Care home top-up fees in Wales: additional costs and choice of home

In Wales, a care home top-up is called an “additional cost”. It is the gap between what the council would usually pay for a suitable care home and the fee of a dearer home you choose. A relative or friend normally pays it under a written agreement with the council. The resident can pay it from their own money only during the 12-week property disregard or under a deferred payment agreement. If no suitable home is available at the council’s usual rate, the council must pay the difference itself.

In short

• The rules are in the Care and Support (Choice of Accommodation) (Wales) Regulations 2015 and Annex C of the Welsh Government’s charging code of practice.
• You can choose any suitable care home with a vacancy anywhere in the UK, if the home accepts the council’s terms. Choice is not limited to homes the council already uses.
• The council must offer more than one suitable home at its usual rate. If none can meet the person’s needs, it must pay more and cannot ask the family for a top-up.
• A top-up needs a written agreement covering the amount, how often it is paid, reviews, fee increases and what happens if payments stop. It must be reviewed at least once a year.
• The resident can pay their own top-up only during the first 12 weeks of a permanent stay (while the home is disregarded) or through a deferred payment agreement.
• The council is liable for the full fee if a top-up stops, and must reassess before asking anyone to move.

Your right to choose a care home

Once a needs assessment shows that a care home is the right type of care, the person has the right to say which home they want. Under regulation 3 of the Choice of Accommodation Regulations, the council must arrange it if:

• the care and support plan says a care home can meet their needs;
• the chosen home is suitable for those needs;
• a place is available; and
• the home agrees to the council’s usual contract terms.

The choice can be a home outside the council’s area, or in England, Scotland or Northern Ireland, for example to be near a daughter. The code says councils must not use strict or unusual contract terms to put a home off. A refusal must be in writing with reasons (regulation 5). These rights cover permanent and longer stays; respite of up to 8 weeks is outside them.

The right applies equally to someone who was paying their own fees and now needs council help because their capital has fallen to £50,000. Our hub explains the means test: paying for care in Wales.

When a top-up is not allowed

A top-up can only be asked for when the family has chosen a home that is genuinely dearer than the council would usually pay, or wants extras beyond the person’s assessed needs. The code is clear on the rest:

• The council must not set arbitrary price ceilings that do not reflect what good quality care for that person actually costs.
• It must have more than one suitable option available at its usual rate.
• If needs can only be met in a dearer home, for example because of specialist dementia nursing, sensory needs or a medical diet, the council must pay the higher fee itself. The person still pays only their assessed contribution.
• The additional cost should be worked out from what the council would pay for that type of care at that time, not automatically its cheapest rate.

If you are told “there is nothing at our rate”, ask the council to name the homes it says are available and suitable. If it cannot, it should not ask you for a top-up.

Who can pay the top-up

A third party

Usually an adult child, another relative, a friend or a charity. The council must be satisfied that the payer is able and willing to pay for as long as the person is likely to need the home, which may be years. The code suggests councils ask for evidence, such as payslips or savings statements.

The resident, in two situations only

Regulation 4(6) allows the resident to pay their own additional cost only:

• during the 12-week property disregard at the start of a permanent stay; or
• under a deferred payment agreement with the council, where the top-up is added to the debt secured on the home.

This catches families out. In Wales, savings under £50,000 are otherwise ignored, so people assume a resident with £40,000 can use it for their own top-up. The regulations do not allow the council to agree that unless one of these two situations applies. Our guide to selling the house to pay for care in Wales covers the disregard and deferred payments in detail.

What the written agreement must say

Before anyone signs, the council must give the payer enough information and advice to understand it. The agreement must include:

• the additional cost, and the amount the council would usually pay;
• how often payments are made, and to whom;
• how and when the agreement will be reviewed;
• what happens if payments stop;
• how increases in the home’s fees will be handled; and
• what happens if the payer’s finances change.

Payments go either straight to the home, with the council paying the rest, or to the council, which then pays the home in full. Either way, the council remains responsible for the whole fee.

Worked example: Rhian’s mother in Cardiff

These figures are illustrative. Ask your council for its current rates.

• The council’s usual rate for residential care is £950 a week. Rhian’s mother, Glenys, chooses a home near Rhian charging £1,080.
• Glenys has £30,000 in savings, which is ignored because it is under £50,000. Her income is £311.30 a week. She keeps the £46.35 Minimum Income Amount and contributes £264.95.
• The council pays £685.05, bringing the total to its usual £950.
• Rhian pays the additional cost of £130 a week, or £6,760 a year.

