Paying for your care

Once your care needs have been assessed and there is a care plan to say how your needs will be met, we will look at how your care is going to be paid for. Adult Social Care is means-tested, so you may have to pay the full costs of your care, make a contribution towards the costs of it or some will have their care fully funded by the Council.

Financial assessments

This determines how much, if anything, you’ll need to contribute towards the cost of your care, based on your income, savings, and assets.

The rules for how we do a financial assessment are different depending on whether you are cared for in a residential care home, or somewhere else in the community – for example in your own home, or in supported living. As part of a financial assessment, staff from the Finance Team will explain how the rules apply to your individual situation.

Depending on your level of assets, we might not do a full financial assessment with you. By ‘assets’ we mean things like the money you have in the bank, your income, and the value of any property you own. Before deciding whether to do a full financial assessment with you, we will ask you to tell us roughly what assets you have.

We might not do a full financial assessment with you if, for example, you have assets above what is called the ‘upper capital limit’. The upper capital limit is set by the government. At the moment, the upper capital limit is £23,250, but it could change in future. If you have more money than the upper capital limit – more than £23,250 – you will be asked to pay the full cost of your care. If we already know that you can afford to pay for the full cost of your care (because you have more than £23,250), you might not benefit from spending time on having a full financial assessment.

If you refuse a financial assessment we will treat you as if you can afford to pay for the full costs of your care.

If you have assets below the upper capital limit (less than £23,250), we will need to do a full financial assessment with you so that we have enough information to help decide what you can afford to contribute to the cost of your care. Most people will contribute something.

The Finance Team at Focus Independent Adult Social Work can tell you more about having a financial assessment. You can contact them by telephone (0300 330 2870) or by email ([email protected]). The Finance Team at Focus acts on behalf of the Council.

When we do a financial assessment, we use the rules and guidance in the Care Act 2014 and in our Adult Social Care Charging Policy 2024-25 (Word, 117KB) .

The Council works closely with Focus Independent Adult Social Work (‘Focus’). The Finance Team at Focus will do the assessment with you, on behalf of the Council. Someone from the team will contact you to agree a time to do the assessment, and talk to you about what is involved.

The team will work with you to complete the assessment in the way that works best for you. You can choose to have someone with you to support you when we do the assessment. The assessment is a detailed conversation about your finances, so if you have someone to support you, you will need to pick someone that you are happy to have hearing about your finances.

The team will ask you questions about your finances, and ask you to share evidence of your finances such as bank statements or benefits letters. You can choose not to answer questions or to share evidence, but if you don’t, the team won’t be able to complete the financial assessment with you. If the team can’t complete the assessment with you, we will assume that you can afford to pay for the full cost of your care. This applies whether you get care at home or in a care home.

The team will take into account what you tell them, and work out what you need to contribute to the costs of your care. The law says that whatever we ask you to pay, you should still be left with a minimum guaranteed amount every week to live on.

The team will also help you to think about whether there are benefits that you might be entitled to that you are not getting. The team will let you know if they think there is anything you could be missing out on, and what to do about it.

The Finance team will ask about:

The money you have coming in (your income). This includes any benefits you might get, such as a pension/disability benefits
The money you have in the bank or in investments (your capital). This includes things like savings or shares
The value of your assets, such as your home or other property that you might own
Any trusts or settlements that you benefit from
Any housing related costs you are liable for, such as mortgage payments, rents, or council tax
Any debts you might have
Any Disability Related Expenditure you may have

Disability Related Expenditure (DRE)?

Although we will ask questions that will help us get a full picture of your financial situation, not everything you tell us is included in how we work out what you can afford to contribute to the costs of your care. For example, we might not take into account all of the disability benefits you get, or all of the debts you pay, as part of the assessment. You can find out more about how we use your financial information to work out what you should pay below.

How we work out your contribution to the cost of your care is set out in the law (the Care Act 2014) and in Adult Social Care Charging Policy 2024-25 (Word, 117KB) .

Some rules about charging are quite complicated and can be confusing. For example, although we will ask you to tell us about all the income you receive (the money you have coming in), we might not take some of it in to account as part of the financial assessment. For instance, if you have a job and earn wages, we won’t take your wages into account as part of your financial assessment. If we don’t take all your income into account, that will generally mean that you will pay less towards the costs of your care. As part of a financial assessment, staff from the Finance Team will explain how the rules apply to your individual situation.

You might also have some expenses that we might not count as part of the financial assessment. For example, if you are a disabled adult living at home with your parents and you pay them a contribution to household expenses, we might not take everything you pay into account. This is because we will generally only take into account expenses that the law says you are responsible for, such as a mortgage, or rent that you have to pay because of a rent agreement. If we don’t take into account everything that you are paying out, that will generally mean you will pay more towards the costs of your care. As part of a financial assessment, staff from the Finance Team will explain how the rules apply to your individual situation.

