Up to three-quarters of care homes in some areas are charging older people top-up fees because councils are failing to meet the full cost of placements, according to a report published today.
In a small number of cases, “apparently arbitrary decisions” are also being made by care home providers on the level of top-ups, the report by the Commission for Social Care Inspection revealed.
Currently, top-up fees are only required where a person chooses a more expensive care home place than the council would usually expect to pay for someone with their needs.
The CSCI said providers were resorting to “cross-subsidy” to compensate for the prices paid by councils which they claimed did not properly fund the cost of care.
More than half of the 38 homes surveyed were also charging different rates for people funded by the council compared to those who paid for their own care, but people paying higher rates did not get a “substantially different” service.
The survey of 10 councils found council purchasing staff felt “constrained to keep fee rates as low as possible” in order to fund the greatest number of places.
The CSCI’s report said that people should only have to pay top-up fees “when they have genuinely exercised choice” and the fee charged by homes should be based on the cost of running a home and meeting people’s assessed needs.
CSCI chair Dame Denise Platt called for a new settlement between the state and individuals on finding and paying for adult social care.
She said she hoped there would be a debate on the issue alongside the recently announced green paper on adult social care funding.
President of the Association of Directors of Adult Social Services Anne Williams said directors shared the CSCI’s concerns about top-up fees.
But she warned the current financial position meant many local authorities could only help older people and vulnerable adults who met high and rising eligibility criteria.
“With growth over the next three years planned not to exceed one per cent, and with demographic pressures threatening to force demand up by many times that amount, assessing, caring for, and protecting the most vulnerable must remain at the heart of our responsibilities. But it would be irresponsible either for us, or for anyone else, to pretend that we can discharge responsibilities we simply haven’t been funded to discharge,” she said.