Families paying ‘secret subsidy’ to meet care home costs, warns charity

Families may be paying more than they should to top-up their relatives’ care home funding due to a lack of checks by local authorities.

Almost three-quarters of councils are failing in their duty to check that the top-up fees paid by relatives to supplement local authority fees for care homes are voluntary and affordable, said a report today by Independent Age. About 56,000 families pay top-up fees in England, according to market analysts Laing and Buisson.

Of the 129 English councils that responded to the charity’s Freedom of Information requests, 93 said they did not know about all the top-up fees being paid by families in their area, including 36 that said they held no information at all on these payments. This is despite national guidance that requires councils to check that relatives are willing and able to pay the fees and states that local authorities must foot the bill if families fail to make the payments, which can be as high as several hundred pounds a week.

The charity also surveyed 68 care homes or care homes groups on their experiences, 79% of which said they had at least one resident that was having their fees topped up by a family member or friend. In 42% of homes, all top-ups were arranged directly between the care home and the family member without any input from the local authority. Independent Age said this suggested councils were ignoring their responsibilities to relatives.

“This report demonstrates a real concern that top-up fees are becoming a ‘secret subsidy’ by which some underfunded councils limit the amount they spend on care,” said Independent Age chief executive Janet Morrison. “But because councils are not keeping records of the payments, no one can be sure about the true level of top-up fees – or whether they are really voluntary.”

The report said councils needed to review their policies and practices to make sure they are following the national guidance and called for greater scrutiny of local top-up payment arrangements by the Department of Health. It also wants all families to be offered independent advice prior to signing top-up fee agreements, a practice that only one in four authorities is currently doing, according to Independent Age’s survey.

What the guidance says

Guidance on top-up fees was issued in 2004 under the National Assistance Act 1948 (Choice of Accommodation) Directions 1992.

Where a council assesses that it is necessary to meet a person’s needs through residential care under section 21 of the National Assistance Act 1948, it must arrange a place for them in a care home of their choice if this would meet their needs and costs no more than what the council would usually pay for such a place (the “usual cost”.)

If the home’s fee is greater than the usual cost, then the council must arrange for the placement if a third-party is willing to fund the difference. However, the council remains responsible for ensuring that the full cost of the placement is paid. As a result it must assure itself that the third-party is able and willing to pay the top-up.

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