In very basic terms, a financial assessment calculation means that we –

Work out what money you have coming in (although like in the example above, we might not count some of it)
Take off the money you pay out (although like in the example above, we might not take all of it into account)
Work out what you have left
Take off the minimum guaranteed amount the government says you need to live on
Ask you to contribute what is left to the costs of your care.

You need to tell us about any changes so we can make sure we ask you to pay the right amount towards the costs of your care. If your situation changes and you don’t tell us about it straight away, once we know about it, we might need to recalculate what you pay. For example, if the amount you get in benefits goes up and you can afford to pay more towards the costs of your care, once we know that, we might recalculate what we ask you to pay and send you an invoice backdated to the date of your benefits increase.

If your situation changes, contact the Finance Team at Focus by telephone (0300 330 2870) or by email ([email protected]).

If you don’t manage your own finances, please let us know so we can involve the person who does. This might be someone that you have chosen to act as your attorney or who acts as your deputy for your property and finances. You can read more about attorneys and deputies at: Future planning. If you have someone who acts as appointee for your benefits, we will also need to involve them.

You can read more about appointees at Become an appointee for someone claiming benefits – GOV.UK.

If you are unhappy with the outcome of the assessment, speak to the Finance Team at Focus. You can contact them by telephone (0300 330 2870) or by email ([email protected]). The Finance Team at Focus acts on behalf of the Council.

If you are still not happy after you’ve spoken to the Finance Team, please visit our feedback page for details on how you can make a complaint or appeal against a charging decision.

Personal budget

Once your support plan is agreed and your financial assessment is complete, your final personal budget is confirmed. This is the actual amount allocated to meet your needs, including any contributions you may need to make

Once your support plan has been agreed, we will confirm your personal budget. This is the actual amount of money allocated to meet your assessed care and support needs. It may differ from the initial estimate, depending on the final plan and the types of support you choose. Your personal budget can be managed in different ways, including direct payments, council-managed services, or a combination of both. It gives you more choice and control over how your care is arranged and delivered.

We will advise you of your indicative (or estimated) personal budget. This will help you to understand how much it may cost to meet your needs and to look at options available to include in your support plan.

The amount of money we identify is called a personal budget and it allows you to:

choose and control the support that is best for you
be fully involved in decisions about the help you need to live independently
support yourself in ways that suit you

We calculate this using our Personal Budget Matrix (PDF, 102KB) .

Your personal budget will be made up of money from us plus any contributions you have been assessed to pay following your financial assessment.

You must use this budget to buy the care and support you need, in one of the following ways:

by receiving services commissioned or arranged by us (see our Micro-commissioning Policy (PDF, 644KB) for more details on how services locally are commissioned)
a direct payment – this means that you can buy your own care and support yourself using your personal budget. Money must be used to pay for the care outlined in your care and support plan but you can be flexible about where this comes from. Anyone over 18 can ask for a direct payment can nominate someone else to manage it on your behalf. For more information read our Direct Payment Policy (Word, 138KB) .
a managed account – your personal budget allocation is held by the Focus finance team, and they arrange the services agreed in your care and support plan on your behalf. This means if you need care and support at home, we will arrange the care services and pay them from your personal budget.

Paying for your care

Nursing or care home

If you get care and support in a care/ nursing home and pay either the whole amount or a contribution, you will receive an initial invoice from the Council. You will need to make your payment direct to the care home. Details will be given to you as part of the financial assessment process and then staff at your care or nursing home will help you with making your ongoing payments.

Top-up payments

Each year the Council and ICB work together to agree a weekly fee with care homes. This weekly fee is the amount intended to cover the assessed eligible needs of anyone that the Council/ICB is responsible for. A top-up is the difference between this agreed amount – which should reflect your personal budget amount – and what a care home might want to charge.

Any extra amount that a care home might want to charge should offer you something over and above what the Council/ICB has agreed to pay to meet your assessed eligible needs. For example, a top-up or additional payment might be paid for a larger room, a room with a view, a room with a balcony or extra care that is more than you actually need. In other words, a top-up should relate to an optional ‘extra’ – something that you want, rather than something that you need.

This is because if care professionals have assessed you as having eligible needs, the Council/ICB are responsible for meeting those needs. The Council/ICB should take into account your wishes and feelings about care arrangements, but is not responsible for paying for optional ‘extras’ or ‘wants’ that are not assessed eligible needs.

In North East Lincolnshire there are a range of care homes that offer accommodation at the fee rate agreed with the Council/ICB and you can read about them on our Care Options page. You can also read about the care homes who want to charge a top-up, and what those top-ups are for.

