This report uses the findings from in-depth interviews with 13 local authorities to show uncertainty and concern among local authorities about their responsibilities to monitor care home top-up fees under the new Care Act. 


  • Uncertainty about the effect of the Care Act on the payment of top-up fees.
  • A lack of awareness from local authorities about whether family members can really afford to pay a top-up fee.
  • An awareness by local authorities that families are increasingly worried about paying top-up fees.
  • Challenges faced by local authorities in monitoring and managing the extent of top-up fee arrangements in their area.
  • Wide variations in practice when councils arrange top-up fees.



  • Local authorities should review all existing agreements with people who pay top-ups.
  • Local authorities should make sure any top-up is really affordable in the long term. 
  • Improve the information and advice older people and their friends and family receive on care home top-up fees.