The next April the home raises its fee by £50 to £1,130, but the council increases its usual rate by only £25 to £975. Unless the agreement says otherwise, Rhian’s top-up rises to £155 a week. The code says there is no guarantee that increases will be shared evenly. Negotiate this before signing.

Fee rises, reviews and what happens if payments stop

• Reviews must happen at least yearly and when circumstances change. Any party can ask for one.
• The resident’s contribution changing, for example a pension rise, does not automatically reduce the top-up.
• If the payer can no longer pay, tell the council early. It can recover arrears, but it remains liable for the full fee meanwhile and must carry out a new needs assessment, looking at the effect on the resident’s well-being, before arranging a move.
• Fee disputes about the home’s own charges can be challenged with our fee increase letter template.

Self-funders whose money is running out

Many top-up problems start when someone has been paying, say, £1,200 a week privately and their capital falls to £50,000. The council will then pay only its usual rate, so the home either accepts that, or someone pays the gap, or the resident may have to move. Three steps help:

1. Ask for a council needs and financial assessment a few months before capital reaches £50,000.
2. Before choosing a home, ask whether it accepts council-funded residents and at what rate.
3. Check the contract terms on what happens when funding changes. See what happens when money runs out in a care home and care home contracts.

Extras that are not top-ups

Hairdressing, newspapers, a private phone line and outings are personal costs, usually paid from the £46.35 a week Minimum Income Amount. They are not additional costs and should not be in a top-up agreement. A bigger room or premium facilities you request can be. See are care home fees all-inclusive?

NHS-funded care

If your relative is eligible for NHS Continuing Healthcare, the health board pays the whole fee and you cannot top up the NHS place. See NHS Continuing Healthcare in Wales.

If something goes wrong

• A refused choice of home must be explained in writing. Ask which condition the council says is not met.
• Complain to the council under its social services complaints procedure, then to the Public Services Ombudsman for Wales, normally within 12 months. The Ombudsman can also look at complaints from people who pay for their own care home.
• Check a home’s Care Inspectorate Wales ratings before agreeing to pay extra for it.

Elsewhere in the UK

England allows third-party top-ups under the Care Act 2014 with similar written agreement rules. See care home top-up fees for England, Scotland and Northern Ireland.

Frequently asked questions

What is a top-up fee in Wales?

It is the “additional cost”: the difference between what the council would usually pay for a suitable care home and the higher fee of a home the person chooses. It is usually paid by a relative or friend under a written agreement with the council, which stays responsible for the full fee.

Can my parent pay their own care home top-up in Wales?

Only in two situations: during the 12-week property disregard at the start of a permanent stay, or under a deferred payment agreement. Otherwise a third party has to pay. This applies even though savings under £50,000 are ignored in the Welsh means test.

Does the council have to offer a home without a top-up?

Yes. The Welsh code says the council must have more than one suitable option at its usual rate. If no suitable home is available at that rate, it must pay the higher fee itself and must not ask the family for a top-up.

What happens if we can no longer pay the top-up?

Tell the council straight away. It remains liable for the full fee, may seek arrears from the payer, and must carry out a new needs assessment before considering a move to a cheaper home. It must consider the effect a move would have on the resident’s well-being.

Can I choose a care home in England for a parent funded by a Welsh council?

Yes. The Welsh regulations cover care homes anywhere in the UK, including England, Scotland and Northern Ireland, as long as the home is suitable, has a place and accepts the council’s terms. A top-up may be needed if it costs more than the council’s usual rate.

Can the top-up go up every year?

It can. The written agreement must say how fee increases are handled and reviews must happen at least yearly. If the home’s fee rises faster than the council’s rate, the difference can fall on the payer unless you agree otherwise in advance.

Sources

• The Care and Support (Choice of Accommodation) (Wales) Regulations 2015
• Welsh Government: Part 4 and 5 code of practice, Annex C (choice of accommodation and additional costs)
• Social Services and Well-being (Wales) Act 2014, section 57
• The Care and Support (Charging) (Wales) Regulations 2015
• The Care and Support (Charging) and (Financial Assessment) (Wales) (Miscellaneous Amendments) Regulations 2026
• Public Services Ombudsman for Wales: complaints about independent care providers
• Care Inspectorate Wales

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.