An adult social care assessment will identify whether you have any needs that the Council is responsible for meeting. If you have, care professionals will work with you to write a care plan, showing how your needs will be met. Your care plan will also set out your personal budget amount. Your personal budget amount is the amount that care professionals say it will cost to meet your needs. You can read more about assessments, care planning and personal budgets in the ‘your care and support journey‘ pages.
If your care plan shows that you need a particular type of accommodation and certain conditions apply, you have the right to choose between different providers of that type of accommodation. The care professionals working with you will give you information about different providers for you to choose from. There should be at least one provider able to offer you that accommodation within your personal budget amount.
What type of accommodation does the right to choose apply to?
The right to choose applies to care homes, supported living, and shared lives accommodation. For example, if your care plan identifies that your needs are best met in a care home, you can choose between different care home providers.
The right to choose only applies to the same type of accommodation that your care plan identifies as suitable for you. For example, if your care plan identifies that your needs are best met in a care home, you cannot choose a supported living setting instead.
What conditions apply to the right to choose?
You can choose accommodation if:
- your care plan sets out that your needs will be met in a specific type of accommodation (for example, a care home)
- the accommodation you want to choose is of the same type as the type set out in your care plan
- the care professionals working with you agree that the accommodation is suitable to meet your assessed needs
- the accommodation is available
- the provider of the accommodation is willing to enter into a contract with the Council/NHS Integrated Care Board (ICB) to provide the care on the Council/ICB’s terms and conditions
- the accommodation costs no more than the amount set out in your personal budget (this amount is usually the same as the Council/ICB’s standard amount for accommodation of this type). If you want to choose somewhere that charges more than the amount set out in your personal budget, an extra condition applies. The extra condition is
- care professionals are confident that someone is willing and able to pay the additional amount for the likely duration of your stay
- the person paying the additional amount signs a written agreement to agree to pay it. You can read more about this extra condition by reading the section below headed ‘What if I want to choose somewhere that is more expensive than my personal budget amount?
What if the accommodation I want to choose isn’t available?
The care professionals working with you will identify at least one suitable provider. If the accommodation provider you want to choose does not have any availability, care professionals will work with you to identify a temporary arrangement to meet your needs. What a temporary arrangement might look like depends on your needs; for example, it could mean going to a different care home while you wait. At the same time, you could be placed on the waiting list for your preferred accommodation provider. Care professionals will not be able to guarantee how long you might have to wait, but they will be able to give you an estimate, and help you think about your options while you wait. Temporary arrangements will be recorded in your care plan and reviewed.
You can read more about care options by reading our care options page.
What if I want to choose accommodation that is outside of North East Lincolnshire?
Subject to conditions, you can choose accommodation outside North East Lincolnshire. Care professionals will work with you to understand why you are thinking about choosing accommodation somewhere else. For example, you might want to move nearer to family. Care professionals will work with you to decide whether a move is necessary to meet your needs, or is just something that you would like, but is not a need.
A personal budget amount is generally based on what it is likely to cost to meet your needs in North East Lincolnshire. In other areas of the country, it might cost more to meet the same needs. If you choose somewhere outside of the local area care professionals will take into account the costs of care in the area you want to live, but unless you need to live outside of North East Lincolnshire, the Council/ICB will usually still pay the amount that it would cost to meet your needs locally. This will mean that agreement must be reached about who will pay the additional cost of out of area accommodation.
Care professionals will work with you to think about the best way of meeting your goals in a way that is best value, both for you and for the ‘public purse’.
What if I want to choose accommodation that is more expensive than my personal budget amount?
If you want to choose accommodation that is more expensive than the amount set out in your personal budget, agreement will have to be reached as to how the extra amount will be paid. The difference between your personal budget amount – the amount care professionals say it will cost to meet your needs – and the amount the accommodation provider wants to charge, is often called a ‘top-up’. The accommodation provider must make it clear what they want to charge and why, before you make your choice.
You can choose accommodation that costs more than the amount set out in your personal budget provided that someone is willing and able to pay the top-up for the length of time you’re likely to stay in the accommodation. The person agreeing to pay the top-up must also enter into a written agreement with the ICB and the accommodation provider.
It is usually a family member who agrees to pay the top-up. In limited circumstances, you may be able to pay the top-up yourself. You may be able to pay a top up yourself if:
- you are subject to a 12-week property disregard (a property disregard means that the value of your home is disregarded – not taken into account – as part of a financial assessment. A disregard usually applies where your stay in a care home is temporary and you intend to return to your own home, or you don’t intent to return home and your home is lived in by your partner or some types of relative)
- you have a deferred payment agreement with the Council/ICB, and the deferred payment agreement reflects the agreement on top-ups
- you are receiving accommodation provided under s117 of the Mental Health Act 1983, for mental health aftercare.
Care professionals will work with you to think about the best way of meeting your goals in a way that is best value, both for you and for the ‘public purse’.
You can find out more about financial assessments on our ‘Paying for Care‘ page. You can find out more about deferred payment agreements on our ‘Deferred Payment Agreement‘ page.
What is a top-up?
Each year the Council and ICB work together to agree a weekly fee with care homes. This weekly fee is the amount intended to cover the assessed eligible needs of anyone that the Council/ICB is responsible for.
