Care home top-ups in Northern Ireland: who pays and the regional rate

In Northern Ireland, a care home top-up can only be paid by a third party, such as a relative, friend or charity, never by the resident from their own savings, income or Personal Expenses Allowance. It is due only when your parent chooses a home that costs more than other suitable homes the Trust could arrange at its usual rate. If the Trust cannot find a suitable place at that rate, it must pay more itself and should not ask the family for a top-up.

In short

• The rule comes from the Health and Personal Social Services (Northern Ireland) Order 1972 and is set out in the Department’s Charging for Residential Accommodation Guide (CRAG) and circular HSC (ECCU) 1/2010.
• The top-up is the difference between the chosen home’s fee and the cost of other appropriate, cheaper accommodation that was available at the time.
• Trusts benchmark against a regional rate set each year. Belfast Trust reported the rates at 31 March 2024 as £697 a week for residential care and £865 for nursing care. Ask your Trust for the 2026/27 figure.
• The third party signs a legally binding agreement with the Trust. Their payment is treated as the resident’s income and collected by the Trust.
• Increases do not have to be split equally between the Trust and the family. If payments stop, the resident may have to move unless a move would cause lasting harm.
• Self-funders paying the full fee themselves are not covered by these rules, but they may face them later if their money runs down.

The regional rate and the “going rate”

Trusts are required to contract for places at the most competitive rate available for accommodation that meets the person’s needs. The Department’s 2010 circular describes the regional rate for residential and nursing places as being set annually on the basis of what is fair and affordable, and as the benchmark for placements.

The regional rate is not the most a Trust can pay. The same circular says Trusts must contract for the full cost of assessed care needs, “even where that is not obtainable at the regional rate”. nidirect puts it simply: if the Trust cannot suggest a place that meets your needs in your area, it must pay more than its usual amount.

These are the most recent figures we could verify from an official source, a Belfast Trust freedom of information response. Rates are uplifted most years: the Department of Health has confirmed final uplifts to the nursing home tariff of 6.91% for 2024/25 and 7.02% for 2025/26, so current rates are higher. Before you choose a home, ask the Trust care manager in writing for the current rate for your parent’s category of care, including any dementia or specialist rate.

Who can pay a top-up

CRAG paragraph 5.005 says the 1972 Order does not permit a resident to use their own resources, including the Personal Expenses Allowance, to pay for more expensive accommodation than the Trust would fund. The circular adds that the extra cost “must be met by a third party such as a family member, friend or voluntary body, who is both willing and able to meet the cost”.

• Can pay: sons, daughters, other relatives, friends, a charity or benevolent fund, or a spouse paying from their own money.
• Cannot pay: the resident, from savings below the limits, pensions, benefits or the £36.62 weekly Personal Expenses Allowance.
• Risky: an attorney paying from the resident’s own money. That is still the resident’s money, so it breaks the rule.

This is stricter than England, where a resident can top up from their own property during the 12-week disregard or under a deferred payment agreement. Our general care home top-up fees guide covers the English rules.

The Department’s circular HSC (CHU) 1/2026 also reminds Trusts that pressure on residents to spend their Personal Expenses Allowance in particular ways “is not acceptable”. Our Personal Expenses Allowance guide explains what it is for.

How the money flows

1. The Trust contracts with the home for the full weekly fee, including the top-up part.
2. The third party’s payment is treated as part of the resident’s income in the financial assessment (CRAG paragraphs 8.018 and 8.063). The Trust collects it along with the resident’s own assessed contribution.
3. If everyone agrees, the third party can pay the home directly instead. The Trust should record that arrangement.
4. A lump sum from the third party is divided by the number of weeks it covers and counted as weekly income.
5. Money a relative pays to clear arrears should go straight to the Trust, so it is not treated as the resident’s capital.

Worked example

Rose, 88, needs residential care in the Western Trust area. She has £9,000 in savings, State Pension of £241.30 a week (basic and additional pension combined) and a £40 occupational pension. She rents her flat. The Trust can offer two suitable homes at £790 a week. Rose prefers a home near her daughter Siobhan in Enniskillen, which charges £850. All figures in this example are illustrative.

• Top-up: £850 minus £790 = £60 a week, or £3,120 a year. Siobhan signs a third party agreement with the Trust.
• Rose’s assessment: her savings are below £14,250, so they are ignored. Income counted is £241.30 + £40 + Siobhan’s £60 = £341.30. Less the £36.62 allowance, the assessed contribution is £304.68 a week.
• Who pays what: the Trust pays the home £850. It recovers £304.68, made up of £244.68 of Rose’s own income and Siobhan’s £60. The Trust’s net cost is £545.32, exactly what it would have paid at a £790 home.

If the home raises its fee to £880 next April and the Trust’s going rate rises to £805, Siobhan’s top-up would become £75 a week. If the going rate did not rise, Siobhan would cover the whole £30 increase. The Trust must keep funding at least the level agreed at placement, even if it could later find cheaper places.

When you should not be asked for a top-up

• No suitable home at the usual rate. If the only homes that can meet your parent’s needs cost more, the Trust must pay. Ask the Trust to name the cheaper homes it says are suitable and available, and check they really have vacancies.
• Interim placements. If your parent’s first choice has no vacancy, the Trust should arrange an interim place from which they can move when a bed comes up. A home chosen for the Trust’s convenience should not carry a top-up.
• Specialist needs. If your parent needs dementia nursing care, for example, the comparison must be with homes that can meet that need, not with general residential homes. Our guide to choosing a dementia care home helps you judge suitability.
• Extras that are really care. The Trust contract should cover the full cost of meeting assessed needs. Occasional services such as hairdressing are a matter between the resident and the home and can come from the allowance.

