The short answer
- A top-up pays for a choice, not for careIt is the difference between the council's budget for your relative's care and the fee of a dearer home the family has chosen.
- The council must offer a home at its own budgetIf no suitable home was available at that amount, the council must pay more itself. A top-up can only be sought when the family has chosen a more expensive home.
- It is a written agreement with the councilWhoever pays signs it with the council, which stays responsible for the whole fee to the home. The agreement must say what happens if payments stop or the fee rises.
- The payer is committing for the whole stayFees can rise faster than the council's budget, and your relative could be moved if the top-up stops. Take independent advice before you sign.
This page covers England, from the Care and Support Statutory Guidance (Annex A) and the Choice of Accommodation Regulations 2014, checked September 2026. We are not financial or legal advisers. Scotland and Wales have their own rules.
What a top-up is
The gap between the council's budget and the home your family chose
When a needs assessment finds that your relative needs to live in a care home, and the financial assessment finds that the council will pay towards it, the council sets a personal budget: its figure for what meeting their needs in a care home costs. A top-up arises only when the family picks a home that charges more than that.
The top-up
Paid by a relative, a friend or a charity
The difference between the home's fee and the amount in your relative's personal budget. It exists only because the family chose a home that costs more.
The personal budget: what the council says your relative’s care costs
The council's share
Paid by the council
The rest of the personal budget, after your relative's own contribution.
Your relative's contribution
Paid by your relative
What the financial assessment says they can afford from income and savings. A top-up is on top of this.
The council signs the contract with the home for the whole fee, top-up included. If the top-up stops, the council stays responsible for paying the home.
Your relative may pay the top-up themselves only in these three cases
During the 12-week property disregard
The first 12 weeks of a permanent care home stay, while the value of their home is ignored.
Under a deferred payment agreement
The top-up is added to the amount deferred against their home.
In section 117 mental health aftercare
Aftercare is free, and the person may pay the extra for a dearer home themselves.
Your relative has a legal right to choose which care home they go to, as long as it is suitable for their needs, has a place, and will accept the council's terms. The choice is not limited to homes the council already uses or to homes inside its area. When the chosen home costs more than the personal budget, the regulations call the difference the additional cost.
Anyone other than your relative can pay the extra: a son or daughter, a friend, or a charity. This is a third-party top-up. Your relative can pay it from their own money only in the three cases in the picture above, because otherwise that money is already counted in the means test. Local authority funding explains both assessments, and deferred payment agreements explains the loan against the home that makes one of those three cases possible.
When one cannot be asked for
The council must offer a suitable home at its own budget
This matters most if a council says nothing is available without a top-up. The statutory guidance is direct about it, and councils are required by law to have regard to that guidance.
Can a top-up be asked for?
| Top-up? | What the guidance says | |
|---|---|---|
| The council offered a suitable home at the budget, and the family chose a dearer one | Yes | This is the only situation a top-up is for. Someone must be willing and able to pay it. |
| No suitable home was available at the budget, and the family expressed no preference | No | The council must arrange a more expensive home and raise the budget to match. |
| The council could not arrange a place at the amount it expected to pay | No | The personal budget must reflect the higher amount, and the additional cost rules do not apply. |
| Your relative has needs only some homes can meet, such as a special diet | No | The budget may need adjusting so that the needs are met. It should reflect the local cost of good quality care. |
| Your relative wants to pay the extra from their own money | Only in three cases | The 12-week property disregard, a deferred payment agreement, or section 117 aftercare. |
The council offered a suitable home at the budget, and the family chose a dearer one
- Top-up?
- Yes
- What the guidance says
- This is the only situation a top-up is for. Someone must be willing and able to pay it.
No suitable home was available at the budget, and the family expressed no preference
- Top-up?
- No
- What the guidance says
- The council must arrange a more expensive home and raise the budget to match.
The council could not arrange a place at the amount it expected to pay
- Top-up?
- No
- What the guidance says
- The personal budget must reflect the higher amount, and the additional cost rules do not apply.
Your relative has needs only some homes can meet, such as a special diet
- Top-up?
- No
- What the guidance says
- The budget may need adjusting so that the needs are met. It should reflect the local cost of good quality care.
Your relative wants to pay the extra from their own money
- Top-up?
- Only in three cases
- What the guidance says
- The 12-week property disregard, a deferred payment agreement, or section 117 aftercare.
Care and Support Statutory Guidance, Annex A, paragraphs 11, 12, 21 and 39.
The statutory guidance says a person "must not be asked to pay a 'top-up' towards the cost of their accommodation because of market inadequacies or commissioning failures". It says the council "must ensure that at least one option is available that is affordable within a person's personal budget and should ensure that there is more than one". And it says that "only when a person has chosen a more expensive accommodation can a 'top-up' payment be sought".
So if the council tells you every suitable home near your relative needs a top-up, ask it in writing to name a suitable home with a place at the personal budget amount. If it cannot, it should pay the higher fee itself. If it refuses your relative's chosen home, it must give its reasons in writing. Disputes go through the council's complaints procedure first, then to the free Local Government and Social Care Ombudsman. Choosing a care home covers visiting and comparing homes before you get to this point.
