping-up) their contribution. Your relative should never be asked to pay any ‘top-up fees’ just because there is no affordable option in your locality.