If you are thinking about paying for something in addition to what you need, you should make sure that you are clear about the extra cost and what it is for. You should also make sure that any extra amount is affordable for the length of time you’re likely to stay in the accommodation, which could be for some years. Like all costs, top-up fees will be reviewed regularly, and could go up. The person paying the top-up would be responsible for paying any increase.

North East Lincolnshire’s Top-ups Toolkit (Word, 133KB) is intended to make sure that everyone involved in paying a top-up understands what they are agreeing to. Anyone wanting to pay a top-up will need to satisfy care professionals that the top-up is affordable, and will continue to be affordable, based on their individual financial circumstances. This means that care professionals will ask the person wanting to pay the top-up to complete the financial questionnaire that is part of the Top-ups Toolkit. You can learn more by reading the Top-ups Toolkit (Word, 133KB)

If professionals are confident that the top-up payment is affordable, they will ask the person paying the top-up to sign the agreement that is part of the Top-ups Toolkit. The agreement is between the person paying the top-up, the ICB and the care home. Anyone thinking about paying a top-up should consider getting independent financial advice. You can get more information about independent financial advice at Money Helper.

If care professionals are not confident that the top-up payment is affordable for the length of time you’re likely to stay in the accommodation, they will not agree to arrange for you to stay at your preferred care home. They will explain their decision in writing.

If the person who has agreed to pay a top-up stops paying it, care professionals would try to negotiate with your accommodation provider. If that negotiation fails, you will generally only be able to stay in your chosen accommodation in exceptional circumstances. If there are no exceptional circumstances, it is likely that you would need to –

move to a cheaper room in the same accommodation (to a room that doesn’t need a top-up to be paid), or
move to a different accommodation provider altogether (to a home that can accommodate you without a top-up payment).

To decide whether your circumstances are exceptional, care professionals will assess your needs, and weigh up the impact of any move on your health and wellbeing against the cost of paying for more expensive accommodation. Care professionals will identify any risks of moving you, and ways of managing those risks. Care professionals will listen to any concerns you might have, and any concerns that others such as your family or GP might have. In broad terms, the higher the cost of your accommodation, the greater the individual impact/risk may need to be for professionals to decide you should not move.

Any move could be very unsettling so you should think very carefully before choosing more expensive accommodation.

Any person paying a top-up should tell the case worker or social worker at Focus Independent Adult Social Work straight away if their circumstances change and they might be unable to pay an agreed top-up. If you are not sure who to contact, call the Single Point of Access on 01472 256256.

You can learn more about what happens if a top-up isn’t paid by reading the Top-ups Toolkit (Word, 133KB) and our local policy (Word, 287KB) .

No. Once your care needs have been assessed and there is a care plan to say how your needs will be met, care professionals will look at how your care is going to be paid for. You may have to pay the full costs of your care or make a contribution towards the costs of it. Professionals work out how much you need to pay towards the costs of your care by doing a financial assessment with you.

A top-up payment relates to additional goods or services that you have chosen. It is separate from any amount that a financial assessment shows you can afford to contribute to the costs of your care needs. You are responsible for making assessed contributions to the costs of your care needs. The person who has agreed to pay any top-up is responsible for paying the top-up.

This means that depending on your circumstances:

you might make a contribution to the costs of your care home, and
someone else might also make a top-up payment for extra goods or services at your care home.

You can find our more about financial assessments on our Paying for Care page.

I have a general query about top-ups. Who do I contact?

Speak to your case worker or social worker. If you are not sure who to contact, call the Single Point of Access on 01472 256256.

What if I’m not happy with how decisions about top-ups have been made?

If you are not happy with the decision, you can contact the Experience Team by:

Telephone: 01904 555999

Email: [email protected]

Writing to: The Experience Team, North East Lincolnshire Health and Care, Municipal Offices, Town Hall, Grimsby, DN31 1HU

You can also ask for a deferred payment agreement, an agreement between the Council and a person whose needs are being met in a care home. A deferred payment agreement means that the costs of a person’s care home are delayed until an agreed time in the future.

Deferred payments

At-home care

If you get care and support at home, there are two ways of paying for it.

You can either pay by standing order, which means the money will automatically come out of your bank every 4 weeks
You can receive an invoice. Your invoice will cover a 4-week period. You can pay it in a number of different ways, which will be listed on the back of your invoice. The invoice will be sent to you by North East Lincolnshire Council.

You can also ask us to pay your personal budget to you, as a direct payment, to arrange care yourself if it will not be at a care or nursing home.

Direct payments

If you have questions about how to pay for your care, speak to the Finance Team at Focus. You can contact them by telephone (0300 330 2870) or by email ([email protected]). The Finance Team at Focus acts on behalf of the Council.