‘Why social workers and families need much greater clarity about top-up fees for care homes

By Andy Kaye, head of policy and campaigns at Independent Age

With eight months to go until the implementation of much of the Care Act 2014, civil servants have been busy working with sector bodies to develop best practice guidance to help councils meet their many legal duties from April 2015.

Independent Age has been involved in this process and we’ve taken a particular interest in guidance on the issue of third-party top-up fees in social care. These are the payments family members can pay to secure better accommodation for relatives entitled to some level of local authority means-tested support. Top-ups should not be paid as a necessity to cover the costs of essential care and councils are supposed to make sure that families are ‘able and willing’ to pay these fees – the contract should typically be signed by the local authority and the relative. Yet our advice service receives many phone calls from sons and daughters who feel they are pushed into the payments by care homes, with councils out of the picture.
To get to the bottom of this, in 2013 we carried out a Freedom of Information request to councils about their knowledge and use of top-ups; 129 of the 152 English councils responded to the survey and what we learnt was worrying. Barely a quarter of councils could say with confidence that they knew about all the top-up payments in their area – the rest could not possibly know whether the

individuals paying them were doing so voluntarily and could truly afford them. It suggested to us a picture where some care homes were unreasonably asking for top-up fees and some councils were turning a blind eye.

We also heard from 68 care providers who felt top-ups were becoming increasingly common because the fees councils were paying for local authority-supported residents were simply too low to cover the costs of their care homes. Care homes also described confusing and contradictory attitudes within councils, with some feeling that individual social workers would caution families against top-up fees when a council was ‘officially’ much more lenient.
This summer, we have carried out a new piece of research. We wanted to get a better understanding of local authorities’ policies and practices. Specifically, we wanted to get councils’ own perspective and an understanding of any difficulties they experience in applying the rules on charging for residential accommodation. Once again we observed a striking difference between councils in their ability to always monitor and review top-ups, though most were keen to get things right and limit unnecessary top-ups. The research also confirmed our earlier finding as councils felt social workers were not always saying the same things about top-ups as the council itself.
But the purpose of the research was not simply to confirm the earlier findings. The 13 councils in England who participated also shared their views on the new guidance so that it is drafted to help them manage the payment of top-ups from next Spring.
We’ve therefore argued for clearer rules so that from 2015 councils recognise they must always enter a three-way agreement with third parties and care homes and they have rigorous processes for checking whether top-ups remain affordable over time. Clarity, we believe, will be good for councils, good for relatives – and also good for individual social workers who may sometimes find themselves caught in the middle.