A top-up is the difference between this agreed amount – which should reflect your personal budget amount – and what a care home might want to charge. Care homes should make clear what their extra charges are. Any extra amount that a care home might want to charge should offer you something over and above what the Council/ICB has agreed to pay to meet your assessed eligible needs. For example, a top-up or additional payment might be paid for a larger room, a room with a view, a room with a balcony or extra care that is more than you actually need. In other words, a top-up should relate to an optional ‘extra’ – something that you want, rather than something that you need. This is because if care professionals have assessed you as having eligible needs, the Council/ICB are responsible for meeting those needs. The Council/ICB should take into account your wishes and feelings about care arrangements, but is not responsible for paying for optional ‘extras’ or ‘wants’ that are not assessed eligible needs.
In North East Lincolnshire there are a range of care homes that offer accommodation at the fee rate agreed with the Council/ICB and you can read about them on our residential care page. You can also read about the care homes who want to charge a top-up, and what those top-ups are for.
What do I need to think about before deciding to pay a top-up?
If you are thinking about paying for something in addition to what you need, you should make sure that you are clear about the extra cost and what it is for. You should also make sure that any extra amount is affordable for the length of time you’re likely to stay in the accommodation, which could be for some years. Like all costs, top-up fees will be reviewed regularly, and could go up. The person paying the top-up would be responsible for paying any increase.
North East Lincolnshire’s Top-ups Toolkit is intended to make sure that everyone involved in paying a top-up understands what they are agreeing to. Anyone wanting to pay a top-up will need to satisfy care professionals that the top-up is affordable, and will continue to be affordable, based on their individual financial circumstances. This means that care professionals will ask the person wanting to pay the top-up to complete the financial questionnaire that is part of the Top-ups Toolkit. You can learn more by reading the Top-ups Toolkit.
If professionals are confident that the top-up payment is affordable, they will ask the person paying the top-up to sign the agreement that is part of the Top-ups Toolkit. The agreement is between the person paying the top-up, the ICB and the care home. Anyone thinking about paying a top-up should consider getting independent financial advice. You can get more information about independent financial advice at Money Helper.
If care professionals are not confident that the top-up payment is affordable for the length of time you’re likely to stay in the accommodation, they will not agree to arrange for you to stay at your preferred care home. They will explain their decision in writing.
What would happen if my agreed top-ups weren’t paid?
If the person who has agreed to pay a top-up stops paying it, care professionals would try to negotiate with your accommodation provider. If that negotiation fails, you will generally only be able to stay in your chosen accommodation in exceptional circumstances. If there are no exceptional circumstances, it is likely that you would need to –
- move to a cheaper room in the same accommodation (to a room that doesn’t need a top-up to be paid), or
- move to a different accommodation provider altogether (to a home that can accommodate you without a top-up payment).
To decide whether your circumstances are exceptional, care professionals will assess your needs, and weigh up the impact of any move on your health and wellbeing against the cost of paying for more expensive accommodation. Care professionals will identify any risks of moving you, and ways of managing those risks. Care professionals will listen to any concerns you might have, and any concerns that others such as your family or GP might have. In broad terms, the higher the cost of your accommodation, the greater the individual impact/risk may need to be for professionals to decide you should not move.
Any move could be very unsettling so you should think very carefully before choosing more expensive accommodation.
Any person paying a top-up should tell the case worker or social worker at Focus Independent Adult Social Work straight away if their circumstances change and they might be unable to pay an agreed top-up. If you are not sure who to contact, call the Single Point of Access on 01472 256256.
You can learn more about what happens if a top-up isn’t paid by reading the Top-Ups Toolkit and our local policy.
Is a top-up the same as any contribution a financial assessment says I have to make to the cost of my care?
No. Once your care needs have been assessed and there is a care plan to say how your needs will be met, care professionals will look at how your care is going to be paid for. You may have to pay the full costs of your care or make a contribution towards the costs of it. Professionals work out how much you need to pay towards the costs of your care by doing a financial assessment with you.
A top-up payment relates to additional goods or services that you have chosen. It is separate from any amount that a financial assessment shows you can afford to contribute to the costs of your care needs. You are responsible for making assessed contributions to the costs of your care needs. The person who has agreed to pay any top-up is responsible for paying the top-up.
This means that depending on your circumstances:
- you might make a contribution to the costs of your care home, and
- someone else might also make a top-up payment for extra goods or services at your care home.
You can find our more about financial assessments on our Paying for Care page.
What if I’m not happy with how decisions about my accommodation and top-ups have been made?
If you are not happy with the decision, you can contact the Experience Team by:
Telephone: 01904 555999
Email: hnyicb-nel.askus@nhs.net
Writing to: The Experience Team, North East Lincolnshire Health and Care, Municipal Offices, Town Hall, Grimsby, DN31 1HU
You can read more about how the Experience Team can help you by visiting our share our health and care experiences with us page.
I have a general query about choosing accommodation and top-ups. Who do I contact?
Speak to your case worker or social worker. If you are not sure who to contact, call the Single Point of Access on 01472 256256.
Useful links
https://www.focusadultsocialwork.co.uk/social-care-handbook/
Page last updated: 10 Nov 2023