Paying for care home fees in Northern Ireland

Paying for a care home can be expensive, but you may be eligible to financial help. The type of support available is different for care home fees in Wales and care home fees in England.

Choice of care homes if the trust pays

The Health and Social Care (HSC) trust must offer a choice of homes that meet the person’s needs. There is no set number of homes they must offer. The trust will have an upper limit (known as the ‘usual rate’ or ‘standard rate’) that they will pay for a care home.

Paying top-up fees for a more expensive care home

In Northern Ireland, the person with dementia (or their carer, controller or attorney) might choose to stay in a more expensive care home. In this instance, the trust may agree to part-fund the person’s place in a more expensive care home. 

This can happen as long as a third party (such as a relative) agrees to pay the extra cost. This is often referred to as a ‘top-up’ fee.

Top-up agreements are made with the trust, who will have a contract with the home. This person paying enters into a written agreement with the trust. The agreement should explain what will happen should fees change, or the person can’t pay the top-up in the future.

The trust must ensure that the third party is willing and able to pay. 

If the person stops paying the top-up fee, the trust may ask the resident to move to a different care home within the standard rate. This new home must meet the resident’s assessed needs. 

This move can be disruptive to a person with dementia. For this reason, the person paying must bear in mind how long they may have to pay the extra amount. Care home costs will also go up over time.

A trust should only offer a top-up arrangement when a more expensive home is chosen out of preference. It should never be requested if the only home that can meet the person’s needs is more expensive than the standard rate.

Self-funding

If someone is paying their own care home fees in full, they can agree on the financial arrangements directly with the care home. 
When making these arrangements, ensure that there is a contract that clearly explains:

• The home’s obligations
• The fees
• The services included in the fees
• What may be charged as ‘extras’
• How much notice will be given if fees increase.

A person with dementia may lack the mental capacity to make the arrangements with the care home. Their attorney under an Enduring power of attorney or their controller can do that on their behalf. 

If no one has been appointed, the trust must make these arrangements for the person. The person with dementia will still be charged for any care arranged.
 

Direct payments

If care is being funded by the HSC trust, a person can choose to receive this funding in the form of a direct payment. 

A direct payment is an amount of money the HSC trust give to someone to spend on meeting their own eligible care and support needs. This is intended to give greater choice and control over how eligible needs are met.