What a top-up fee actually is
When a council agrees to fund someone's care home place, it pays its standard rate: around £930 a week for residential care and £1,074 for nursing care under the interim Interim 2026/27 National Care Home Contract. Some homes charge more than that rate. Where a family chooses one of those homes, someone has to meet the difference, and that difference is the third-party top-up.
How the arithmetic works
- Home's weekly fee (nursing)
- £1,400.00
- Council standard nursing rate
- £1,074
- Weekly third-party top-up
- £325.87
- Annual cost of the top-up
- £16,945
Illustrative figures. Always work from the actual fee for the actual room and the actual level of care.
Seeing the annual figure rather than the weekly one changes how most families think about it. A top-up of a hundred pounds a week sounds manageable in a difficult week; over four years it is a significant commitment, and it will usually rise with the home's annual fee review.
When a top-up applies
A top-up relates to choice rather than to assessed need. Where a family chooses a home or a room that costs more than the council's standard rate, the difference is met by a third party. Where the council is arranging a placement to meet assessed needs, the cost of meeting those needs is the council's responsibility.
| Situation | Does a top-up usually apply? |
|---|---|
| The family prefers a home that charges above the council rate | Yes. This is what top-ups exist for. |
| The family wants a larger room or a particular view in a home that would otherwise be within the rate | Yes, if the home genuinely prices that room higher. |
| The person's assessed needs can only be met in a more expensive home | Not normally. Meeting assessed needs is generally the council's responsibility, so ask the social worker to explain their view. |
Every council applies its own process, so confirm your own position with the social worker arranging the placement.
Who is allowed to pay a top-up
A top-up is paid by a third party: usually an adult child, another relative or a friend. In most circumstances the resident cannot top up from their own income or capital, because their contribution has already been settled by the financial assessment. There are limited exceptions, including during the 12-week property disregard and under a deferred payment agreement, where the person's own resources may be used.
- The council must be satisfied the top-up is affordable and sustainable for the person paying it, not just today but for the length of the placement.
- It should be set out in a written three-way agreement between the council, the care home and the person paying.
- The agreement should state how and when the top-up will be reviewed, and give notice of any increase.
- It should be clear what happens if the top-up stops being paid, including notice periods and next steps.
- Paying a top-up does not change the resident's own assessed contribution, and it does not buy a different standard of care.
What to check before you sign anything
- The exact weekly top-up figure, in writing, for the specific room and the specific level of care.
- How often the fee is reviewed, what has happened to the fee over the last three years, and how much notice you get of a rise.
- Whether the top-up changes if the person's needs increase or they move room within the home.
- What the extras list contains, so you know what sits outside both the council rate and the top-up.
- What happens if the person paying dies, retires or can no longer afford the payment.
- That the arrangement is recorded in a written three-way agreement between the council, the home and the person paying.
What happens if the top-up becomes unaffordable
Circumstances change: a job ends, another relative needs support, or the fee rises faster than the family budget. If a top-up is becoming difficult, act early. Homes and councils have far more room to help before arrears build than after.
- 01Tell the home manager and the council social worker as soon as you can see the problem coming, not once payments have been missed.
- 02Ask the council to review the placement. If no suitable alternative exists at the standard rate, the top-up requirement itself may need to be revisited.
- 03Ask the home whether a different room at a lower rate is available. A move within a home a resident knows is far gentler than a move between buildings.
- 04Check the financial assessment is still correct. Capital falls over time, and a reassessment may increase council support.
- 05Take free independent advice from Citizens Advice Scotland, Age Scotland or an independent financial adviser who specialises in later-life care funding.