Fee increases and what happens if payments stop

The third party agreement should make clear that the top-up can change. Under the circular:

• The third party stays liable for the difference between the chosen home and the rate at which the Trust can secure suitable care in each later year.
• Any increase in the total fee may not be divided equally between the Trust and the family.
• A home that wants to raise the third party payment must ask through the Trust, as the contracting party. If a home writes to you directly about a rise, refer it to the care manager.
• Before agreeing, the Trust should risk-assess whether the third party can keep paying.
• If the third party defaults, the Trust stays liable to the home, but may consider moving the resident somewhere cheaper. It should not do so if the move is likely to have a lasting detrimental effect on their physical or emotional well-being.

Budget for the long term. A £60 weekly top-up over three years is £9,360 before any increases. Our care cost calculator can help you model it.

Self-funders and running out of money

If your parent pays the full fee from their own money, there is no top-up: they simply pay what the home charges. The issue comes later. When their capital falls towards £23,250, the Trust’s means test applies and it will usually only fund at its going rate. nidirect advises self-funders who may need Trust help later to choose a home that charges the same as the Trust usually pays.

If the home costs more, the options are a third party top-up, a move, or the Trust agreeing to pay the full fee because no cheaper suitable home is available. Talk to the Trust a few months before the money runs low. Our guides on what happens when money runs out in a care home and selling a house to pay for care in Northern Ireland cover the wider picture, and our Northern Ireland paying for care hub explains the means test.

Before you sign a third party agreement

• Ask the Trust for its going rate and the names of the cheaper suitable homes, in writing.
• Check the agreement is with the Trust, not only the home.
• Ask how and when increases will be notified.
• Ask what happens if you die, lose your job or can no longer pay. If siblings share the cost, decide who is legally liable.
• Keep a copy of the home’s contract and fee schedule. See our care home contracts guide.

Placements outside Northern Ireland

If your parent wants to move to a home in Great Britain to be near family, the Trust must get Department approval first. The family must be told in writing that the home will be regulated by that nation’s inspector, not RQIA. Top-ups for such placements carry extra risk, so expect a closer check of the third party’s finances. For homes elsewhere, see top-ups in Scotland and top-ups in Wales.

Complaints

Disputes about whether a top-up is fair, or about pressure from a home, go to the Trust’s complaints manager under the HSC complaints procedure. A full reply is due within 20 working days. The Patient and Client Council can help for free on 0800 917 0222. After the Trust’s process, you have six months to go to the Northern Ireland Public Services Ombudsman.

Frequently asked questions

Can I pay my own care home top-up in Northern Ireland?

No, not if the Trust is helping with your fees. CRAG says the 1972 Order does not allow residents to use their own resources, including the £36.62 weekly Personal Expenses Allowance, to pay for more expensive accommodation. Only a third party, such as a relative, friend or charity, can pay the difference under an agreement with the Trust.

What is the regional rate for care homes in Northern Ireland?

It is the benchmark weekly rate Trusts use for residential and nursing placements, set each year. At 31 March 2024, Belfast Trust reported £697 for residential care, £865 for nursing care and £929 for nursing care with physical disability. Ask your Trust for the 2026/27 rate for your parent’s care category before choosing a home.

Do I have to pay a top-up if there is no cheaper home?

No. If the Trust cannot find a suitable home that meets your parent’s needs at its usual rate, it must pay more. A top-up only applies when you choose a dearer home while other suitable, cheaper accommodation was available at the time. Ask the Trust to name the cheaper homes in writing.

Can a care home increase the top-up?

Yes, but the request must go through the Trust, which holds the contract. Each year the third party stays liable for the difference between the home’s fee and the rate the Trust can secure suitable care for, and increases need not be shared equally. Check how increases will be notified before signing.

What happens if the family stops paying the top-up?

The Trust remains liable to pay the home in full, but it may consider moving the resident to cheaper suitable accommodation. Department guidance says it should not do so if the move is likely to have a lasting detrimental effect on the resident’s physical or emotional well-being. Tell the Trust early if payments become difficult.

Do self-funders pay top-ups in Northern Ireland?

Not while they pay the full fee themselves. But once their capital falls to £23,250 and the Trust starts funding, it will usually pay only its going rate. Any difference must then come from a third party, or the resident may need to move unless no suitable cheaper home exists.

Sources

• Department of Health: Circular HSC (ECCU) 1/2010, paragraphs 54 and 77 to 91
• Department of Health: Charging for Residential Accommodation Guide (CRAG)
• Department of Health: Circular HSC (CHU) 1/2026, Charges for Residential Accommodation 2026/27
• nidirect: Paying your care home fees
• Belfast Health and Social Care Trust: FOI 32171, weekly regional tariff
• Department of Health: FOI DOH 2026-0129, annual nursing home fee uplifts 2022/23 to 2025/26
• Health and Personal Social Services (Northern Ireland) Order 1972
• nidirect: How to complain or raise concerns about health services
• Northern Ireland Public Services Ombudsman: FAQs

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.