The written agreement
What the top-up agreement must say, and who signs it
A top-up is not a private arrangement between you and the care home. The regulations say the person paying must enter a written agreement with the council, and the council must give them enough information and advice to understand it first.
What the agreement must include, by law
- The top-up amount
- The home's fee less the personal budget amount.
- The personal budget
- The council's amount for the place.
- How often
- Weekly or monthly, for example.
- Who is paid
- Usually the council. The guidance tells councils to discourage paying the home directly.
- Reviews
- How and when the agreement is reviewed, what triggers a review, and who can ask for one.
- If payments stop
- What happens if the top-up is not paid, including that your relative may be moved.
- If the home's fee rises
- How any increase will be shared, and how that is agreed.
- If your finances change
- What happens, and what you must tell the council.
The person who agrees to pay signs the agreement with the council. Ask to read it before your relative moves in, not on the day. The guidance tells councils to consider pointing the payer to independent financial advice, because a top-up can run for years. The Age UK Advice Line gives information and advice on paying for care, and a regulated financial adviser who specialises in care fees can look at whether the commitment is affordable for you.
The council, not the payer, holds the contract with the home for the whole fee. The guidance says that when a council places somebody in a home that costs more than the personal budget, "the local authority is responsible for the total cost of that placement". If the top-up stops, the council keeps paying the home until it has recovered what it is owed or made other arrangements, and it can ask the payer for that money.
If your relative cannot choose for themselves, the council should act on the choice of their advocate, carer or legal guardian unless it is against their best interests. If you manage your relative's money under a lasting power of attorney, paying for care as an attorney explains what you can and cannot sign on their behalf.
Rises and risks
Top-ups can go up, and the payer carries the risk
The agreement runs for as long as your relative lives in that home, and the council must be satisfied that the payer can keep paying for the likely length of the stay.
The home's fee can rise faster than the budget
Paragraph 35
A change in your relative's contribution may not help
Paragraph 37
If the top-up stops, your relative could be moved
Paragraph 33
Your own circumstances can change
Paragraph 38
Reviews happen at least once a year
Paragraphs 31 and 32
A care home becomes your relative's home, and being moved from somewhere they have settled can be distressing, especially for somebody living with dementia. The guidance says the council must carry out a new assessment before it considers a move, including whether a health assessment is needed. Ask at the start what the council would do if you could no longer pay, and whether it will agree future price rises with the home when it signs the contract.
Care at home
Care at home has no top-up agreement
The top-up rules come from the right to choose accommodation, which covers care homes, shared lives and supported living. Care in your relative's own home is not in that list, so there is no top-up agreement and nobody signs a commitment to the council for extra fees.
The same need for care, met in two places
| Care home | Care at home | |
|---|---|---|
| Who chooses the provider | Your relative chooses the home; the council contracts with it | With a direct payment, your family chooses and pays the carer |
| Paying more than the budget | A written top-up agreement with the council, for the whole stay | No top-up agreement. Anything extra, such as more hours, is paid for privately |
| The house in the means test | Counted once the move is permanent, after the 12-week disregard | Not counted while your relative lives there |
| A typical week | About £1,160 for a residential place, nearer £1,410 with nursing | Live-in care on PrimeCarers from £1,050, or visits at £18 to £25 an hour, our fee included |
Who chooses the provider
- Care home
- Your relative chooses the home; the council contracts with it
- Care at home
- With a direct payment, your family chooses and pays the carer
Paying more than the budget
- Care home
- A written top-up agreement with the council, for the whole stay
- Care at home
- No top-up agreement. Anything extra, such as more hours, is paid for privately
The house in the means test
- Care home
- Counted once the move is permanent, after the 12-week disregard
- Care at home
- Not counted while your relative lives there
A typical week
- Care home
- About £1,160 for a residential place, nearer £1,410 with nursing
- Care at home
- Live-in care on PrimeCarers from £1,050, or visits at £18 to £25 an hour, our fee included
PrimeCarers figures are what families pay on the platform with our fee included. Agencies charge £28 to £35 an hour for visits.
If the council has agreed to pay towards care at home, it can give the money to your family as a direct payment, and you choose the carer. If the carer you want charges more than the council allows, or you want more hours than the plan covers, you pay the difference to the carer privately.
If you are weighing a top-up against care at home, you can search for carers near you and compare their rates, and is live-in care cheaper than a care home? sets the two weekly costs side by side.
Questions
Questions families ask about top-up fees
No. A top-up is always voluntary. The council must offer at least one suitable home at the personal budget amount, and if none is available it must pay the higher fee itself. You are only asked for a top-up if the family chooses a more expensive home, and nobody can be made to sign the agreement.
Only in three cases: during the 12-week property disregard at the start of a permanent stay, under a deferred payment agreement, or if the home is part of section 117 mental health aftercare. Otherwise his savings are already counted in the financial assessment, so the top-up has to come from somebody else.
Usually to the council, which then pays the home the whole fee. The guidance tells councils to discourage paying the top-up straight to the home, although it allows it where everyone agrees. Either way, the agreement is with the council.
Tell the council as soon as you know. The council stays responsible for paying the home, but it may recover the unpaid top-up from you. It may also, after a new assessment, move your relative to a home that meets their needs within the budget. Ask for a review of the agreement before payments stop.